Transconjunctival Lower Blepharoplasty - Septal Suture Repair - Sadove Method risks.

I have bulging fat pads causing lower eye bags, been to see two doctors,both recommend transconjunctival surgery. One doctor takes the additional approach of suturing the orbital septum to the bone to hold the fat in place naturally, which means very little fat removal is needed, and the results are longer lasting, I have not come across this before - he called it the Sadove method, but i was wondering is this more risky than a plain transconjunctival approach vs the perceived benefits ?

Doctor Answers 3

Orbital septum tightening for herniated fat

I have not done the Sadove technique, but I have done many transconjunctival fat removals.  On that  basis I believe that the septal tightening requires more time and dissection as well as adding sutures.  Therefore there is likely to be more swelling, internal scar tissue and thus more complications.  Every operation has its own complications especially when undertaken by someone who has little experience.


Orlando Plastic Surgeon
4.6 out of 5 stars 12 reviews

The procedure of suturing the inferior orbital septum is not generally associated with Dr. Sadove.

It is more accurate to cite Dr. Sam Hamra's name in association with this procedure he called septal reset.  The idea is to retention the orbital septum a layer of connective tissue that extends from the lower eyelid to the orbital rim and fuses to the periosteum.  Behind this layer is orbital fat.  The idea is that if you tighten this layer it hold orbital fat back.  The problem with these procedures is they tether the lower eyelid margin to the bone and contribute to complications.  There is no inherent value in performing a septal reset in my opinion and you most definitely do not want the complications it causes.  I say avoid this approach.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Transconjunctival bleph

Many surgeons use the transconjunctival approach to lower lid surgery.  It is an excellent way to approach the bulging fat pads of the lower lid.  I have not heard of this Sadove technique although there was a septal reset technique done by Dr. Hamra in the past.  Most surgeons would either remove the fat or reposition it.  I like to reposition the fat into the tear trough as it helps to give a very smooth contour with little risk of future hollowing of the lid. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.