This is a 52-year-old, female, San Francisco, California resident who presented to the San Francisco office at Union Square for evaluation for a facelift procedure. She underwent a facelift and a lower lid eyelid lift. She had a SMAS plication, which is tightening of the deep layer of the face with an overlapping suturing technique for more fullness and higher cheek fullness and tightening of the neck region. The lower lid eyelid lift was performed through an external incision with tightening of the underlining muscle. The lateral portion of her eyelids was tightened as well. The surgical procedure was performed at Marin Cosmetic Surgery Center in Marin County, California. Note the fullness in her cheeks from the SMAS plication and rotation of the SMAS.