When I was a 1st-year medical student I fell in love with the field of Facial Plastic and Reconstructive Surgery. At that point, however, I never knew any actual patients. Interestingly, the field of Facial Plastic Surgery was not very popular at that time. People did it, but it did not have the same level of public interest. My interest was based purely on three things. 1) I loved surgery. That’s why I went into medicine in the first place. I loved working with my hands and in my mind; surgery was the greatest way of helping those in need. It’s immediate gratification. 2) I loved the idea of thinking through things and offering creative, unique solutions based on the case at hand. In facial plastic surgery, there are very few patients who look the same or have the same problem. 3) I loved the idea of helping someone enhance or restore his or her appearance. Undeniably, the face is one of our greatest assets and it is so valuable to each of us. Even though at that point, I had never met a facial plastic surgery patient, I could only imagine how important it would be for that person to get the greatest outcome possible. I knew the challenge and pressure of working on the face and meeting or exceeding my patients’ expectations would keep me excited and enthusiastic throughout my career.

These were all impressions I had early on. After a decade of specialized training, I had finally started working with my own patients. From very early on, one of my primary philosophies about plastic surgery has always been that it is 100% about the patient. What I mean by that is that it is so important to really understand the patient’s motivation and goals for undergoing cosmetic facial surgery. I have always been one to spend a lot of time trying to really get a handle on their expectations and desires. As I spent more and more time having these lengthy and interesting conversations, a few clear concepts came through. First, no one approaches cosmetic surgery lightly. Despite the reputation that cosmetic surgery patients are vain or superficial, most patients approach the decision with thoughtfulness and solid personal reasons. It is not a trivial decision. Whatever the problem, it is emotionally bothersome enough for them to seek the help of a plastic surgeon to correct it. Second, 99% have a very clear idea about what they hope to achieve. They are not simply saying, “Doc, just make me look younger or prettier.” They typically know what it is that bothers them and they know if they correct it appropriately they will feel better about themselves. Third, 100% are worried about ending up looking unnatural and “operated-on.”

As far as why a patient would seek cosmetic surgery, a few themes have also become lucid. In a general sense, it falls into the category of something about their appearance really bothers them and it is impacting their quality of life either by affecting their self-image or self-confidence. For example, the patient seeking rhinoplasty for a hump on the nose often feels self-conscious by it. They typically don’t like to be photographed or seen from certain angles. Many feel like the nose doesn’t belong to them. As a result, they spend a lot of time avoiding certain social and interpersonal situations. As you can imagine this type of constant self-awareness can be inhibiting and distracting for the individual as well as consume a lot of conscious energy. Now, notice I said the “rhinoplasty patient” with a hump and didn’t say the person with the hump. Because not everyone with a nasal “hump” feels bothered by it or feels like they want to correct it. It is only those patients who are significantly bothered by that particular feature or appearance that seek cosmetic surgery. When they have the surgery done successfully, they feel that their new nose was the nose they were meant to have. It is really interesting how often I hear those sentiments. They are finally at peace with themselves.

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I have recently learned something very interesting from my facial rejuvenation patients as well. Procedures that are designed to turn back the clock are extremely popular. I have been trying to get a real handle on what motivates patients. Aside from the obvious, most people don’t like to age or like the look of an aging face, but what I wanted to know was why. What is the core reason someone would seek a facelift? For example, after listening to my patients as they describe their feelings and reasons for pursuing these treatments, I think I finally figured it out.

Now, from my point of view, I am biased. I see lots of wonderful stories. I am fortunate to have a very happy practice, which makes my job so unbelievably rewarding. I feel like I participate in changing and enhancing lives everyday… not just faces.

In summary, I hope you find this insight as interesting as I do. My cosmetic patients have always been the most grateful and appreciative. This has further reinforced my early impressions and ultimate decision to go into this specialty and dedicate myself to providing the highest level of facial plastic surgery in San Diego to every one of my patients.


Francine M.

I had a vertical restore at age 65 with Dr Amir Karam. It has been a little over a year and I am delighted with the results. Some of my friends have not even noticed - I just look rested. Dr Karam will provide you with all the information and supplements that you need to make the procedure and the recovery time as comfortable as possible. I usually bruise very easily but with the supplements that were given to me prior to my procedure and afterwards, my bruises were gone within a week.

I highly recommend Dr. Karam and would go back to him for anything I might want done in the future. I totally trust his approach and recommendations. You won't be disappointed!

Kris R.

I'm one month out from a Vertical Restore with Dr Karam. Dr Karam is an incredibly talented Surgeon. I can barely see my scars already. I also did a laser peel, within 8 days I was wearing makeup and admiring my new jawline and neck. I'm 65 this month and so happy I chose him. He is the best there is. His staff are fun, caring and kind. They made my entire experience so easy. I would not hesitate or even think about going anywhere else. Check out his Instagram account. He does all his content himself. Extremely informative, with many before and after photos. I decided on Dr Karam after researching his Instagram and had made my decision before we had even met.

Janice S.

Dr Karam is a great surgeon, a true artist and a wonderful human being. He has done 2 procedures on me over the last 3 years. Both with excellent results. His fat transfer and his lip lift technique are extraordinary. I wouldn't think of going to anyone else and I would highly recommend him to anyone who is looking for the best.

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