Facing the Future: Is Vertical Restore 2021’s Most Promising Procedure?

By January 18, 2021 November 14th, 2021 Beauty
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On December 3, 2018, Dr. Amir M Karam, a double board-certified facial plastic surgeon in Carmel Valley, San Diego, used the name “Vertical Restore” for the first time in commerce. On March 24, 2020, the U.S. government issued him a certificate that officially recognized it as a registered trademark.

Twelve years of practice and perfectionism had gone into the procedure it referred to, but the name had finally clicked. It rang true.

“Vertical Restore is a rejuvenation procedure that impacts the brow, midface, jawline, and neck,” the trademark filing says.

It’s a Class 44 mark—a class that covers services, not products—and Class 44 is known for its nuances.

“Class 44 is a rather interesting class, as it mostly covers services which increase the health and beauty of people, plants, and animals,” says Tingen & Williams law firm. “Remember that this class is for services, not the production of goods. So, while dog grooming would fall under this class, dog shampoo would not.”

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And that’s an important distinction.

Vertical Restore is a surgical procedure–a service—not easily replicated. While the outcome of any surgical procedure depends more on the surgeon’s skill and dexterity than it does anything else, not all procedures are unique enough to warrant trademark registration.

But, even those that don’t are not the product of predetermined manufacture.

Unlike a car or an iPhone, surgeries aren’t the work of an assembly line on which every movement is predefined and controlled by computers.

Unlike a car or an iPhone, no two faces (or facelifts) are the same. Ever.

Your doctor is the single most important variable.

Cosmetic surgeries are commission art by a doctor on a canvas dictated by the patient.

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These doctors manipulate the same raw material—skin, tissue, muscle, bone—that are composited differently every single time.

Thin, thick, gaunt, flush, hollow, smooth, sharp, bony, pointed, protruding, round, arched, curved, humped—a good surgeon has seen it all on the “same” body part, one patient to the next. It’s how, or if, their methods acknowledge and account for these variables that matters to you.

Karam, widely known for his surgical results that look natural, went to medical school, did his surgical residency in head and neck surgery, and a facial plastic and reconstructive fellowship at Southern California’s UC Irvine.

After that 11 year process, he arrived in Carmel Valley, San Diego, where he built his private practice 15 years ago. Today, he’s double board-certified, has created two proprietary facial plastic surgeries, and is one of the most famous plastic surgeons in America, and thus the world.

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Any surgeon, and particularly one in private practice, is known by results.

Results breed a certain reputation and it takes verve and expertise to be the bold name and bright face of a practice in the beauty capital of America.

For Karam, there are some 4,000 men and women here in Southern California, nationally, and even abroad who’ve experienced his natural results.

Prior to his creation of Vertical Restore, patients already routinely flew in for his work. Vertical Restore increased that number. And contrary to intuition, as with most other cosmetic surgeons nationwide, COVID-19 and stay-home orders only increased the number even further.

Patients have the time and resources to invest in themselves, and they’re in the perfect environment for rest and recovery. 

“Vertical Restore is a culmination of [tackling] 10-12 years of the things that bothers people the most, says Karam. 

Vertical Restore is “a facelift” in the sense that it does lift the face. But beyond that, the two procedures seem to share more differences than they do similarities.

Vertical Restore versus Visible Facial Aging

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In September 2013, scientists in Paris, France, operating out of L’Oreal’s Department of Applied Research and Development, discovered that sun exposure was responsible for as much as 80% of visible facial aging.

Alas, the fountain of youth was found and it was evidently just a good sunscreen.

But there was a problem: the signs of facial aging that these researchers had isolated and attributed to sun exposure were things like texture, spotting, pigmentation, and color contrast.

Sagging skin, however, wasn’t one of them. Sagging skin isn’t the result of sun exposure. It’s linked more to Earth’s gravity than it is to anything else.

And sunscreen doesn’t change gravity.

