Latest / The Dr. Randi Show / Why the Vertical Facelift is Changing the Conversation — Dr. Amir Karam

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Why the Vertical Facelift is Changing the Conversation — Dr. Amir Karam · The Dr. Randi Show

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  The views expressed in this podcast are for informational
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  purposes only and do not constitute medical advice.
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  This episode of the Doctor Randy Show is proudly sponsored by New
• 0:13
  Beauty, the ultimate authority in beauty and aesthetics.
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  Whether you're looking for the latest innovations, expert
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  insights or trusted recommendations, New Beauty is
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  your go to source. Visit newbeauty.com to stay
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  ahead of the trends and discover what's next in beauty.
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  Now let's get into the episode. Hello everyone, and welcome to
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  the Doctor Randy Show the future of aesthetics one conversation
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  at a time. Our next guest has performed
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  more than 7000 facial rejuvenation surgeries.
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  He developed and trademarked the vertical restore procedure and
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  his Carem MD Trifecta skin care line brings his approach to
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  beauty beyond surgery. Please welcome Doctor Amir
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  Karam. Thank you very much, Doctor
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  Randy. I'm happy to be here.
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  So excited to have this conversation.
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  So excited to have you here today and in doing research and
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  looking at your before and afters and everything that
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  you've accomplished. It truly is an honor to talk to
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  you. You've performed more than 7000
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  facial rejuvenation surgeries. You are the expert.
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  That's an extraordinary number. When you look at your scope of
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  work, what are you most proud of?
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  I think the part that I'm the most proud of is the fact that
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  the results look so natural. You know, that was always an
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  incredibly important part of the decision to go into facial
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  rejuvenation surgery in the 1st place was a funny little back
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  story to this. You know, when you're going
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  through residency and fellowship, you have a lot of
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  different choices, especially in facial plastic surgery between
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  reconstruction, rhinoplasty, facial rejuvenation, a number of
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  different things. But 20 plus years ago, the
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  results in the community looked so unnatural and so clearly done
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  that it really caused me to have some pause in terms of deciding
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  or even thinking that this was an area worth going into.
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  In fact, I think at one point I had decided that I was going to
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  be specifically cancer reconstruction and rhinoplasty
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  and not do faceless because faceless just looks so, so awful
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  and so people look like aliens and windswept and different,
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  etcetera. So it's sort of ironic that now
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  my entire practice is focused on facial rejuvenation and
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  facelifts. But I think the reason why I
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  felt that way was because I didn't realize that there was a
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  way to do these in a natural looking way.
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  And then once that was discovered of how that could be
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  done, then it became passion that couldn't be put out because
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  people just felt so grateful to have themselves back again
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  without looking like they've had any work done.
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  And I think at the end of the day, that's kind of what this is
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  all about. Absolutely.
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  And your work is consistently described as natural and
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  timeless, which really is not easy to achieve in this
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  industry, right? Which is why people are seeking
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  you out from all over the world, literally.
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  So what do you think makes your approach stand out?
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  What are you doing differently? Well, I think there's a
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  philosophical part of the outcomes that I think of as
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  paradigms, how you think about the aging face and therefore how
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  to rejuvenate it. If you have the wrong starting
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  paradigm, then your approach to reverse it is going to be also
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  wrong because it's going to be predicated off of the wrong
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  initial concepts. And I think I was lucky in the
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  sense that I had a long runway of understanding this field in
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  this profession because I decided I want to go into facial
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  plastic surgery literally my first year of medical school.
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  It's almost 11 years before you even become a facial plastic
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  surgeon. So there's a long period of time
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  to look and contemplate, etcetera.
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  And I think what has come from that sort of time is the
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  realization that the aging face is a combination of this sort of
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  downward direction of the fascia.
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  I think of it as elongation where the face gets longer with
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  age. At the fascial level, it
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  deflates and it loses the youthfulness of the skin.
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  So I had this opinion or this paradigm that to rejuvenate it,
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  you need to address the skin, you need to replace the volume,
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  and then you need to reposition the soft tissues in the exact
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  opposite vector that aging has taken you in.
