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.On May 24, 2011, The Roots performed a freestyle song about her during her appearance on Late Night with Jimmy Fallon.
Fakih was born in Srifa, a small city in the Jabal Amel region of Southern Lebanon, to a Shi'a Muslim family.
During and after the Miss USA pageant, Fakih's religious and ethnic identity became the subject of widespread discussion.
On the subject of identity, she was quoted as saying "I'd like to say I'm American first, and I am an Arab-American, I am Lebanese-American, and I am Muslim-American." but some Muslims felt she did not properly represent their religion. Responding to the issue in interviews, Fakih said she and her family are Muslims and respect the religion, but they may not be as strict as many people and do not define themselves by their religion; they view themselves as more "spiritual" than "religious" and appreciate all religions.
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, 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.