• What is a SOOF Lift? 

• Are You a Candidate For a SOOF Lift?

• What To Expect At Your Consultation 

• Preparing For Your Surgery

• How a SOOF Lift Is Performed

• The Road To Recovery

• Risks & Complications Of a SOOF Lift

• The Least You Need To Know 

• Frequently Asked Questions About SOOF Lift

• Related Links

• References 

• Talk To Real Patients on Our Message Board

As we age, the Orbicularis oculi, the muscles around the eyes, and its surrounding fat and fascia start sagging and can make us look, tired, haggard and sometimes even angry.  The orbit becomes hollow-looking and your tear troughs become apparent, resulting in a worn look. The SOOF lift may be able to help you cosmetically but is a great procedure to help correct functional disorders, as well.  Fat repositioning sure has its benefits and advantages, as for rejuvenation purposes it can sometimes be safer to resuspend fatty tissue to rejuvenate the midface and undereye area.  

What Is a SOOF Lift?
 This surgery is meant to reposition the fat pad rather than remove it such as is practiced with a standard lower blepharoplasty including fat removal.  However, it is common to have lower blepharoplasty which may require only skin excision.  Just remember that the SOOF lift is a newer procedure and may not be offered in all surgeon's offices.  Please discuss this procedure fully and determine your surgeon's expertise before committing to a surgery as there are inherent risks which go along with this procedure.

This procedure can also be performed for the below reasons as well for cosmetic.  The definitions for some terms may not be familiar so they have been provided in blue for your convenience.

• after involutional ectropion: [: an abnormal turning out of a part (as an eyelid) due to bodily changes after menopause]

• ciatricial ectropion

• 7th nerve palsy (aka Facial Nerve palsy or Bell's palsy): a disorder where the eye muscle can not blink or close the eyelid.  Usually persons with these disorders cannot produce enough tears to lubricate the eye properly due to the inability to blink or close the lids.  So, artificial lubricant drops are used during the day and a thicker, ointment used at night.

• traumatic lid retraction: retraction of the eyelid due to blunt force or sharp, physical trauma.

• Congenital lid retraction: Can be caused from several acquired factors...

  • thyroid eye disease

  • secondary to contra-lateral [: occurring on or acting in conjunction with a part on the opposite side of the body] ptosis (due to increased neuromuscular stimulation to the ptotic [sagging] eye.

  • iatrogenic [: induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures] from overzealous ptosis [sag] operation.

  • neurogenic (from lesions in the upper dorsal midbrain, Collier's signs and can occurs with Parinaud's syndrome [: paralysis of the upward movements of the two eyes that is associated esp. with a lesion or compression of the superior colliculi of the midbrain])

  • myogenic [1 : originating in muscle] dysfunction

  • other (where lid retraction occurs in other direction of gaze but not in primary position)

• post blepharoplasty: see the Blepharoplasty Page for more info. [: plastic surgery on an eyelid esp. to remove fatty or excess tissue ]

• reconstruction after lower lid excision

cosmetic uses:

• malar festoons: excess skin and Orbicularis resting on the upper malar region

• tear trough deformity: the palpability and appearance of the prominent inner-under eye area due to lack of fat or ptotic (sagging) fat.

• infraorbital dark circles: dark circles [: situated beneath the orbit] due to fat loss or sag.

• prominent nasolabial folds: The folds or deep grooves [: of, relating to, located between, or occurring between the nose and the lips]

cosmetic uses:

• malar festoons: excess skin and Orbicularis resting on the upper malar region

• tear trough deformity: the palpability and appearance of the prominent inner-under eye area due to lack of fat or ptotic [:sagging] fat.

• infraorbital dark circles: dark circles [: situated beneath the orbit] due to fat loss or sag.

• prominent nasolabial folds: The folds or deep grooves [: of, relating to, located between, or occurring between the nose and the lips]

It is worth mentioning that some surgeons consider a SOOF lift a cheek pad lift, or midface lift. Teh SOOF is the fatty area right under the eye.

Understanding the Structure of the Eye 
In standard Blepharoplasty procedures, the fat pads and atrophied muscle are removed.  With SOOF lift it is repositioned instead.  An aggressive approach can cause complications such as ectropion, entropion, unusual eye roundness, hollowness and more, in some patients.