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  And that was a totally different approach, you know, because
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  especially 20 plus years ago, surgeons were lifting the face
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  horizontally or pulling the face, I should say,
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  horizontally. Some dermatologists were
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  starting to get into volume augmentation with sculpture and
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  different things. The surgeons weren't really
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  doing that. So they certainly weren't doing
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  it in conjunction and they definitely weren't paying
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  attention to skin is like an important part of the story.
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  So right out of the gates, I started putting all three of
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  these areas together and I started doing a facelift that
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  was more vertically oriented. Because when you look at
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  somebody describe to you what they want to see after surgery,
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  they're always lifting themselves in the sort of
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  vertical orientation. When you look at them across
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  from you and they're pulling themselves up and you're like,
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  yeah, that looks beautiful, that looks natural, etcetera.
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  But why is our surgical textbooks describing a smash
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  facelift is going towards the ears when in reality it should
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  be moving up towards the temples?
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  And so I started looking for techniques that would allow me
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  to go in this upward direction simultaneously.
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  Using fat transfer to replace volume and treating the skin
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  with a combination of intraoperative things like
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  chemical peels or lasers and then putting them on a really
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  solid skin care routine afterwards.
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  And then when you put that all together, you know the
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  combination of the technique, but also just I guess a
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  sensibility that knows what natural looks like artistically,
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  then your results started looking right out of the gate.
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  So natural. And that, as you said, became
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  the biggest point of demand for people because they compared it
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  to what was available and they thought this was a way better
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  outcome to go for. So getting that paradigm right
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  and then applying the procedures has been a game changer in terms
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  of career development and practice building for sure.
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  And that is how you came upon vertical restore, right?
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  And that's your trademark procedure.
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  Yeah, the vertical restore actually was an interesting
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  evolution because like I said, I was from day one lifting the
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  face in this vertical direction. But I was doing it using a
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  spasectomy technique, which was not a deep plane.
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  And for 10 years, I was combining fat transfer, this
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  kind of lateral spasectomy with a lateral brow lift, neck lift,
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  and then as I said, taking care of the skin.
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  But one of the things after sort of auditing my 10 years of
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  results and looking how those faces aged, I realized there's
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  two things that were missing. 1 was the address of the mid face.
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  The mid face wasn't. And such an important part of
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  the rejuvenation process is lifting the mid face.
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  That was not being addressed with a technique that I was
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  using. And the durability was not, I
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  felt as long as it could have been.
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  You know, deep planes have been around since the mid 80s.
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  And one of the hallmarks of a deep plane lift or working in
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  that deep plane fascia level is that the results are longer
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  lasting than traditional Smats because you're releasing all the
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  ligaments and the binding tissue points so that the face is
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  moving freely without any opposition.
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  And that the ability to do that, I felt would enable me to not
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  only move the mid face up, getting a more rejuvenated
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  heart-shaped look, but also get a more durable result.
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  So then I started moving into the deep plane but using the
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  same vector addressing the lateral brow, mid face, jawline
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  and neck and the whole thing together became the vertical
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  restore. So one thing that I read in my
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  research is that not every patient is a perfect match for
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  vertical restore. So who is the ideal candidate
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  and who is not? So, you know, sometimes you get
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  a combination of factors that would lead us as a practice to
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  saying somebody is not a candidate.
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  So I would say that the candidacy components are #1
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  there has to be enough to physically move, right?
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  So you can't have somebody come to you.
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  Maybe either they're too young or they just had a facelift and
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  they think it could be better and they are coming to you
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  asking you for revision. You know, they've gone somewhere
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  else and they want, they think it could be better.
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  And then you lift their face and you can hardly move the thing.
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  Or if somebody is younger and they're like, oh, I should get a
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  facelift to get in front of the aging process and you move in,
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  there's like nothing to move. So there's a physical criteria,
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  which I consider kind of anatomic criteria to be met.
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  So that's one of them. That's very sort of objective.
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  And then there is the more subjective aspect of it, which
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  is the emotional part of it, where somebody should be doing
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  this for the right reasons. Meaning that their expectation
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  of the procedure is because they feel like they no longer look as
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  young as they feel and they want to recapture that.
