Skincare First: The Key to Successful Surgical Results

Dr. Karam's Vertical Restore patient who uses Trifecta skincare

Written by Founder, Amir Karam MD

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Before you even consider a facelift, there's a critical step that is going to make all the difference in your anti-aging efforts: skincare

This is a topic I am deeply passionate, because whether surgery is in your future or not, mastering skincare is the key to looking youthful.

In my career as a facial plastic surgeon, I have seen it all--from those who have spent their lives tanning here in sunny southern California, to others who barely see the sun up in cold northern countries.

I’ve compared what my patients have done to care for their skin, and what has made the most difference in their aging process all the way up to the day they sit in my office considering surgery. 

And I’ve also watched my wife, who has been an excellent example of everything I want to explain here today, so let’s start with Neda to help paint the picture.

My Gold Star Patient: Neda Karam

Most of you know by now that I performed a Vertical Restore facelift on my wife, Neda.

If you haven’t been following along, check out my Instagram and watch her progress, I think you’ll enjoy it. 

It’s been really incredible to go through this journey with her, and there have been some key points I’ve noticed during the behind-the-scenes of her recovery that I think are worth sharing.

First, Neda’s commitment to a daily skincare routine began 15-20 years ago, well before she was considering surgery. She has been taking care of her skin for years with active ingredients and diligent sun protection.

She started using Trifecta when it came out, which not only cleared up her melasma but enhanced her complexion and gave her skin a youthful, healthy glow. 

She has also consistently made lifestyle choices that have absolutely contributed to the ease of her recovery and beautiful results. She knows good nutrition supports overall skin health, combating the signs of aging from within, so she eats foods rich in antioxidants, vitamins, and minerals which help maintain skin elasticity and radiance. She is also active and exercises regularly, which plays a major role in looking and feeling younger.

Now that Neda is post-op, it’s beautiful to see what can happen when you take care of your skin before undergoing surgery.

While she was already radiant before, now she feels more confident because she looks like a younger version of herself.

Consistent use of high-quality skincare products has not only supported her skin health but also enhanced the outcomes of her surgery.

Neda’s example served as the inspiration behind this week's guide. I hope it reaches others who might be at this point in their aging process, helping to determine the best course of action to achieve remarkable results, both with and without surgery.

A Youthful Appearance: The Balance of Face Shape + Skin Health

Facial aging results from changes in two things: face shape and skin quality. However, despite both being contributing factors to aging, they are two separate sides of the same coin.

When it comes to facial and skin rejuvenation, understanding both sides is essential. 

Youthful Facial Shape

On one side, we have aging changes that alter the face shape. These are structural changes like volume loss, laxity, and sagging.

A youthful facial shape is characterized by a firm jawline and neck, a full upper face, and smooth contours without hollows under the eyes. This youthful face is shaped more like a heart. But, over time, the face transitions from this heart-shaped appearance to a more rectangular shape.

As we age, facial fat pads diminish in areas like the temples, around the eyes, chin, lips, and cheeks, leading to less volume. Skin laxity plays a role, causing the jawline and neck to sag into jowels, the midface to droop and create nasolabial folds, and the brows and eyelids to become heavier and hooded. 

The only way to restore that youthful shape is through surgical intervention.

At a certain point in the aging process, no amount of skincare is going to be able to lift and tighten that skin to restore your facial structure to where it once was.

Young-Looking Skin

On the other side, we have changes related to the skin itself.

These changes stem from various circumstances, including environmental factors, hormonal shifts, and the natural decline of collagen production, which can lead to a cascade of negative effects that can make us appear even older if not corrected.

As we age, collagen production decreases. Fibroblasts, the cells responsible for pumping out collagen, begin to produce less collagen over time. Since collagen creates the scaffolding and thickness of the skin, a decline in collagen production leads to thinner skin—a telltale sign of aging skin.

Thinning skin impacts our appearance by making signs of aging more pronounced. It leads to increased wrinkles and fine lines, loss of firmness and elasticity, and pigmentation becomes more noticeable. Thinner, older skin often becomes dry, dull, and rough, losing that youthful vibrance. 

Young skin is supple, thick, smooth and free of fine lines and wrinkles. It has a clear, even skin tone without spots of discoloration. Young skin looks healthy. It is bright and reflects light, which gives it that luminosity and glow. And, guess what...

I know people well into their 60s and 70s who still have these youthful qualities to their skin.

