This patient in her late 60s, with no prior history of aesthetic procedures, consulted with Dr. Buckingham to address age-related changes in both her lower eyelids and lower face. She was particularly bothered by the tired appearance of lower eyelid bags, dark circles caused by facial volume loss, and increasing jowling and skin laxity along her jawline and neck. Upon physical examination, Dr. Buckingham noted prominent orbital grooves (tear troughs) accompanied by lower eyelid fat prolapse—predominantly in the medial region, with secondary involvement of the central and lateral compartments. Additionally, significant facial volume depletion and lower-face tissue descent were identified. To achieve comprehensive facial balance and a natural rejuvenation, Dr. Buckingham recommended a combined surgical approach: a lower blepharoplasty with facial fat transfer, paired with a lower facelift. The lower facelift was essential to lift sagging deep facial tissues, address jowling, and redefine the jawline and neck contour, ensuring the lower face complemented the refreshed appearance of the eyes. At her 3-month post-operative review, the patient demonstrated remarkable results. The lower facelift beautifully re-established a crisp, youthful jawline and smooth neck contour, seamless with the restored volume in her midface and lower eyelids. The excess lower lid skin and fat bags were eliminated, while fat transfer successfully softened the orbital grooves and restored soft, youthful cheek contours. The overall combination resulted in a harmonious, refreshed, and naturally elegant appearance, and the patient is thrilled with her outcome.