The many reasons for an improper functioning eye post-op Standard Blepharoplasty -- or even cosmetic deficiencies -- result from too much tissue (be it fat, muscle, skin) being removed.

"The orbital septum, which lies deep to the Orbicularis, is a key structure and landmark in blepharoplasty. The septum is a thin sheet of fibrous tissue that originates along the superior orbital rim and hangs like a curtain across the lid. It joins the levator aponeurosis by interdigitating fibers at the upper edge of the tarsal plate. The septum keeps the orbital fat in its posterior position. Weakening of the septum with aging, hereditary predisposition, or trauma may cause protrusion of the orbital fat." 8

Are You a Candidate for SOOF Lift?
First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery.  Communication is crucial in reaching one's goals.  You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are.  Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure.  This is an operation which requires patience and stability in dealing with the healing period.  There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue.  Please consider this before committing to a procedure.

Most individuals seek out Blepharoplasty in their mid thirties.  However, if saggy or fatty under eye bags are hereditary you may wish to go undergo a SOOF Lift or blepharoplasty procedure at an earlier age. 

Also, if you have Hyperthyroidism, or myxedema -- THINK THIS OVER.  No amount of surgery will ever reduce your edema (swelling from fluid retention) of your eye - ever.  If you would like to hear more on this as well as from patients who have had negative outcomes regarding misdiagnosed situations go to our Cosmetic Surgery Message Board and ask outloud.  It could be a matter of your eyes never looking "normal" again.  This is important. Please read the risks, complications and contraindications of a SOOF Lift. 

"Blepharochalasis is a commonly misused term that should be reserved for a rare familial condition characterized by chronic, recurrent edema of the eyelids with subsequent breakdown of the tissues within the eyelids, including the orbital septum. This causes prolapse of the orbital fat, resulting in drooping of the lid. Blepharochalasis is a functional indication for a blepharoplasty. Dermatochalasis means relaxation of skin. It is associated with the aging process and variable amounts of fat herniation and prolapse. This is part of the normal aging process and is not a functional indication unless there is dermatochalasis causing "pseudoptosis" with superior visual field defect. Blepharoptosis, or the drooping eyelid is caused by a malfunction of the levator muscles. Levator function is measured by blocking the action of the frontalis muscle and measuring the excursion of the eyelid from downgaze to upgaze. Levator excursion from 15-18 mm is considered normal and 10-14 mm is good function." 8

What to Expect at Your Consultation
After checking a few surgeons' backgrounds and credentials, you will make an appointment for a consultation.  You will meet with these surgeons and discuss your goals and you will disclose all information regarding your health.  These surgeons should ask for your complete medical history.  It is advisable to go over any medical records to refresh your memory prior to your meeting with the surgeon.  The surgeon should ask but if he does not, be sure to disclose any allergies that you may have, disorders, past illnesses and if you are a smoker.  Be sure to advise him of the medications, if any, you are taking. T his includes vitamins, herbal supplements, over the counter medications, etc. You should not take any aspirin containing products at least 2 weeks prior to any surgery.  See Medication & Supplement List for an extensive, but partial, list of medications to avoid before surgery. If you are taking any of the listed medications advise your surgeon and anesthesiologist so that they can take note of it or have you cease consuming them. 

You will then discuss your complaints and concerns. Your surgeon will explain the technique and incision placements or methods that may be most appropriate for you and should discuss the risks associated with SOOF lift with you, as well. 

You will also discuss the available anesthesia that will be used for your procedure.  Most SOOF lift procedures are performed under Light Sleep Sedation or General Sedation.  Either way, discuss this beforehand as many people are not aware of the risks of Anesthesia.  If you do go under Deep General, ascertain that the anesthesiologist is certified.  Please read the All About Anesthesia Page -- the risks regarding anesthesia should be considered for a fully informed choice. 

You will discuss where the surgery will be performed as well as after care and post-operative visits. Discuss with your surgeon your vision problems, if any and tell him if you wear contacts or glasses.  He will discuss with you all of the aspects of surgery and if you will have blepharoplasty as well, if you should need all 4 or just the upper or lower eyelids only operated on with your SOOF Lift. *You will also be taught how to clean your eyes post-operatively at your pre-operative visit.

