Neda and Amir Karam met in medical school. Finally. They had been delivered by the same doctor in the same hospital in Iran. Both of their families later moved to San Diego; they attended rival high schools and worked at the same mall. They went to the same college. But they didn't meet until they were both studying at the University of California Irvine School of Medicine. They were engaged in three months.
Neda became a family medicine doctor; Amir is a plastic surgeon. Earlier this year, a few months shy of their 26th wedding anniversary, Neda decided she wanted to get a facelift. And there was no question in her mind who would perform the surgery. “I didn't want to go to him just because he was my husband, but I felt like I was in the unique situation of living with the best choice,” Neda says. “I don’t think I would’ve had the guts to do it with someone else.”
Amir agreed there wasn’t a better surgeon for the job. “If I thought there was somebody out there that could do a more natural-looking result or have a more consistent-looking outcome, then 100% I would say: ‘Neda, let's go to so-and-so,’” he says. “But I knew in my mind and my heart that I could deliver and that was reassuring for us both. I would not want her to come out of a facelift and look like a different person. The aging process is relatively short. We’ve been married for 25 years and it’s just in the last few that she’s shifted to an aging version of herself. I don’t want a new version of her. I just want the old version.”
If the thought of bringing a scalpel to your spouse’s face (or any part of their body for that matter) gives you chills, you are probably not a plastic surgeon. In 2010, a survey of 465 plastic surgeons revealed that 83.9 percent had operated on a spouse or family member, for a simple reason—the doctors said they believed they were the best surgeon for the job. (In the same survey, 88 percent of plastic surgeons said they would operate on a spouse or family member.)
Facelifts and facelift-adjacent procedures (Neda also got a fat transfer and a lower eyelid “skin pinch”) are the only operations that double board-certified facial plastic surgeon Amir Karam, MD, performs in his San Diego practice, six to eight times a week. (He doesn’t do body surgeries, or even nose jobs.) His technique of choice combines a lateral brow lift, neck lift, and deep-plane facelift, in which a surgeon goes under the SMAS (the fibrous tissue covering the facial muscles) and into the “deep plane” layer, where they release ligaments to raise the jawline and mid-face as a single unit. Like many social-media-savvy plastic surgeons today, Dr. Karam has branded his particular approach with a catchy name: the “Vertical Restore.” (Dr. Karam has nearly 600,000 followers on Instagram, and another 150,000 or so on TikTok.)
“Because it’s all I do, the process has become almost unconscious or subconscious,” he says of his experience in the OR. “I become hyper-focused and then it’s almost flow-like.” With his wife, though, he did worry, “Would I be in that same frame of mind operating on her as I am with everyone else?” So in the weeks before the surgery he started doing something he used to do in his early days of practice. “It’s a sort of visualization,” he says. “I would operate the case in my mind over and over and over and over again. By the time I actually did it, it felt routine. I did that before Neda’s surgery to get over the potential of any anxiety. You don’t know how you are going to feel the moment the scalpel hits the skin when operating on a human being, especially when it is your wife. But the visualization exercises worked—once I started the procedure, it really did feel like every other day that I'm operating.” Except for one part (and we’ll note here that Dr. Karam does his facelifts under IV sedation, not general anesthesia): “She’s the only patient I’ve ever had who was asking toward the end of the surgery, ‘Are you done yet?’”
Here, both patient and surgeon, wife and husband, explain every step of the process.
Neda Karam: Around 48 or 49 I noticed that the shape of my face was changing. I started thinking about a facelift. I just had to get up the guts to do it, and be ready for the downtime. So that was 48: “Maybe after Christmas I’ll do it.” “Maybe next year.”
I kept coming up with different months in my head, but every time I would get close, I would say “No, I have this event” or “I really love sleeping on my stomach.” After a facelift you have to sleep on your back for six weeks.
About three years passed and I started really disliking every single picture. I would put on makeup, I would have my hair done, and I'd be like “Okay, I'm looking my best.” And I still wouldn't like the pictures. I’d go back to look at photos from just seven or eight years ago and they looked so different.