While we can't control facial shape, we can maintain younger-looking skin by using the right tools to stimulate collagen production.

Why is Skincare Essential Before Surgery?

No plastic surgery can improve the quality of your skin. If you don’t take care of your skin, all of a sudden one day you are going to look in the mirror, and aging will hit you.

If, at that point, you decide to get surgery, you can address structural concerns and sagging, but it won’t make your skin beautiful and radiant.

Even after surgery, you will still have thin, pigmented, dull skin that will make you appear older. Maintaining proper skincare is crucial if you want to defy aging.

If you know you’re not planning to have surgery, then your anti-aging focus should be entirely on skincare. 

And, if you are ever considering surgery down the road, consistent use of medical-grade skincare products will not only significantly improve your skin quality now, but will also make the most impact leading up to surgery day. Your skincare habits will also determine how your results look and how long the results last.

Being proactive with the anti-aging skincare process is so important. If you do this, you’ve won half the battle because your skin can still look beautiful and maintain youthful qualities your whole life. I’ve seen it.

You don't have to make the decision about surgery until later in life, but you need to make the decision to take care of your skin as early as possible.

The longer you are committed to anti-aging skincare, the more you can counteract collagen loss and prevent signs of aging from appearing. Don’t miss this opportunity. 

Here’s where you can start, right now, for age-defying skin.

Proactive Skincare: What You Can Do

While there is little you can do to prevent the changes in facial shape, there is much you can do to control the aging of your skin.

To reverse the signs of aging in your skin and keep it looking youthful, you need to slow down the loss of collagen and re-accelerate its production.

-If you’re younger, following these steps will help you to resist aging, and maintain your firmness and radiance for the long term. 

-If you’re older, these steps will help restore your skin and reverse signs of aging, because it's never too late to get your glow back.


Start with Sun Protection

Sun accelerates skin aging, specifically via UVA light. As a result of being out in the sun throughout our lives, when you get older, your skin starts to show the consequences of that sun exposure. These effects include the production of pigment and the breakdown of collagen and elastin.

The most crucial step in preventing skin aging is protecting your skin from the sun. 

Consistent sun protection can significantly slow down the aging process. Sun protection means using a broad-spectrum sunscreen that is sweat-proof and waterproof. Ideally, choose a sunscreen with a little tint so you can use it as a foundation. Look for non-greasy, non-comedogenic options with zinc and titanium.


Commit to Active Skincare Ingredients

Active skincare involves molecules and compounds that directly address the source of aging.

If you don’t have active ingredients in your skincare, you are missing your chance to build collagen, reduce pigment, and work towards more youthful skin on a daily basis.

Consistent use of actives can prevent skin aging and restore its youthful quality. You must incorporate these key ingredients into your routine:

  • Retinol: Stimulates collagen, increases cell turnover, reduces pigmentation. Retinol is crucial for anti-aging, and daily use is necessary for optimal effectiveness. Regular application builds momentum and delivers better results. 
  •  Vitamin C: An antioxidant that stimulates natural collagen, reduces pigmentation to balance skin tone, and counters sun damage.
  • Hyaluronic Acid: Hydrates the skin by retaining moisture.
  • Niacinamide: Enhances surface immunity and overall skin health.
  • Lipids and Oils: Balance skin’s oil texture, reducing dryness or excessive oiliness.
  • Peptides: Stimulate collagen and reduce the effects of aging.
  • Growth Factors: Further stimulate collagen production.
  • Non-Hydroquinone Lighteners: Reduce pigment production without the long-term risks of hydroquinone.

Products like Trifecta make it easy to maintain this many ingredients in your routine, by combining all of them into one simple system.

It's important to understand that the minute you stop caring for your skin, it will continue to age and the effects will only become more noticeable over time. 

Without any effort, the signs of aging will progressively show up and continue to worsen as you get older. However, with the right ingredients and a personal commitment, maintaining healthy, youthful skin can be an achievable and sustainable goal.


Incorporate At-Home Exfoliation 

In addition to a daily skincare routine, it is important to exfoliate the skin weekly to remove dead, dull cells from the surface.

This instantly refreshes your appearance, revealing renewed bright skin below.

The addition of an exfoliator like Polish Enzymatic Exfoliator can dramatically improve the results of your routine because it primes the skin for better product absorption.

