This 60 year-old gentleman was very unhappy with the appearance of his eyes. He felt that the prominence of his eyes and the excessive bags made him appear very sleepy and tired. On his preoperative examination, his lower lids had gradually loosened throughout his life and lacked structural support to maintain their position. In cases such as this, standard lower eyelid procedures can actually worsen this appearance. During lower blepharoplasty, a tissue support “spacer” graft (i.e. acellular dermal matrix) was utilized to strongly reinforce the lower eyelid position. An endoscopic browlift and upper blepharoplasty were also performed. At 6 months, the lower eyelid maintains perfect position with an substantial improvement of the lower eye bags.