One of the most creative procedural plans I have ever had to create and execute - yet for such a simple and common issue: under eye bags and dark circles. This sparkling lady wanted to make her lower eyelids look as good as she feels, but she has a very significant medical issue with dry eyes, which drastically limited our treatment options. Normally, a touch of volume or a laser resurfacing with volume preserving and fat transposition lower blepharoplasty would be the perfect combination to smooth out the junction between her eyelid and cheek while appropriately revolumizing long term with her own fat, and improving the skin quality and texture of her lower eyelids. Her level of dry eyes would tolerate no procedures directly around her eyelids, so we had to get creative and find a different means to achieve that same end! I made a plan to do something I had never heard of or seen before, but was relatively simple and low risk to achieve that result that we were after. All under local anesthesia, I created a distant, tiny access point to access her lower lid fat pads so that I could sculpt and rearrange them to blend with her cheek fat pads. I then utilized very specific, smart laser resurfacing to precisely rejuvenate the most pertinent areas of skin change.