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  They stop enjoying taking photographs or they try to avoid
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  video or photography and this and that, and they're feeling
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  emotionally sort of upset with that new state of reality thanks
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  to aging. But they have realistic
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  expectations about what would make them satisfied or happy.
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  And they're not looking at this as all I want to look like I was
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  20 again or I want to do this. And then suddenly, you know, be
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  able to get acting jobs that I used to get when I was in my
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  early 20s or whatever it is. So I always think if they're a
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  person that has the right expectations, that is
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  emotionally ready and they have the physical changes to justify
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  the procedure, they're a good candidate for it.
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  And if any of those things are not being met, then we ask them
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  to, you know, basically pass on the procedure in a nice way, of
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  course. So after thousands of facial
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  surgeries, what still surprises you when patients see themselves
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  for the first time after one of your procedures?
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  The. Thing that probably surprises
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  others more than it surprises me because I think at this point
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  I've seen it so much that I almost come to expect it.
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  But really what it is this feeling of kind of completeness
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  that they feel about themselves again, you know, and that comes
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  with a tremendous amount of gratitude and sort of like hope
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  for the future and just this joy that comes from being able to
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  see the person in the mirror in the photograph that resembles
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  how they expect to be seen when their minds eye.
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  And what was fascinating is one of the things that I kept
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  hearing over and over and over again.
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  And I think any listener who's perhaps in their late 40s,
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  fifties, 60s and 70s could probably relate to this.
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  If you're healthy and you know, you don't have any medical
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  reasons to feel differently. But if you're a healthy person,
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  age is just a number. The image that you maintain of
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  yourself in your head is still of somebody who's a lot younger.
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  So you see yourself as like a 30 something year old version of
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  yourself, even when you're 50, even when you're 60, even when
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  you're 70. And because you have this
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  particular image of yourself and then you have these points of
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  reality, like a photograph or a zoom call or a mirror or
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  whatever it is that bring you to this new reality that in fact
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  you're not 30 something despite feeling 30 something.
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  Then that's where the sort of this disconnect and discordant
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  starts to happen. And that's where people start to
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  feel upset by the changes. And then the reconnection
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  happens when it's brought back. And then there's this like, you
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  know, over amount of joy that they experience, which is so
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  gratifying to be in a field like this that you can press those
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  buttons and help people feel that way again.
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  And there's not that many aspects of medicine that give
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  you that instant gratification. I'm sure.
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  So you know what's interesting is comparing probably faceless
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  from 10 years ago as well as expectations from patients.
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  What do you think the most has changed from what they expect
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  and what they want to see? Oh, yeah, That's a great
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  question. I think one of the, you know,
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  and I always feel for the younger surgeons or the surgeons
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  who haven't really devoted the last say 1520 years of their
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  practice towards facial rejuvenation.
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  Because suddenly the combination of social media and the
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  exhibition of these type of outcomes on social meaning like
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  our before and afters, right? Showing them to the world and
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  getting literally millions of views on these things.
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  It's set a new standard for what the consumer comes to expect,
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  what the perspective patient comes to expect.
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  Because before there was almost this feeling of trade off, like,
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  okay, I'm going to get a tighter looking face, except the fact
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  that I'm not going to quite look like myself, maybe have a little
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  bit of this windswept look, but I really can't stand the Turkey
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  gobbler in my neck and the jowling.
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  This is the trade off that just you have to accept.
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  And if you weren't willing to accept that trade off, then you
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  just didn't do anything. But now because they're people's
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  eyes have seen what they've seen and you can't Unsee them after
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  they've seen it. And, you know, it's possible.
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  The expectation of the consumer and the patient is basically to
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  look like themselves, natural looking and look years younger.
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  And that's a high bar to set. And as you said earlier in the
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  conversation, doing that consistently every single time
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  is the hardest part about this because the faces come in all
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  shapes and sizes and, you know, different histories and previous
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  surgeries and this and that, but the expectations remain the
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  same. And so being able to do that for
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  the person every single time is really, really an important part
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  of this whole thing. I think you have one of the
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  hardest jobs in the world. I say that all the time.