Facelifts: Fashion With a Flaw

That’s why in 2019, even with an estimated $50 billion spent on consumer cosmetics, there were 123,685 people in the U.S. who had facelifts, making it the 5th most popular procedure that year. That’s less than half of one percent of the. U.S. population. But that metric is similar to the flawed logic in the classic, comical observation that, “Only 28 percent of car accidents are caused by drunk drivers.” (Ergo, 73 percent are caused by sober drivers, so shouldn’t we all just….)

Because when you crunch the numbers, 66 percent of facelifts are done on patients aged 55 and above;  81,875 such patients for 2019. That’s 2% of a choice demographic getting a facelift—in just one year.

If that doesn’t strike you as staggering, consider the fact that in January 2020, the AARP announced that in that same year, 23 percent of “older Americans” had purchased a smartphone, and only 12 percent had bought a computer or laptop.

Sunscreen won’t solve sagging. Surgery will.

In January 2020, a patient on RealSelf™ asked the key question: “What percent of facelifts need a revision?”

“Facelift revisions are not uncommon,” replied Dr. Charles Nduka.

There’s another point, too. Facelifts “officially” last 5 to 10 years, depending on whom you ask.

But Karam told me he “does redos all the time” for people who are a year or two out from a facelift, who have come in to see him for a Vertical Restore because they “look just like they did before.”

So, what is there to Vertical Restore that makes it unique? That makes it a trademark? That makes it a procedure that’s intrigued and attracted the attention of 150,000 people?

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A Word With the Creator:
Dr. Amir Karam

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The week I spoke to him, Karam had seen patients for his Vertical Restore from Seattle, WA, Los Angeles, CA, the United Kingdom, and, of course, Paris, France, where seven years prior, L’Oreal researchers had told us sagging skin wasn’t a result of overexposure to the sun, but a result of gravity.

The excitement was obvious and the feeling of accomplishment totally relatable. Here’s what I wondered and what he answered. According to the number of people Karam is now reaching, interest in Vertical Restore has well more than doubled since we spoke in March. So here’s what they, too, are wondering.

How long does Vertical Restore last?

Ten to 15 years.

How does that lifespan compare to a traditional facelift?

“Traditional facelifts, or the SMAS facelift, can typically last anywhere from 3 to 7 years. So the Vertical Restore is significantly longer than that.”

How does Vertical Restore last so long?

“It incorporates a category of facelifting that has been around for 40 years, that’s called the deep-plane. The deep-plane is an approach that is very advanced in terms of how it’s performed. What it does is it enters a level of the tissue that is basically a cleavage plane where the tissues slide with aging.

“And what we do at that level is we separate all the important ligaments that are holding the skin and fascia down to the bone. And when we separate them from the cheek area down to the jaw area, and Vertical Restore takes it a step or two further and separates it from the neck area. What happens in those cases is you get complete freedom of the fascia which has been elongated with age. And with that movement, what ends up happening is you’re able to move the entire face without any opposition.

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“There’s no counter tension to that. And that’s a very important point, because if you were try to lift the face while those ligaments are attached, what you end up feeling is resistance, and what ends up happening is there’s counter-tension like a rubber band that starts to defy the changes you get on the operating table shortly after.”

What is Vertical Restore’s recovery period?

“Two weeks, it’s 10 to 14 days of recovery and the incisions are basically imperceptible once everything is healed.”

Ten to 14 days. Is there a settling period?

Yes. It keeps getting better and better as the weeks and months go on. Most people are ready to get back to work and what not after two weeks, but when we see them in a month, three months, six months, they look better and better as time goes on.

“The healing process after full facial rejuvenation, especially when combined with laser resurfacing looks a bit rough no doubt but it’s definitely worth the results. I have been showing Carolann’s (age 53), our operating room nurse, journey over the last several post (check out the previous posts on the feed). This shows her at different stages of healing and the progress that comes with time. The fact is there is no easy way to get results like these. The changes need to surgical and with it comes healing. But the end result, when using the right techniques, is you get a long lasting, massive improvement that is totally natural looking and doesn’t require constant touch ups. There are no short cuts 😊. But man… look at the difference at 2 months. She is so happy and so am I! To achieve these beautiful results, I performed a #verticalrestore to address her facial shape and neck laxity. An #upper and #lower #eyelid #blepharoplasty to address the puffiness under her eyes and excess upper and lower eyelid skin. A fat transfer to restore volume throughout her eyes and face. Finally, a deep laser resurfacing to remove fine lines and brighten the skin. All of this is the magic of full facial rejuvenation using the right combination of procedures.” – Dr. Amir Karam

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What anesthesia is Vertical Restore done under?

