Fakih is widely believed to be the first Lebanese American, the first Arab American and the first Muslim to win the Miss USA title; however, pageant officials have stated their records are not detailed enough to confirm this claim. The first Michigan delegate to win the Miss USA title, Carole Gist, became the first African-American Miss USA in 1990.

In 1993, her parents, Hussein and Nadia Fakih, moved their family to New York in order to escape the effects of the Lebanese Civil War.

In 2003, her family moved to the large Arab-American community in Dearborn, Michigan.

In 2008, Fakih was selected to represent Michigan in the Miss Lebanon Emigrant competition. The event is part of the Miss Lebanon pageant, and is open to young women who are Lebanese or of Lebanese origin, living in countries of the overseas Lebanese community. She placed third in the contest, held August 13 in Batroun, Lebanon, finishing behind Carina El Kaddissi of Brazil and Jessica Kahawaty of Australia.

Fakih won the Miss Michigan USA pageant on September 19, 2009 at the McMorran Place Theater, Port Huron, Michigan. In May 2010 she represented Michigan at the Miss USA 2010 pageant held at the Planet Hollywood Resort and Casino in Las Vegas, Nevada. She won the Miss USA title on May 16, 2010, beating out first runner-up Morgan Woolard of Oklahoma and Samantha Casey of Virginia, breaking a 5-year streak of Southern states winning and becoming the first Miss Michigan USA to win the national title since Kenya Moore in 1993.

As the holder of the Miss USA title, Fakih represented the United States in the 2010 Miss Universe pageant, held at the Mandalay Bay Resort and Casino in Las Vegas on August 23. She failed to place in the semi-finals. This made her the first representative of her country since 2002’s Shauntay Hinton to not place at the pageant.

Fakih appeared as a guest star on the November 29, 2010, edition of WWE Raw, where she crowned Sheamus, the winner of the King of the Ring tournament. In December 2010 at WWE Tribute to the Troops, she served as the ring announcer for the matches. She later competed on WWE Tough Enough on USA and was eliminated in week four.

After her coronation as Miss USA in 2010, Fakih was among the guests at the American Chamber of Commerce conference in Cairo alongside former US President Bill Clinton. She was named the ambassador for The Children’s Cancer Center in Lebanon (CCCL) in February 2020. In January 2010, Fakih received the key to Dearborn which was presented by Mayor John B. O’Reilly Jr.

She is listed number 86 on AskMen.com’s top 99 women 2011 edition. On May 24, 2011, The Roots performed a freestyle song about her during her appearance on Late Night with Jimmy Fallon. She also appears in the movie Real Steel, starring Hugh Jackman, which premiered on October 7, 2011. Fakih revealed that she is receiving wrestling training. In 2015, she participated in Netflix’s The Apartment season 4, where she became the runner-up behind actress/model/jewelry Designer – Xiao Wang.

Due to conflicting schedules with promotional events for Miss USA 2011, Fakih was the only contestant not to appear on the live final episode. In 2012, she participated in Fox’s dating game show The Choice.

In April 2016, Fakih converted to Maronite Christianity, in Bkerké, the see of the Maronite Catholic Patriarchate, northeast of Beirut, before her marriage to Lebanese-Canadian music producer Wassim “Sal” Slaiby also known as Sal. Slaiby manages Canadian artist The Weeknd, who went to Lebanon specifically to commemorate the wedding, which took place in the church of Bkerké, the Maronite Patriarchate, on May 15, 2016. The couple has three children, Rima Jr, Joseph (Sal Jr) and Amira.