He should advise if he feels as if you have excess fat, skin or even atrophied muscle that needs to be removed (blepharoplasty). You will discuss the incision placement, the realistic expectations you should have and what other options you may have instead of surgery. 

You will also discuss fees, medication costs and any hidden costs that may arise.  If your eyelids interfere with your vision, you may be able to get your insurance to cover the blepharoplasty portion of the operation.

If you would like more information on Consultations or a list of questions to ask your surgeon please visit the Consultation Help Page.  If you should choose to book or reserve a surgery date you will usually give a deposit to hold your surgery date.  Most times if you cancel a few days beforehand, this amount is non-refundable.  After paying your deposit and scheduling a surgery date, you will also schedule a pre-operative appointment...

Your Preoperative Appointment
This appointment addresses more questions you may not have thought to ask at the initial consultation, such as more surgical details, concerns and even ascertaining that your surgeon is aware of what you desire from your procedure.  Just as your surgeon will make certain that you know what it realistically possible from this procedure.

You will also discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the months ahead. You will be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs and perhaps a box or directions for gaining a box of Arnica montana.  Would like to know more on the benefits of Arnica montana?  Perhaps you will be instructed to obtain Bromelain or other types of remedies, although many surgeons would rather have you not take ANYTHING other than your prescription medications, please do not go against your surgeon's wishes. Remember, always ask your doctor before taking any of these products. 

Please do not hesitate to address any concerns that you may have during this time and even after your pre-operative appointment. If you remember something when you get home or the next day or even the day of surgery -- don't be afraid to ask. 

Preparing for Your Surgery
You should be given a pre-operative information packet that explains everything you should do and know before your surgery date.  The packet should include a list of all the medications you should not take starting usually at 2 weeks before your surgery.  These medications will include, but are not limited to, aspirin containing products, stimulants, seratonin supplements, etc.  Would you like to view a typical Medication & Supplements List?  We have a printer-friendly version as well.  Also, if your surgeon advised that you may take Arnica montana, Bromelain, etc. for swelling and bruising you should either have this in your packet or begin shopping for your necessities.

It is quite possible that you will have preliminary blood work performed. This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count (complete blood count or CBC) to alert your surgeon to disease or disorders beforehand.  If you are a female they may take an extra vial for a pregnancy test.  Some surgeons ask that you have physical.  This can be yet another out of pocket expense so ask at your consultation what will be needed when you are quoted a price.

So many things to do... so little time.  Surgery will be here before you know it so visit the Preparing For Surgery page and relax.  This section contains, printer-friendly pre-op lists, tips and advice as well as things you must do to prepare for your big day.

How This Procedure Is Performed
A SOOF Lift normally takes from 1 to 3 hours to perform.  If you are having upper blepharoplasty as well the surgery will last closer to 3 hours. If this is the case, the upper Blepharoplasty will more than likely be performed first. Larger amounts of skin are excised for upper Blepharoplasty and the swelling is more intense than with the lower lids. The exception is when unusually large bags are present.

You will then be marked with a magic marker type pen for the placement areas. You will then be scrubbed with Betadine although the surgical marker markings will remain -- although not as dark. However, some surgeons scrub beforehand and then mark the skin. You will be injected with a solution of Lidocaine, epinephrine and saline.  The epinephrine is a vasoconstrictor. This will impede  your skin's ability to bleed excessively. The incisions will follow along the natural lines and creases of the upper and lower eyelids. All efforts possible should be made in order to achieve inconspicuous scars. Although, the incisions may extend into the crow's feet area (aka smile lines) at the outer corners of your eyes. 

There are two SOOF lift techniques that are usually performed. The definitions for some terms may not be familiar so they have been provided in purple for your convenience.