It’s done under local anesthesia and IV Sedation, not general anesthesia. I would say 90-plus percent of surgeons do these procedures under general anesthesia. But it’s not necessarily the technique of Vertical Restore that allows it to be done under IV Sedation, it’s more that I have done and it doesn’t take me forever to do it and I have it down so it’s a comfortable thing for people to have under IV Sedation. People love it that way.

How much does Vertical Restore cost?

As the extent of work to be done for Vertical Restore depends on a patient’s facial anatomy, accurate pricing is available only in a personal consultation. To help put a potential price in perspective, a popular facial plastic surgeon in New Jersey says, “patients should expect to pay approximately $8 – $10,000 for a full facelift.” As Vertical Restore is more than a “mere facelift,” patients can expect to pay a premium a bit higher than that.

“Post 3 of Dawn’s facial rejuvenation journey. Have a look at the previous 2 posts on my feed. Keeping it real to show you the progress during the healing process over the first month. At 57, she had a #verticalrestore to address the presence of jowls and neck laxity and an #upperliplift to shorten the elongated upper lip that happens with age. Keep in mind she had a #fattransfer and lower eyelid skin pinch with me 10 years ago. Let me know if this something you’d like to see more of and if it’s helpful…. I can make a more detailed post of the process. Bottom line is that everyone heals a little differently… but because these cases are done under local anesthesia with IV sedation the recovery is easier… coupled with the fact we we prep patients ahead of surgery with herbs and vitamins and because I do this everyday bruising and swelling is very minimal. General recovery is 2 weeks. Doesn’t she look amazing 😍🔥. Let me know what you think! Also send this along to your friends and family to help them see what’s possible. The Vertical Restore… isn’t your traditional facelift.. natural looking 💯of the time. #spreadthegoodword #lookasyoungasyoufeel” – Dr. Amir Karam


Is Vertical Restore covered by insurance?

Elective cosmetic surgeries, as opposed to medically necessary ones, are never covered by medical insurance.

What sets Vertical Restore apart from a traditional facelift?

Vertical Restore is a unique procedure. It’s vaguely related to the facelift in that both operate on the same canvas, but beyond that, there are probably more differences between the two than there are similarities.

Where the traditional facelift tugs facial tissue backward, Vertical Restore lifts it at about a 60 degree angle upward. It ends up looking a lot more natural, not to mention that it makes a lot more sense that if gravity is pulling your skin downward, it should be restored vertically.

Yet another important distinction is that Vertical Restore doesn’t just treat the surface of the problem. It also releases and repositions the ligaments that were holding everything out of place to begin with. They’re returned to where they were when you were younger and probably liked the way you looked a lot more. That looks great and lasts a lot longer.

And the third aspect of it is that it is comprehensive and it’s balanced, meaning that all four areas are being treated at once. So it’s basically like having four individual procedures being done together and they’re never separated because the face doesn’t age in segments, it ages together. And by bringing it all together, you end up also compounding the fact that you’re going to have a very, very natural outcome which is so important to all of these procedures.