Amir Karam: She was bothered by the changes in her face earlier, but I don’t think I would have done a facelift on her at 48. I know I wouldn’t have. We would do this thing every six months or so, move her face around a little bit and examine it. But it was just too early. So between me not encouraging her and her not feeling totally ready, we could just push it further and further away. I tell patients that there are two criteria for readiness: 1. Is your aging face really bothering you? 2. Are there enough physical changes, enough laxity, to justify surgery? Age isn’t even a part of it. We've done these facelifts on 36 and 37 year olds and on 61 year olds, who just started to become ready for it. The timing of these changes typically starts happening in the late 40s and then progresses after that, but the rate is very individual.
Neda: If I felt that there was a surgeon who could do a better procedure with maybe easier downtime, just some other solution, I’d be willing to travel the world. This is my face. But I just couldn’t see myself getting a facelift with someone else. I wouldn’t feel 100% guaranteed that I'm going to really look my best and look natural. There are so many results that I see every day out there on the street, in the grocery store, that oh my God, I'd just be so unhappy if I had that result. The way Amir does a facelift, the patient just looks rejuvenated. They don’t look the same age, but with a different neck and jawline. They look like their younger selves.
Amir: In my opinion, a face should either look the way it did when it was younger, or it should be aged. There’s no in-between. Natural aging, though it might bother you, is 1,000 times more beautiful and normal and acceptable than a noticeably tweaked postoperative face.
Neda: I’ve seen the results of every surgery Amir has ever done, and I know his level of dedication. I also know that he will tell me “no” if something isn’t a good idea.
There was a time when I really really really wanted a nose job and that was a big point of argument between us. When I was young, of course I didn’t notice volume loss or laxity, it was my nose. I’d always wanted a small nose. We went back and forth on my nose, and he wouldn’t do it.
Amir: There are certain anatomic features that are high-risk and limit the ability to make a very predictable or natural-looking outcome that ages well, and Neda has those features in her nose. I knew she would end up regretting the decision down the road.
Neda: I'm a family medicine doctor, but I stopped practicing when we had our four boys. Since Amir opened his practice in 2008, I’ve been going in to help out with administrative work. And he’s always said, “When you come in the office, come watch me. You can look in the window and see me operating.” And I've never wanted to because I knew I was going to be his facelift patient one day. So I didn’t want to see what's happening.
Even after my facelift was finally scheduled, there were moments of doubt. I had a dinner party, like a week before surgery, and a few of my friends’ husbands came up to me and said, “I really don't think you need to do this.” And it does kind of suck when people keep telling you, “You don't need to do this.” Well, why the hell am I doing it? Why would I want to go through all this pain and downtime when nobody thinks I need it? Then you go look in the mirror and say, wait, but I do need it. I'm not happy with what I see. But then everybody is so discouraging: “You look so great. Why would you do this?” It's very conflicting. You kind of have to shut out those voices completely and just go with what's bothering you.
On the morning of the surgery, my biggest thing was for Amir to let me do my workouts. At first he said, “No. You want to walk for two hours and then do your F45 workout. Three hours of working out is not a smart way to use your energy when you're going to have a major surgery and have to recover.” But he finally agreed when he understood that exercise would help me feel calm.
I was very naive. I had no idea what was going to happen in the operating room. And, really, it was easier than a dental procedure. They give you an Ativan and then put an IV in you and you just go to bed. Then you wake up. My surgery took about three hours.
Amir: On Neda, I did the Vertical Restore and also a lower eyelid “skin pinch,” which is when you remove a small amount of skin underneath the eyelids. Crepiness under the eyes can be exaggerated by the vertical lifting of the cheeks so this helps. She also did a fat transfer. The first step of the procedure that day was using a micro cannula to suction some fat from her outer thighs. It was processed and then injected underneath her eyes, along the upper eyelids, into her temples, in her lips, and around her mouth.
Neda: When it was over, the nurses bandaged me, and I was wide awake talking to them. Then they took me straight to the car. I had made snacks for myself—sliced up pears and bone broth—so I started eating and I was really happy. It was behind me. I was done. We had friends over that night because it was a big Final Four game. I had a full dinner. The pain after the surgery was minimal, I just took Tylenol for about three days.