The External Approach with a visible scar:

1. A lateral canthal incision of 1-2 cm is made. Which means an incision at the outer corners of the eye where the two lids meet.
2. Lateral Canthotomy and Inferior Cantholysis
3. Lateral Canthopexy
4. create pocket superiorly [: in or to a more superior position or direction] to expose deep temporal fascia and periosteum [: the membrane of connective tissue that closely invests all bones except at the articular surfaces] over the lateral orbital rim.
5. The skin is then dissected [separated from the underlying structure] at a lateral aspect incision, extended 2-3 cm inferiorly to create a flap [: a piece of tissue partly severed from its place of origin for use in surgical grafting] of malar [cheek or zygomatic] fat, SMAS [Superficial (or Sub-) muscular Aponeurotic System], Orbicularis oculi [muscle around he eye] and SOOF [the sub-Orbicularis oculi fat pad]
6. With forceps the SOOF is grasped and two braided permanent sutures are threaded through the flap and anchored to the deep fascia [the thick white muscle covering] of the temporal area [: of or relating to the temples or the sides of the skull behind the orbits] and periosteum.
7. The excess skin is then excised [removed]
8. The suture lines are then closed


The Transconjunctival, or through the conjunctiva [: the mucous membrane that lines the inner surface of the eyelids and is continued over the forepart of the eyeball] approach:

1. the incision/permanent suture is made subperiosteal [: situated or occurring beneath the periosteum, or : the membrane of connective tissue that closely invests all bones except at the articular surfaces]  and the above techniques are applied, the only difference is the incision placement. The Transconjunctival technique leaves no visible scar.

After the surgery is completed, the surgeon will lubricate your eyes with an ointment and perhaps apply a pressure dressing. Your eyelids will feel tight and quite tender as the anesthesia wears off. Your prescribed medication should alleviate this pain and discomfort. However, if you believe your pain to be out of the ordinary, call your surgeon or the staff on call immediately. You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.

The Road to Recovery 
You may be groggy from the anesthetic and/or oral medications and probably won't remember much of the first day or two. You will have to take it easy and sleep on two pillows to keep your head elevated for 7-14 days - or however long your surgeon suggests. When you wake up you will notice that your eyes will look even more swollen in the first 3 days. But, as the days go on the swelling will dissipate. There may be bruising, but this will go away, as well. So make a mental note of this or you may be shocked into a depression. Bruising and swelling are a normal occurrence in most surgeries.

Your will be instructed to keep your head elevated for several days. Two to three medium-filled pillows should do the trick. Take your temperature regularly. An elevated Temperature could mean an infection. Take those antibiotics ON TIME. And don't forget if you are taking birth control that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well. You should also use cold compresses to keep swelling and bruising to a minimum. Some surgeons may recommend the Swedish Therapy Gel Eye Mask or the BioDermis HydroGOLD™ eye mask because it is incredibly comfortable and stays cool, without being "wet",  for long periods of time.  

The amount of bruising varies with the individual.  It will be at its worst during the first week. You may not swell and bruise too much directly after the surgery, but the next day and especially the third, you may feel as if the swelling and bruising is rather extreme. You will begin cleaning your eye area as shown at the pre-operative visit.  Your surgeon may recommend using eye drops or oculo-wetting solution to help with lubricating your eyes. It is quite possible that your tear glands will not be able to produce enough tears to lubricate your eyes properly for the first few days or even weeks. Although quite the opposite is possible as in excessive tearing.  You may also experience light sensitivity and blurred or double vision. You may be instructed to wear a special hard mask over your eyes while sleeping. This type of mask is also utilized for post-operative care of LASER vision correction (LASIK) patients. This mask prohibits the patient from accidentally applying pressure or rubbing the eyes while at rest.

Your sutures will be removed after 2 - 5 days, more than likely 3 days. You swelling will begin to subside at the end of the week although it is known to remain for 3 weeks. You will instructed to not wear contacts (if your vision requires it). And even after the allotted time your contacts may give you discomfort while wearing them. You may still experience hyper-lacrimation (excessive tearing) or hypo-lacrimation (excessive dryness from lack of tears) of the eyes. This should return to normal within a  few weeks and may be more of n aggravation than anything.

Most patients return to work in a 7 to 10 days. You should limit your sun exposure as your eyes will be sensitive to it as well as your incision sites; sun block should be used on the eye area. Make sure that the sun block is safe for eyes and will not irritate them.

Avoid too much movement for the first few days (about 5). And even if you are feeling better, you should take it easy while you are recovering. Do not participate is strenuous activates for at least 3 weeks. And definitely NO CONTACT SPORTS. Your bruising will subside within a few weeks and after your surgeon gives you the "go ahead" you may begin wearing cosmetics to hide residual bruising.