Take advantage of this step by applying actives and essential elements such as ceramides, lipids, hyaluronic acid, and other moisturizing agents.

Products like Quench Vitamin C Serum and Illuminate Anti-Aging Cream provide the active ingredients your skin needs to support its renewal process and enhance its overall health and appearance.

Then, top off your routine with Enrich Breathable Barrier Balm, our deeply nourishing, anti-aging, final boost of hydration.

Exfoliation can leave your skin temporarily vulnerable, so look for products that restore moisture, soothe irritation, enhance barrier function, and promote healing to ensure your skin stays healthy and resilient. 


Preventative Treatments & Boosting Collagen

There are now numerous approaches to preventative facial rejuvenation treatments: different lasers, microneedling, microdermabrasion, chemical peels, etc. These in-office treatments help to resurface your skin and in doing so, boost collagen production and rebuild the skin at a cellular level. 

Each of these treatments and therapies offers unique anti-aging benefits and can be combined with your skincare routine to help improve the quality of your skin.

You can also incorporate preventative techniques like Botox or subtle filler to slow or reduce signs of aging. Botox can help stop repetitive movement that leads to creasing and lifting the heaviness of the brow. Filler works for hollows around the eyes or plumping fine lines, like around the lips.

But you must be judicious with these treatments, as your results are going to change with age. At a certain point, they are no longer going to serve you without completely distorting and changing your face.

There are also non-invasive treatment options for skin care, like Red Light therapy, for example, which stimulates collagen production and improves skin tone and texture. I even took a dive into facial yoga, if that interests you.

But, a note of caution, don’t be fooled by shortcuts and lofty promises. There are lasers that claim they “will give you results of a facelift,” but the amount of time and money you will spend chasing those results is not going to be worth it.

These treatments will not address your concerns long term, and can actually make your facelift surgery more difficult when the time comes.

These non-surgical options are not meant to address face shape, but just like consistent skincare, incorporating some of these preventative and collagen-building treatments into your routine can help your skin stay healthy and maintain its shape longer.

Sticking to an Effective Routine: The Importance of Consistency

All the best and most expensive skincare products in the world won’t achieve your goals unless you use them consistently.

One of the problems I ran into with my surgical patients who wanted to achieve beautiful skin was the fact that they had so many different products and had such a complex skincare routine that they couldn’t keep up with it consistently.

That’s why I created the Trifecta, so that every ingredient that I mentioned here, and more, is easily available in a simple skincare program.

Commitment to a thorough skincare regimen will ensure your skin looks its best, both now and after any procedures. Focus on proven, effective skincare practices for lasting benefits.

Dr. Karam's patient using Trifecta skincare after Vertical Restore procedure

Here is a nice example of a patient who has taken excellent care of her skin using Trifecta. Her complexion is free of wrinkles, discoloration, and looks like it has a healthy glow to it.

We just needed to restore her face shape, which we did with a Vertical Restore. Her face has gone from rectangular to heart-shaped again, and her youthful skin has added to her beautiful results.

The Vertical Restore: How it’s Different from Other Facelifts

My patients come to me because they want to look natural. At my practice, that is always the goal. 

The beauty of the Vertical Restore is that you look at yourself in the mirror, and you still recognize yourself, but as a younger version. Isn’t that what everyone wants as we age?

Through your 30s and 40s you look relatively like yourself. Then as you enter into the 50s and your face shape starts to shift, aging becomes a lot harder on us physically, mentally, and emotionally.

When you get to this place you have two decisions: undergo surgery to restore the laxity and structural changes, or don’t.

If you are not going to pursue surgery, stick to skincare and you're going to be actively fighting aging. That's great. 

But, if you get to a place in your life when you no longer recognize that person in the mirror, and are struggling with the fact that your outer image and inner vitality aren’t aligned—that’s where the Vertical Restore comes in.

The Vertical Restore is not like a traditional deep plane facelift.

It addresses the outer brow/temple, midface, jawline, and neck--all in one procedure. A Vertical Restore is meant to reestablish the youthful facial shape. It gets rid of all the sagging. 

I also often perform upper and lower eyelid blepharoplasties to remove extra skin and puffiness from around the eye area as well. This helps lift that heaviness and drooping around the eyelids and gets rid of under-eye bags that notoriously make you look tired. 

For volume loss, I perform fat transfers help to fill in places that may have volume loss and create a refreshed look.

I lift and sculpt the tissues so they retain natural movement and vitality, restoring the face to its youthful position.

