This 49 year old woman came to Minneapolis Plastic Surgery for facial rejuvenation. Her lateral upper eyelids appeared droopy, but lower brow position was the culprit. She also had loose skin and “dark circles” in her lower eyelids. Her cheeks exhibited loose skin, early jowl formation, and deepening of the folds beside her nose and at the corners of her mouth. With loose neck skin, this all contributed to an “exhausted” look despite her excellent health and energy. She underwent SMAS facelift, necklift, forehead lift, and lower eyelid surgery in our AAAASF-accredited on-site surgical facility. Her TIVA general anesthesia allowed rapid wake-up with no post-op nausea or vomiting, and after an hour in the recovery room, she was sipping a soda, up to the bathroom, and dressed for home. She continued to do well and her final sutures and scalp staples were removed on post-op day 10. Her after photos are at 3 months from surgery.