A Refined Detail That Completes the Face

The eyes are often the first area to show signs of aging, and one of the hardest to correct convincingly. Fine lines, crepey skin, and subtle sagging beneath the eyes can create a tired or aged appearance, even when the rest of the face feels refreshed. 

For patients undergoing Vertical Restore®, a skin pinch offers a precise, conservative way to refine the lower eyelid without altering expression or disrupting facial balance. Rather than relying on volume or aggressive tightening, this technique focuses on one thing only: removing excess skin that no longer belongs—nothing more.

Man smiling with his arms crossed

What a Skin Pinch Addresses

A skin pinch is a targeted lower eyelid technique designed to improve loose or crepey skin without disturbing muscle, fat, or the natural shape of the eye. It is especially effective for patients who feel that fillers, lasers, or skincare alone can no longer address textural changes under the eyes. A skin pinch may be appropriate for patients who notice:

  • Fine wrinkling that persists despite non-surgical treatments
  • Crepey or excess skin beneath the lower eyelids
  • Mismatch between refreshed cheeks and aging lower eyelids
  • A tired or heavy appearance around the eyes

When thoughtfully incorporated into Vertical Restore, the skin pinch helps ensure the eyes reflect the same vitality as the rest of the face.

How the Skin Pinch Fits Within Vertical Restore®

Vertical Restore® is built on the principle that facial aging is structural, global, and interconnected. The lower eyelids do not age independently of the cheeks, midface, or jawline, and they should not be treated that way. As part of Vertical Restore, the midface is repositioned, and volume is restored where it has been lost. 

This alone improves the lower eyelid–cheek junction significantly. A skin pinch is added only when residual excess skin remains after structural correction.  This sequencing matters. By restoring support first and refining skin second, the result remains smooth, natural, and familiar—never tight, hollow, or overcorrected.

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Dr. Karam’s Technique

A skin pinch involves the careful removal of a narrow strip of excess skin from just beneath the lower lash line. Because the underlying muscle and fat are left undisturbed, the eye retains its natural contour and movement.

The incision is meticulously placed and closed to heal discreetly, blending into the natural eyelid anatomy over time. When performed in experienced hands, the result is subtle but meaningful: brighter eyes that still look like your own.

The procedure is typically performed under local anesthesia with sedation when combined with Vertical Restore® and is completed entirely by Dr. Amir Karam, without the involvement of a surgical fellow or physician assistant, including meticulous closure.

Who May Be a Good Candidate for a Skin Pinch in San Diego?

A skin pinch is not for everyone, and that selectivity is intentional. Ideal candidates are patients who:

  • Are already undergoing Vertical Restore or considering comprehensive facial rejuvenation
  • Have good eyelid tone, but excess lower eyelid skin
  • Want refinement rather than dramatic change
  • Value natural expression and identity preservation

During your consultation, Dr. Karam evaluates eyelid anatomy, cheek support, skin quality, and overall facial balance before recommending this technique.

Dr. Karam performing surgery

Recovery and What to Expect

Recovery from a skin pinch is typically straightforward and well-tolerated. Mild swelling or bruising beneath the eyes is expected and generally resolves within one week. Because the procedure is conservative and skin-only, downtime is minimal compared to more invasive eyelid surgeries. 

Most patients feel comfortable resuming normal activities quickly, especially when the skin pinch is performed as part of a coordinated Vertical Restore recovery plan. Clear post-procedure guidance is provided to support healing and comfort throughout the process.

Ready to Schedule a Consultation?

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The KaramMD® Trifecta Support Your Surgical Outcomes

Designed to align with Dr. Karam’s long-term philosophy, the KaramMD Trifecta supports tissue quality and recovery through physician-selected skincare and regenerative care. Its role is to help Vertical Restore® results age with consistency and integrity.

Explore KaramMD Skin Products

Why This Approach Looks Different

Lower eyelid rejuvenation is one of the most nuanced areas of facial surgery. Overcorrection, excess tightening, or misplaced volume can permanently alter expression. 

Dr. Karam’s approach avoids those risks by:

  • Prioritizing structure before surface correction
  • Preserving muscle and fat whenever possible
  • Using the skin pinch only when it truly adds value
  • Integrating eyelid refinement into a full-face plan

The goal is not to make the eyes look “done,” but to remove the distraction of excess skin so expression can come through naturally.

Dr. Karam smiling with his hand touching his chin

Meet Dr. Amir Karam

Dr. Amir Karam is a double board-certified facial plastic surgeon who has dedicated decades exclusively to facial rejuvenation. His work is guided by a singular focus: restoring balance, familiarity, and confidence without altering identity.

As the creator of Vertical Restore®, Dr. Karam approaches every facial detail—including the lower eyelids—through a structural, whole-face lens. Techniques like the skin pinch are refined over years of experience and applied selectively, not routinely. Patients from around the world seek Dr. Karam’s care for results that are consistent, natural, and built to age gracefully.

One word to describe Dr. Karam is professionalism!

How welcome he made me feel since day one, when I was only looking for information, his bedside manners at the time of surgery, his energy, and his personality make me feel so secure in every singl...