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  I think a facial plastic surgeon has a job like no weather, like
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  if I don't feel good in the morning, I can still, you know,
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  keep going and nothing's really nothing's going to affect
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  anybody else. If I have a bad day, but you
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  wake up and you have a bad day, that's somebody's face, right?
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  So it's a very big difference. And I think that the pressure
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  and the stress that probably goes along with that, you know,
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  you're very calm and mild mannered, but I'm sure that is
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  something that it affects you every day of like I have to get
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  up and feel my best every day to perform my best.
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  And I'm sure that makes you take excellent care of yourself as
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  well. Yeah.
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  No, that's a really, really good point.
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  In fact, that was one of the reasons actually I decided I
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  wanted to go into this profession because it had this
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  sort of no room for error, you know, pressure.
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  Gosh, I mean, it really is incomparable to any other aspect
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  of medicine. I mean, just think about it like
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  people think neurosurgery or heart surgery is hard, but there
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  comes an expectation when, you know, you operate on a 78 year
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  old patient who's had multiple heart surgeries and then you're
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  taking them in as they're basically dying and you're
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  trying to save them. There's a clear expectation in
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  everyone's mind that you may not make it out of that surgery
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  alive, right? Or that you might not make it in
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  recovery. You come out of a facelift and
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  you leave a few millimeters of jowling or a little line here or
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  there or a scar that didn't look.
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  I mean, it's unforgivable. There is no tolerance for even
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  the slightest bit of imperfection, really from the
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  mind of the patient. The expectations are enormous.
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  And with a face, especially compared to other areas of
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  plastic surgery, you can't cover it.
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  So it's visible to the world. So you really have to accept and
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  and almost embrace that pressure and let that pressure inspire
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  you to put your absolute best for the person every single day
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  without exception. And I actually, that was one of
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  the things that was compelling and exciting about the field for
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  me. Like I ran towards that type of
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  reality as opposed to as, you know, I didn't want something
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  that that gave me a lot of room for error.
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  I wanted something that was is high pressure and very
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  meaningful for people. But you're absolutely right.
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  It is a part of the profession. And I think you don't even
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  realize what you're experiencing.
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  But to your point, you know, it is effectively guided how I wake
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  up every single day, what time I go to sleep, the foods I eat
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  every single day, the way I exercise, everything is designed
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  like literally to AT to make me feel exactly the same way and be
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  in that perfect compartment mentally and physically so that
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  I can operate and deliver the exact same for each person.
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  It's an interesting space to me. And because you're right, I
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  mean, if you have like a bad day, obviously the poor patient
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  is going to feel the effects of that and see the effects of
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  that. And you're going to hear about
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  it and feel it from them for for a very long time after surgery.
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  And that's never a fun place to be.
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  Yeah, I think it's a very high pressure environment, but it
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  does sound like you have to live a super structured life to do
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  whatever it takes. So let's talk about your skin
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  care line. Caram, MD.
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  For those who can see us, I'm going to show your packaging.
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  The product is beautiful, great to use, but I love the
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  packaging. And you created this skin care
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  line to compliment your surgical work.
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  But as I understand now, there's over 50,000 subscribers to the
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  skin care line. Is that correct?
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  So 50 + 1000 customers. There's about 13,000 daily
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  subscribers to the trifecta. Got it.
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  OK, so tell me a little bit about what inspired you to bring
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  skin care into the mix. So as I said earlier, this
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  concept of facial rejuvenation for me was a combination of
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  surgery, volume, augmentation and skin.
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  Again, we back up far away and you say, OK, when you look at a
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  20 something year old or a 30 something year old, what are
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  their features in their face? Well, a 2030 year old has
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  beautiful, supple, clear looking skin, right?
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  Clear in the sense of no discolorations from sun damage,
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  etcetera. They have essentially no lines
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  and wrinkles. They have a thickness and a
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  suppleness in their skin in a glow.
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  So there's this envelope to the shape that is effectively skin
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  and then you have the shape which, you know, there's no
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  jowling, there's no laxity. There's this what we kind of
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  described as like a heart shape or or a reverse triangle.