“6 weeks out and it’s hard to imagine Heather is actually in her 50s 🙌🏼. More like 20s or 30s, right? I absolutely love how these comprehensive facial rejuvenation cases come together. Their purpose is to address every aspect of the aging face simultaneously so the overall look appears balanced and seamless. In addition to the right techniques and experience, that is also a key for a natural-looking result. In Heather’s case, I addressed the excess skin around her eyes with lower eyelid skin pinch and upper #eyelid #blepharoplasty. I didn’t touch the muscle or remove fat. This approach makes sure the shape of the eyes don’t change.. which is key. Next, I performed a #fattransfer to restore all her lost volume. I performed a #verticalrestore to reposition all her loose tissue effecting her outer eyebrow, mid face, jawline and neck. Those aging changes really make someone look older and different than they use to. That’s what bothers people. If you look closely… she really has the jawline and neck of a 20 year old. Finally, I performed a lip lift to help restore a beautiful and youthful mouth. She looks AMAZING and I am so happy for her. She is so sweet to share her results and story. We posted her 1 week and 2 week photos earlier so go check them out to see the progress.” – Dr. Amir Karam

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Vertical Restore tackles what common cosmetic concerns?

“As everyone ages, the fascia—which is effectively the net that holds the whole face up—starts to loosen up. And when the facia loosens up, what ends up occurring is you get downward drift of the tissues of the lateral brow and temple region, and the midface, the jawline, and the neck.

“So what ends up happening, in layman’s terms, is these are all drifting down. So what you end up getting is you get hooding, you get heaviness around the outer parts of the upper eyes, and the nasal-labial folds get deeper and the midface sags, and then you get jowls, and then you get sagging and all the variations of neck looseness that occur. So that’s happening to everyone.

“And what typically happens is patients will go in and they’ll have a facelift, or they’ll have a neck lift, or they’ll have a mid-face lift, or brow lift or whatever the thing is, a lot of times in isolation. So they’re looking at the problem in a very direct way. They’re saying, ‘Okay you have jawline looseness so we’re going to have to fix that with a facelift,’ but they don’t necessarily always do the neck, or they definitely don’t do the midface, and rarely do they do the outer brow. And so what ends up happening is you’re treating parts of this continuum in, in my opinion, a very sort of illogical way, since all of it is technically one unit and so it should all come up together.

“So the four areas are: the outerbrow, mid face, jawline, and neck. And what we’re doing is basically lumping them into one anatomic unit and treating them together in every single case, so that there’s harmony and balance and a very natural look.

“Because one of the things that makes people look unnatural is technique obviously. The standard face lift pulls you sideways. We go vertical. But the other thing is omitting these other components, because in a naturally aging face or a naturally young face, it’s all or nothing. It’s either you’re all drifting down or, when you’re younger, they’re all up. You don’t have a blend between these different things.

“So the distinction between this and a traditional facelift I think is an important one to make, and it’s basically two things, one is that facelifts historically are horizontal procedures, they pull the face horizontally. This is vertical, and again, this is all-inclusive of all these different elements.”

Who would be a good candidate for Vertical Restore?

The ideal candidate for Vertical Restore is someone who starts to notice that the jawline and neck, their mid face and brow have started to descend downward. You can’t miss it, Karam says, because suddenly you no longer look like you. “The jaw becomes more square, the face becomes longer. You start to become a little heavier in the middle of the face and the eyes start to get a little more crowded.”

Vertical Restore leaves you looking good. Young. Alive. Attractive. Your jawline will smooth out and have better definition, with greatly improved contour in the neck and face, and the midface will be back up over the cheeks where it belongs. And a slight lift to the eyebrows will also give you a more refreshed look.

Karam’s office has put together an extensive ebook on Vertical Restore which you can download here.

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References & Resources:

1. U.S. beauty industry revenue 2002 - 2020, 24 Nov 2020, Statista 
2. Plastic Surgery Statistics Report 2019, ASPS
3. Registration Certificate, Vertical Restore, USPTO
4. Trademark Class 44: Healthcare, Beauty, and Agricultural Services, Tingen & Williams
5. United States Demographic Statistics, Infoplease
6. What percentage of facelifts need a revision?, 11 Jan 2020, RealSelf
7. Cosmetic Industry, last edited 15 January 2021, at 21:10. Wikipedia
8. Older Adults Keep Pace on Tech Usage, January 2020, AARP Research
9. Karam Vertical Restore Response Book_Rev, Dr. Karam

James Anthony

James Anthony has written on self-improvement for 22 years, with his work appearing in five national magazines and on the websites of more than 100 U.S. Drs, MDs, and board-certified surgeons.