In this brief video, Dr. Zelken highlights the techniques and decision-making steps in a wide awake plastic surgery operation. A 77-year-old man seeks steps to enhance his appearance without changing his identity, as most men do. He is on blood thinners and requires meticulous control of bleeding vessels and was kept awake and conscious throughout. A direct browlift and previous Botox addressed his hyperdynamic forehead while upper and lower eyelid surgery (blepharoplasty) corrected and improved his lower eyelid laxity. A skin cancer was excised for margin control on his right cheek and the entire field was treated with a CO2 laser peel to enhance his pigmentation and further tighten his skin. The before and after photos were taken 3 months apart.