42 year old seeking consultation regarding facial again around her eyes. She states the areas she is concerned with and wants addressed include: her upper and lower lids, the lateral aspects of her eyes, and her nasolabial folds. There is minimal sun/actinic damage. There is volume loss at the upper lid and moderate bulging and tear trough deformity is present bilaterally, creating a hollow and shadowing appearance. She has a very deep upper lid sulcus “nursing home eyes” which would specifically be very helped with fat grafting at the upper lid level. We performed: bilateral lower lid blepharoplasty, with minimal skin resection, minimal superficial fat resection, and fat grafting at the infraorbital rims, supraorbital rims, malar areas, cheeks, and marionette lines. The procedure was performed in-office in our fully accredited (AAAASF) facility under light sedation and local anesthesia. Results shown at 4 months.