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  Those are the physical anatomic changes that are happening in
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  the deep structure. So I've embraced that from the
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  very beginning that it can't be just surgery and it can't be
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  just volume and it can't be just skin.
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  And I basically married all these together in my treatment
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  plans. So from the get go, I took skin
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  really, really seriously, which was very unusual for a facial
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  plastic surgeon in general. And what we would do for our
• 18:15
  patients after their surgery is we would sit down with them for
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  45 minutes, sometimes an hour, and either with myself or with
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  our aesthetician or our nurse, we had like a post operative
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  skin assessment and planning meeting post surgery.
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  So three months usually after surgery, we give them this
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  assessment and then put them on the products that we had
• 18:35
  available to us. But what was fascinating was the
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  more you learn about skin, you realize that the aging of the
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  skin is multifaceted. There's a lot of different
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  things happening simultaneously. And as a result of that, those
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  changes that are happening, you need to address them
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  simultaneously. And as a result, that ends up
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  being a number of different components to your skin care,
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  right? You've got to increase collagen
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  production. You have to decrease the
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  production of melanin. You have to add ceramides and
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  oil back for skin barrier, antioxidants to protect and
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  blah, blah, blah. Like it just goes on and on.
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  So there's all these different aspects, cleansing it and
• 19:13
  protecting it. Our typical patient was on 8
• 19:16
  different products. And as a result of that, they
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  were very, very unable to maintain that compliance that a
• 19:26
  products on a daily basis would require.
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  Even though they were seeing results, they just couldn't keep
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  up with it. The cost, the time, all that
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  stuff. So years before I even had like
• 19:35
  a social media platform to potentially even sell the
• 19:39
  product to my community. I thought of it as basically I'm
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  going to make something that is really, really simple to use
• 19:47
  that combines all those important things and then
• 19:51
  effectively let the person get it from our office once a month.
• 19:54
  You know, just automatically it just refills for them and they
• 19:57
  just get it once a month. But as this thing was
• 19:59
  developing, it took like four or five years to develop to get the
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  chemistry right, to get it actually to be tolerable,
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  etcetera. Simultaneously, I started
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  getting some social media following and this and that.
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  So by the time it came out at the end of 2021, it was like,
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  OK, well, we can not only let our patients enjoy this, but
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  also. The community at large.
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  So therefore it became a brand and it became a thing to sell to
• 20:26
  people because surgery is totally non scalable.
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  There's only so many people you can treat each month.
• 20:32
  And skin care is one of those things where if you have
• 20:35
  something that's super effective and easy to use and beneficial,
• 20:38
  I mean, anyone can benefit from it.
• 20:40
  And there's a need for that type of efficacy and simplicity on
• 20:44
  the market. And that's where we felt that it
• 20:46
  was worth bringing the trifecta to the public.
• 20:50
  So tell us about what's in the trifecta.
• 20:54
  So the trifecta is a combination of basically every major active
• 20:59
  that you've ever heard of. So things like retinol, vitamin
• 21:05
  C, peptide, niacinamide, variety of ceramides, like an entire
• 21:10
  lipid compass, botanical lighteners to decrease
• 21:12
  pigmentation, and then just a host of other botanical
• 21:16
  components for antioxidants, aloe, different things.
• 21:19
  I mean, there's like between the three components, there's like
• 21:22
  21 different actives in there. And pretty much the key and main
• 21:25
  ones you've all heard about over and over again, it just happens
• 21:28
  to be packaged together in these three individual products.
• 21:31
  So a cleanser and then two treatment steps.
• 21:34
  And the beauty of it is you do it twice a day, so it's split
• 21:38
  dose, so it's not hitting your skin in a harsh way and you can
• 21:41
  tolerate it because as you know, any retinols and things like
• 21:45
  that are and vitamin CS can be very difficult to tolerate and
• 21:48
  most people don't use them on a daily basis.
• 21:50
  So this is the solution to that particular problem.
• 21:54
  Well, I find it phenomenal, so thank you for introducing it to
• 21:57
  the world. And it sounds like this has
• 22:00
  really been a nice integration into your practice.