Risks & Complications of SOOF Lift
Please read these risks completely:

The minor complications that are associated  with SOOF Lift include double or blurry vision for a few days, temporary swelling at the corners of the eyelids, and milia (or tiny whiteheads) that can be removed by your surgeon by pricking them with a micro-needle. It is possible to develop asymmetry during healing or excessive scarring if you are prone to such a thing.

It is possible that you may experience difficulty in closing your eyes when sleeping. In rare instances this condition may be permanent. Also there is the rare possibility of ectropion. Ectropion is a condition where your lower lids are pull down or gape.  If you should develop ectropion, further surgery will more than likely be needed to correct it. Which could lead to more risks and more cost to you, the patient. Ascertain whether or not, if you should develop ectropion, your surgeon's fees will be waved.

If you have thyroid problems (hypothyroidism or Graves' disease) dry eyes or insufficient tearing, circulatory disorders or high blood pressure, having a SOOF lift may be more risky for you than an otherwise "healthy" individual who does not have such disorders. Grave’s disease is frequently associated with severe swelling of the periorbital tissues. This swelling may be misdiagnosed as excess under-eye fat pads.  If you are myxedematous* (in a severe state of hypothyroidism) you may have severe edema, or fluid retention, especially in the eye area;  is a common symptom of hypothyroidism.  The fluid filled tissue areas are often misdiagnosed as excessive fat in the eye area and when removed can lead to disastrous results. As your edema subsides and your fluid levels level out, after removal the eye area will look very sunken in. Ascertain that your surgeon establishes whether or not your eye "bags" are caused by fat or chronic edema prior to your SOOF lift.  Edema will not be corrected by surgery - ever. 

"A review of the past medical history is also important to reveal any contraindications or underlying illnesses that may affect the surgery. The surgeon should always be aware of the possibility of thyroid disease manifesting as orbital disease. Graves' ophthalmopathy can cause globe protrusion, eyelid retraction and symptoms of dry eyes, while hypothyroidism may produce myxedema, which the patient and surgeon may misdiagnose as protruding orbital fat. Previous facial palsy may result in persistent weakness of the periorbital musculature, which may lead to inadequate corneal lubrication and corneal desiccation or ulceration. Allergy may cause intermittent swelling and dermatitis of the eyelid skin and recurrent periorbital edema. Chronic renal disease and diabetes may affect wound healing and increase the risk of infection."  8

Other disorders that may increase your risks are myasthenia gravis, cardiovascular disease, diabetes, a detached retina or glaucoma (and other high pressures of the eye), poor circulation and poor elasticity. Please disclose all disorders or concerns with your plastic surgeon - you're health and well-being might depend on it. 

Sometimes the eye area will not heal correctly and you just may have to have an additional surgery to correct it. The surgeon may or may not charge any additional fees if another surgery is necessary.

Even though the SOOF lift may be sought to re-suspend or re-position the fat pads instead of removing them partially, or entirely. Some patients do need fat removal.

*myxedematous: severe hypothyroidism characterized by firm inelastic edema, dry skin and hair, and loss of mental and physical vigor. (Merriam-Webster dictionary)

The Average Prices of SOOF Lift
Although costs may vary from region to region and depending upon the physician, the average prices:  $2,000. - $5,000. US.  These prices may not include medications, post-operative supplies or O.R. and anesthesia fees.

The Least You Need To Know

• What: The SOOF lift is a procedure to lift the Sub-orbicularis oculi Fat and/or cheek fat pad

• Why: This surgery is meant to reposition the SOOF and cheek pad.  Some surgeons may consider this lift to involve lifting only the SOOF, others both the SOOF and cheek fat pad.  Be sure you find out ahead a time.

• When: from late 20's to 70's, usually.

• Who: Research your doctor very well!  He should help you decide which technique would be best for you and discuss this openly. 

• Where: Accredited Surgical suite or hospital

• Risks: READ THEM!

• incisions/scars: in the outer area where the lids meet or inside the lower lid.

• Anesthesia: IV Sedation (Light Sleep) or General. Read All About Anesthesia

• Duration:  1-3 hours

• Pain Factor: mild, pain meds should alleviate any discomfort. If not, call your surgeon immediately!

