Who gets a nose and eye job in their late 60s or early 70s? It also looks like he has fuller cheeks now.

Mostly older women. My guess is that Joe probably has narcissistic personality disorder, he does check all the boxes for it.

The only thing I can think of with the ear lobes is that he might have gotten cosmetic nose surgery using a ear cartilage graft while at the same time got a face lift, then attached the earlobes to keep the skin pulled back, and then Botox for the cheeks.