• 22:02
  And Speaking of the practice, you know, from my research, I
• 22:06
  found it says that you're really known for the way that you
• 22:10
  communicate with patients. I can tell by, you know, just
• 22:13
  talking to you, you must have a really great manner with the
• 22:16
  patients. How do you build the trust and
• 22:19
  set the expectations, make them realistic from the first
• 22:22
  consultation? How do you make people feel
• 22:24
  comfortable? Well, I think people appreciate
• 22:28
  and enjoy the honesty and the candor that comes with not
• 22:33
  trying to sell them on something that is not going to happen or
• 22:37
  that it's not, you know, truthful.
• 22:38
  I've always had this opinion that every patient is basically
• 22:42
  my family member. And as you know, I operated on
• 22:44
  my wife a year and a half ago and pretty much everything that
• 22:48
  I ever have done in my practice, the litmus test was, is this
• 22:54
  something that I would do for her?
• 22:56
  Is this something I would do for my family member?
• 22:58
  And that has been a really important lens to evaluate
• 23:03
  different types of treatments. As you know, the space is filled
• 23:07
  with variety of different treatments that come in and out
• 23:09
  of popularity over time, right? Trends and media hype and
• 23:13
  everything else. And from my point of view, I've
• 23:15
  always just kept this attitude that the patient deserves to
• 23:19
  really only do things that are efficacious and low risk.
• 23:23
  So there's this balance between high reward, low risk and those
• 23:27
  are the things that we're going to bring in.
• 23:28
  And the same applies to surgery. I mean, we do these surgeries
• 23:31
  under local with IB sedation, for example, and focus on and
• 23:36
  delivering really safe outcomes, predictable outcomes, and being
• 23:39
  very straightforward about when something is going to be a
• 23:42
  limitation and making sure the person understands that ahead of
• 23:45
  surgery so they don't come to hear it afterwards and say,
• 23:48
  well, why didn't that change? And then you're having to
• 23:50
  explain it later. So, you know, honesty and
• 23:53
  authenticity are all really important aspects of it.
• 23:55
  And I think our patients really appreciate that.
• 23:58
  Absolutely. I think that everybody wants
• 24:00
  that honesty instead of being sold a dream that can't come
• 24:03
  true. And you did touch upon new
• 24:05
  technologies and innovations. I'm curious, you know, these
• 24:10
  things emerging all year, every year, Which ones have your
• 24:13
  attention right now? And also, how do you decide
• 24:16
  which ones deserve your attention and which ones are
• 24:18
  just noise and marketing? Yeah, that's a great question.
• 24:21
  So I think the general conclusion that I can make is it
• 24:26
  anything non surgical that's supposed to improve shape, you
• 24:29
  know like lift tissue is probably in a general statement
• 24:35
  not worth doing. And so I have not found any
• 24:39
  energy device, any thread concept or liquid facelift with
• 24:44
  fillers or things like that to be a remedy for laxity and
• 24:47
  tissue descent. I don't honestly see anything on
• 24:50
  the near horizon because everything that has come has
• 24:54
  already they come and then just gets repeated in a different
• 24:57
  marketing cycle with a different name and a different branding
• 25:00
  and a different promise. But the end result is usually
• 25:03
  falls very short. For example, these RF micro
• 25:06
  needling devices, you know they were the pottest thing for
• 25:10
  trying to lift tissue and improve laxity and not being non
• 25:14
  surgical etcetera. Then you start hearing patients
• 25:18
  come to you and asking you to do fat transfer because they use
• 25:22
  these devices and they felt like it aged them, it made them look
• 25:25
  older. And in fact, the FDA just
• 25:27
  recently put out a statement that these treatments, radio
• 25:31
  frequency micronealing devices can cause a lot of problems.
• 25:35
  And therefore the providers as well as the patients should be
• 25:38
  aware and really go through the informed consent process.
• 25:41
  And so often it takes years for something to be on market for us
• 25:46
  to realize the negative consequences of them in addition
• 25:48
  to where they fall flat. So my approach has always been
• 25:52
  never an early adopter to any technology anything.
• 25:56
  I wait two or three years for it to be on the market.