The day after the surgery, a friend of mine—who is also one of Amir’s nurses—picked me up for an 11am appointment to take my bandages off and see how things were healing. I had follow-ups every day that week and after that first day, I drove myself.
Until the stitches come out, you have to clean your incisions twice a day. I was lucky to have Amir at home to do it. It’s definitely doable for a non-doctor friend or spouse but it’s pretty gross for people who aren’t used to stitches.
In terms of recovery, one of the pleasant surprises was that in two weeks I was back to working out—walking and lifting light weights at home. I didn’t go back to the gym just yet because it’s dirty. Week three, I was back to my F45 workouts—with some weight modifications.
Amir: Before Neda’s surgery, I was very hardcore with patients about no working out before four weeks. But then seeing what Neda was going through physically and understanding that you're past the point of bleeding or hematoma [bleeding under the skin] by two weeks, I’ve changed my mind. If the patient wants to exercise a bit at two weeks, maybe they'll get a little bit more swollen, but that's their choice. If they feel better mentally when they work out, then I'm going to be much more lenient.
Neda: The first six weeks, my face felt like a rock, very numb. It didn’t look swollen, but it felt swollen. I didn’t really like touching it, to put sunscreen on for example. It just didn’t feel like normal skin. But after six weeks, that weird uncomfortable feeling went away. There’s still a little numbness now, at about 10 weeks, but it’s not very noticeable.
Amir: The swelling that's under the skin, that numbness, usually settles down by month three or four.
Neda: Beforehand, my kids were just like “Oh, okay, when are you doing it?” The two older ones, who are in college, said “Just don’t do it when we’re home.” And I didn’t want to do it when they were home. I did look a little scary those first few days. My sons who still live with us would sit in the kitchen with their backs to me so they didn’t have to see me.
Amir and I never talked about what would happen if something went wrong, if there was a complication. But we did talk a lot about the recovery because I have a hard time sitting still and he was really concerned I was going to be too active and get a hematoma or something. But I relaxed as much as I could and I was lucky, there were no complications, which can of course always happen. Even in the best hands, some people will get an infection, for example.
Amir: After a facelift, I usually don’t see the patient until the end of week one. They’ll come in before that to have their incisions cleaned, take out the stitches, that kind of stuff. But I don’t see them. Living with Neda and seeing what she went through has made me a way better, more empathetic surgeon because now I understand better what they go through on a day-to-day basis in the beginning.
Neda: The day before the surgery I took a selfie in my bathroom at 8am—no makeup, workout clothes. I sent it to my girlfriends saying, “This is why I'm doing the surgery.” Everybody said, “Oh my god, it’s a selfie, it’s first thing in the morning, it’s just the angle of your face.” Then yesterday morning—almost 10 weeks after the surgery—I took the same selfie. Same bathroom, same time, same angle of my face. And it’s unbelievable. It’s like Amir just took an eraser, erased everything that had anything to do with aging, and gave me my face back.
There’s so much interesting energy around women who get a facelift. It’s still kind of taboo. People think you’re going to get an unnatural result. Like those husbands who came up to me at the dinner party. Their thinking was probably, “Look, you may have a little bit of jowls now, but you look a lot better than you’re going to look like after a facelift, when you look abnormal.”
Now my friends are truly in awe. They cannot believe the change I got. And I still look like myself. They’re like, “I’m beyond jealous.” I’m the first person in my friend group to get a facelift and I think I started something. I don’t know if any of them will go to my husband—the Vertical Restore can cost anywhere from $130,000 to $200,000, depending on the specifics of the case. That's definitely more than most other local surgeons. But I do have one friend who said, “well… my face is more important to me than my car.”
I’m so used to going, going, going. Always busy. Sometimes I’d look in the mirror at the end of the day, feeling haggard and tired, and that’s how I’d look, too. Now, even when I’m exhausted, I look in the mirror, and I look refreshed. It’s amazing.
Read more about what it's like to get a facelift:
- 13 People Get Real About Their Facelifts
- What's the Ideal Age for a Facelift?
- I'm 96 and I've Had Three Facelifts—Here's What I Learned
Watch the history of plastic surgery:
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