How welcome he made me feel since day one, when I was only looking for information, his bedside manners at the time of surgery, his energy, and his personality make me feel so secure in every single visit before and after surgery. He always makes sure that all of my questions are answered, until this day, and I am 4 1/2 months out, I have no complaints, his work is ART, he is just AMAZING, and his hands are blessed! Until this day, I still follow and look at other doctors, and there is not one day I have felt any doubts. I truly believe I chose the BEST Face surgeon and would do it again and again.

Patient

Doctor Karam and his team are outstanding in every area.

From the first phone call I made to inquire about a Vertical Restore, every team member was professional, personable, genuine, prompt, and communicative. I have been in private business for more th...

From the first phone call I made to inquire about a Vertical Restore, every team member was professional, personable, genuine, prompt, and communicative. I have been in private business for more than 30 years. I understand how to build a team and I know a good team when I see one. Dr. Karam has succeeded on all fronts in creating an amazing team. I applaud his leadership. Embarking on this procedure can be daunting. Dr. Karam and his team made this journey very comfortable. I had the utmost confidence that I would receive amazing care and that the skills of Dr. Karam are the very best. Thank you, Dr. Karam. And thank you to your awesome team.

Patient

My surgery experience with Dr. Karam and his team was excellent.

My surgery experience with Dr. Karam and his team was excellent. I waited a year to have my surgery with him. He’s well worth the wait. I was hesitant to undergo surgery because of some of th...

My surgery experience with Dr. Karam and his team was excellent. I waited a year to have my surgery with him. He’s well worth the wait. I was hesitant to undergo surgery because of some of the results I’ve seen from less qualified surgeons who have not specialized in facial surgery only, and who do a horizontal lift instead of Dr. Karam’s vertical lift procedure. He and his team provided videos and support materials that answer questions both pre- and post-surgery (even a spreadsheet of significant events; who doesn’t love a spreadsheet!), and they are always available to answer questions and meet with you even over the weekend to ensure your easy progress in week 1 post-surgery. It’s an almost painless procedure, even when undergoing multiple procedures at once. I’m so happy to have chosen Dr. Karam and his team!

Patient

I had a full face rejuvenation with Dr. Karam and his team.

I turned 50 today. A little over one year ago, as a present to myself, I had a full face rejuvenation with Dr. Karam and his team. Based upon 18 months of research, I would only go to 4 facial plas...

I turned 50 today. A little over one year ago, as a present to myself, I had a full face rejuvenation with Dr. Karam and his team. Based upon 18 months of research, I would only go to 4 facial plastic surgeons in the world, and Dr. Karam is one of them. I consider the work I have done as an investment in myself. I had a full face fat transfer, upper and lower blepharoplasty, deep plane neck lift, and full face lift. I do not have movie star looks, but in my biased opinion, I can easily pass for 38 years old.

Patient

His signature Vertical Restore creates a natural, youthful look.

I did a lot of research before deciding on Dr. Karam for my procedures. It was a big decision to make and a big investment, but now I can say with complete honesty that it was the best decision and...

I did a lot of research before deciding on Dr. Karam for my procedures. It was a big decision to make and a big investment, but now I can say with complete honesty that it was the best decision and I have no regrets. I am so pleased with the outcome and how much more youthful I look. I look much more like how I always felt inside- younger, more vibrant- my face now matches my healthy and fit lifestyle. Dr Karam is so warm and caring- he listened to me and my concerns before the surgery. And his staff was really the icing on the cake- supportive, available by phone day or night, and nurturing in their office care. I especially must thank and give my appreciation to Tina, Taisha, and Taylor, who were my anchors in this new storm on day 1 after surgery and beyond, while my body tried to adjust and start to heal from surgery. Tina even wanted photo updates after I had returned home, and was so encouraging, positive, and reassuring. I can’t thank everyone enough and have such immense gratitude. Big hugs to them all and especially to Dr. Karam’s expertise and artistry. His signature Vertical Restore creates a natural, youthful look. Since returning to my life, no one has questioned, “Did you have a facelift?” The outcome is unlike any other “facelift” I have seen—really, I don’t even consider this a facelift- he is an artist, and our face is his canvas to create a work of art the world will gaze on and admire in our newfound youthful beauty.

Patient

I totally trust his approach and recommendations

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 reste...

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!

F. M.

Dr. Karam is an incredibly talented Surgeon

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, and within 8 days, I was wea...

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, and 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 is 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.

K. R.

I would highly recommend him to anyone

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 ...

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.

J. S.

Schedule a Consultation With Dr. Karam

For the right patient, a skin pinch is not an add-on; it’s the detail that completes the picture. When combined with Vertical Restore, it helps ensure the eyes reflect the same clarity and vitality as the rest of the face. A consultation with Dr. Karam will determine whether this refinement fits naturally into your treatment plan.

KaramMD® Journal: A Weekly Journal on Aging Well“In my weekly journal, I explain facial aging, skin quality, and long-term vitality. The journal is purely educational. There's no selling, just clarity.”

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