• 25:59
  Then I start asking a ton of my colleagues and friends from all
• 26:02
  over the country, even outside the US, what their personal
• 26:04
  experiences have been with the device or whatever new
• 26:06
  treatment. And if they can give it a
• 26:08
  glowing thumbs up, because they're not going to lie to me,
• 26:10
  you know, And if they can give it to me, then I'm going to
• 26:13
  potentially bring it into the practice.
• 26:15
  The fact of the matter is, almost to a point of 100%, those
• 26:20
  treatments that have been out on the market for a long time have
• 26:23
  been shared to me as ineffective or, you know, not worth getting,
• 26:28
  despite the fact that they exist in their own practices.
• 26:31
  Now it's smart that you kind of wait and not become the early
• 26:34
  adopter and have your patients become the test dummies for
• 26:37
  that. So my question to you is, in the
• 26:41
  aesthetics industry right now, you know you've been doing this
• 26:44
  for a long time. What do you have your attention
• 26:47
  on? What excites you the most for
• 26:48
  what's coming next? You know, I think what's really
• 26:51
  happening, we're talking about after 20 years, what's finally
• 26:55
  happening. And I don't mean this in like a
• 26:58
  I'm excited that this is happening, but I like the fact
• 27:01
  that there is there's a direction towards reality and
• 27:06
  what's ultimately going to lead to people having the results
• 27:09
  that they're looking for. But there's a trend towards
• 27:12
  surgery that we haven't seen in literally almost 20 years where
• 27:17
  the trend was everything non surgical.
• 27:19
  And then and then surgery was sort of this like, you know,
• 27:22
  catch basin for some people who had given up on non surgical and
• 27:25
  many people who just simply, you know, sort of thought they knew
• 27:28
  better and they went to surgery, but there wasn't a trend
• 27:31
  involved in it. Now there is this growing
• 27:34
  directionality towards the facelift surgery, which is also
• 27:37
  making the younger surgeons and the less experienced surgeons
• 27:41
  really level up their game to creating nice looking results
• 27:45
  and really realizing that they have to elevate their own
• 27:48
  standards if they're going to participate because the consumer
• 27:50
  and the patient simply won't sign up for them if they don't
• 27:53
  have nice looking results. So there's that aspect that I
• 27:56
  think is a trend, but there's nothing technologically that I
• 27:59
  see that is that's on the horizon that is exciting.
• 28:03
  Otherwise, you know, I think where we we are with all this
• 28:06
  facial rejuvenation stuff is, you know, when you look at some
• 28:09
  of our outcomes, it's hard to imagine how it could be better
• 28:12
  than it already is. So the answers are already
• 28:15
  there. It's just now the question is,
• 28:17
  are people going to follow in that direction as opposed to
• 28:20
  looking for something different or better?
• 28:23
  And how that's going to play out over the years will be
• 28:25
  interesting to see. So tell me, Doctor Karam, what
• 28:28
  does 2026 look like for your clinic for Karam MD?
• 28:33
  What's on the horizon? Anything new and exciting?
• 28:36
  Guys, you know, at this stage, after 20 something years, I'm
• 28:38
  not super on exciting and new. I feel, you know, at this point,
• 28:43
  just, you know, from the surgical space, just more of the
• 28:46
  same, continuing to just refine our patient experience and
• 28:49
  making sure patients get a better and better experiences
• 28:52
  both before and after surgery. So always refining that.
• 28:56
  And then as far as the Keramen B skin is just getting in front of
• 28:59
  more people and letting them experience it.
• 29:01
  Because what we found is that if you use the product consistently
• 29:05
  for three months, you're hooked. And that's a beautiful thing
• 29:08
  because once you have a product that you love and you see the
• 29:11
  results and you see your skin transforming over time, it's
• 29:14
  very rewarding and just takes a lot of the stress.
• 29:18
  And it's very free because you're not looking for something
• 29:20
  new all the time. You're not trying new things all
• 29:22
  the time. And that which can be very
• 29:23
  exhausting and emotionally taxing after a while, as well as
• 29:27
  financially taxing to a constantly trying new things.
