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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 is the 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 lower and mid-face as a single unit. Like many social-media-savvy plastic surgeons today, Dr. Karam has branded his particular deep-plane 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?’”
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