These are the facets of aging that can’t be solved with skincare alone.

Undergoing surgery can achieve beautiful results, but youthful skin enhances those results. Make skincare a daily commitment now, and you’ll thank yourself down the road, especially if you consider surgery at any point later in your life.

Your Own Personal Anti-Aging Journey

Now that you understand what contributes to the appearance of aging, you can set realistic expectations about your own personal course of action.

If looking as young as you feel is important to you, it is imperative to understand what contributes to a youthful appearance and tailor your approach to target both the structural and surface-level changes that occur with time. 

By doing so, you can achieve a comprehensive rejuvenation that aligns with your aesthetic goals.

You control your skin, and a surgeon controls your shape.

If you work on your skin and one day get a facelift, your outcome will be significantly better.

Young skin and young shape = looking young.

If you never get a facelift, having youthful skin is beautiful and you will feel much better about the aging changes. 

Good skin = confidence.

If You are Proactive About Your Skin, Half the Battle is Won

I’ve been doing this for over 20 years: talking to patients about aging, focusing on facial rejuvenation, performing surgeries, doing research and development on skincare, and ultimately helping people look as young as they feel. 

With that, I’m going to make a very important statement--I believe skincare is the most important thing you can do to resist aging. 

This is why I am so passionate about Trifecta. Trifecta is a proactive approach to anti-aging.

It comes down to preventing and restoring aging skin by using the right actives, like Retinol, Vitamin C, Niacinimide, and using them consistently over time, coupled with sun protection. If you do those things, you will have beautiful skin well into your 60s and 70s and beyond.

I see patients every day who have followed this advice, my beautiful wife included. Neda’s story serves as a beacon of hope and empowerment for anyone facing similar feelings around aging, or contemplating whether or not surgery is a suitable next step. 

Neda is an example that when facial shape and skin are made youthful, the face appears truly young. She is proof that using scientifically-backed ingredients in Trifecta will fight the battle against aging skin by boosting collagen production, balancing skin tone, and improving skin texture. 

She feels like herself when she looks in the mirror and likes herself in pictures again. She is confident, and that’s my goal with every patient.

I’m eager to share these insights because they resonate universally.

Aging can be challenging, and undergoing plastic surgery is a big decision to make. But just like the other side of the coin, that’s only half the battle.

While it would be wonderful if a single procedure could completely stop the aging process, the reality is that aging is ongoing, and taking care of your skin daily is a decision of equal importance.

Neda’s experience highlights the power of self-care and embracing opportunities for personal growth. It’s a reminder that investing in ourselves, whether through skincare, surgery, or other means, can lead to profound transformations.

Aging is a lifelong journey that none of us can avoid or escape. Skin changes continue to happen slowly over time, so remain consistent with Trifecta and sun protection, commit to skincare as a lifelong habit, and you’ll maintain youthful, radiant skin for years to come. 

And remember, it’s never too late to start.

Amir Karam MD

Board Certified Facial Plastic Surgeon
Founder / Creator of KaramMD Skin

Dr. Amir Karam is a renowned facial cosmetic surgeon and an authority in his field. With over two decades of experience helping patients achieve a younger, refreshed appearance. In addition to surgical procedures that sculpt a youthfully-defined facial shape, Dr. Karam takes the quality of the skin into account.


Vivian Olson

I would like to get a consultation appt with the doctor. I am seriously interested in the lift, I am 67 years old and I do use his skin care, as well I have take care of my skin. I have had a couple procedures on my face years ago.
KaramMD Skin replied:
Hi Vivian—Thank you for your interest in Dr. Karam and congrats on continuing to take care of your skin with KaramMD products, we love to hear it! The most efficient way to get all the information for Dr. Karam’s procedures, you will need and request a virtual consultation on his website: If you decide to request a consult, you must submit the contact form and your photos and Dr. Karam’s surgical team will assess your candidacy and move forward from there. Hope that helps!


I d like to have a vertical restore but im a greek citizen, living in Athens.
Is that posdible?

Donna Watkins

I 100% agree, skincare has always been the most important thing to me since I was young. I’m now 60 and can’t wait to try the Trifecta products so I’m ready for a vertical restore in the next 2 years. They are due to be delivered today! Cannot wait to see the change in my skin!


Neda looks amazing. I love the way you share her procedures, thank you! She’s obviously an awesome woman.

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