• 29:29
  So yeah, we're just going to continue building awareness
• 29:32
  around it. Sounds like a plan.
• 29:34
  Well, thank you so much for joining us today.
• 29:37
  Is there anything else you'd like to share with our list
• 29:40
  before we take you into the speed round?
• 29:42
  I think we covered everything. This is wonderful.
• 29:45
  OK, I think so too. I think a lot of people will be
• 29:48
  now checking into the skin care line, looking at your before and
• 29:51
  afters on social media, which there are some phenomenal
• 29:54
  photos. So I welcome the audience to
• 29:56
  take a look. So we'll dive into the speed
• 29:58
  round, OK? Sounds good.
• 30:00
  We're going to do a rapid fire list of industry trending the
• 30:04
  topics, right? And you just tell me in or out.
• 30:07
  OK, OK, sounds good. Bio stimulators.
• 30:11
  It's great for volume, cautious for skin.
• 30:15
  Threads. Out.
• 30:17
  Preventative Neurotoxin. In.
• 30:20
  Lip flips. In.
• 30:22
  Under eye filler. In if you do it very
• 30:26
  conservatively. Too much filler.
• 30:28
  I'm definitely out for that concept.
• 30:30
  Non surgical nose contouring. Used to be in, now out because I
• 30:35
  think the risks of occlusion is a too big of a risk to take.
• 30:39
  Jawline contouring with filler. In moderation in.
• 30:45
  Chin augmentation with filler. In.
• 30:48
  Fat dissolving injections. Out.
• 30:51
  Collagen banking. As a concept in for sure.
• 30:55
  Micro dosing neurotoxin. In.
• 30:58
  Injectable skin hydrators. Out.
• 31:02
  Gummy smile. Neurotoxin.
• 31:05
  In. OK here's the hot 1 I keep
• 31:07
  seeing pictures of. Massive or slimming with
• 31:09
  neurotoxin? I don't see an issue with it,
• 31:12
  yeah. Platelet treatments for skin.
• 31:15
  Indifferent. I would say overall closer to in
• 31:17
  than out. There's nothing terrible about
• 31:19
  it. Traditional micro needling
• 31:21
  without RF. In.
• 31:23
  Laser resurfacing. In.
• 31:25
  Energy based skin tightening. Out.
• 31:28
  Broadband light. Intense light therapy.
• 31:30
  In. In office light therapy facials.
• 31:35
  In. And at home, LED masks.
• 31:37
  Sure, N. Oxygen facials.
• 31:41
  Yeah, they're fine. Retinol.
• 31:43
  Strong N. And vitamin C.
• 31:46
  Big N. Niacinamide.
• 31:48
  N. Hyaluronic acid.
• 31:51
  Absolutely N. Peptides.
• 31:53
  N. Ceramides.
• 31:55
  N. Chemical exfoliants.
• 31:58
  N. Enzyme peels.
• 32:01
  N. Skin cycling.
• 32:05
  What does that mean exactly? So we're using certain products
• 32:08
  on certain days, right? You're not using every product
• 32:11
  every day. Oh, I see now.
• 32:13
  Skin slugging. In.
• 32:16
  All right, that's it. That's our whole list of speed
• 32:19
  rounds, so we love your opinion on those things.
• 32:21
  Yeah, no, the the last, the last group was basically everything
• 32:24
  that's in the trifecta and the slugging is the stuff that's in
• 32:27
  the Ridge. So of course it's a big in.
• 32:29
  Yeah. Awesome, awesome.
• 32:31
  Well, thank you. This was a lot of fun.
• 32:34
  Well, thank you so much for joining us.
• 32:35
  We had fun too. I know the listeners and viewers
• 32:38
  will love it. So thanks for joining us again
• 32:41
  and thanks for listening. The conversation continues next
• 32:45
  time on the Doctor Randy Show. Doctor Randy Boyett holds a PhD
• 32:49
  and is a recognized leader in the aesthetics and medical
• 32:52
  industry. She is not a licensed medical
• 32:54
  doctor. All commentary and product
• 32:57
  recommendations are based on industry expertise and are
• 33:00
  provided for informational purposes only.