• Swelling: Moderate -- Medium; depending upon individual; I suggest arnica montana and bromelain.

• Bruising: Moderate -- Medium; depending upon individual; I suggest arnica montana and bromelain.

• Post-operative instructions: Have someone there to help care for you during your recovery, keep elevated -- even when sleeping.  A recliner works best. Cold compresses for first 48 hours are suggested. As well as cleansing of the eyes after your pre-operative visit. You shouldn't try to read or watch television -- at least for long periods of time --  for up to three days post-operatively.  And do NOT wear your contacts, if you wear them, for at least 2 weeks post-operatively.  Try not to rub your eyes  in the weeks following your surgery.  This action could further irritate your eyes.  Some surgeons offer a metal or hard plastic face mask (coated with a soft material) to keep wandering hands and fingers away during healing times. Patients having undergone Lasik are familiar with these face masks.

• 1st Post-op visit: day 2 to 5 (more than likely day 3) for suture removal

• Return to work:  7 to 10 days

• Activity: No exercise until at least 3 weeks post-operative. Be careful not to raise your blood pressure for several weeks, you don't want to inhibit proper healing or get an infection. You should remain inactive for 3 to 5 days. Check with your surgeon!

• Sun exposure: UV light may cause hyperpigmentation in some patients around the incision lines. 

• End result: The swelling and proper positioning of the eyelids post-op may take several months. 

• Loss of Sensitivity: It is possible to lose sensation along the incision lines.  Long term or permanent loss of sensitivity is possible. 

• Anything else? Possible eyebrow and eyelash loss from medications.  Possible asymmetry as well. Possibility of hypertrophic scarring that some patients get Erbium laser treatments to abate.

• Longevity: the skin is still subject to aging, especially with photo-aging. You may wish to seek Erbium or CO2 laser for wrinkles, or even NLite.

• But Wait! There's More! Research as much as you can on the subject.  Disclose all your medical background. If you are a smoker, if you are taking medications, or if you have any other medical concerns. Have realistic expectations about your results.  If you are 50 years of age and you choose to undergo Blepharoplasty, the procedure will not give you the eyes of 20 year old. Besides this look would not suit your face and appear done.  NO plastic surgeon can perform miracles, he can only try and improve upon what you have beforehand.

• The average prices for a SOOF Lift  both lower lids, $2,000. - $5,000.;  

Related Links   
EyeRepairs.com - Plastic Surgery and Reconstructive Surgery for the Eye and Orbit. 
Emedicine - Eyelid Surgery 
Meronk - Eyelid and Facial Anatomy in Photos 
Oculoplastic Photo Gallery AMAZING!

References
Hamara ST. The Role of Orbital Fat Preservation in Aesthetic Surgery. Clinics of Plastic Surgery; 23(1) 17-28. 1996
Hamara ST. The Aging face: Analysis Surgical Approach and Result Assessment: Aesthetic Surgery Quarterly 16(1), 65-74
Hoenig JA, Shorr N, Shorr J, The Sub-orbicularis Oculi Fat In Aesthetic and Reconstructive Surgery; International Ophthalmology Clinics; 37(3): 179-191. 1997
McCord, CD et al. Re-draping the Inferior Orbicularis Arc. Plastics and Reconstructive Surgery; 102(7): 247 1-9. 1998
M. Sean Freeman, MD, Trans-conjunctival Sub-Orbicularis Oculi Fat (SOOF) Pad Lift Blepharoplasty: A New Technique for the Effacement of Naso-jugal Deformity
Goldberg, Robert Alan; MD, FACS "SOOF Lift Helps Rehab Eyelid Complex Fat Relocation Rather Than Removal Is The Name Of The Game In Today’s Lower Lid Blepharoplasty"  *R. Goldberg  can be reached at the Jules Stein Eye Institute, 100 Stein Plaza, Los Angeles, CA 90095-7006; (310) 206-8250; fax: (310) 825-9263.
Ophthalmics Direct, Differential Diagnosis of Common Physical Signs in the Eyelids
8 Greenberg, Jayson, M.D.; Baylor College of Medicine. The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences. Blepharoplasty February 4, 1999
Merriam-Webster Medical Dictionary

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