48 year old who presented with complaints of a tired appearance and fullness over the lower eyelids. Exam showed excess skin over the upper eyelids and a prominent tear trough with lower lid fullness worse on the left side. Patient is shown before surgery and six months after upper and lower blepharoplasty. Note that the excess skin over the upper eyelid is removed and she has restoration of eye shadow space in the after photos. Also note that the tear trough is not as prominent and the excess fat/fullness over the lower lid has been corrected. The lower blepharoplasty was done through the inside of the lower lid (trans conjunctival) without any skin incisions. The excess fat was not removed but moved into the cheek to produce a smooth blending of the cheek and lower eyelid.