V3 midface lifting through a subciliary approach: a three-vector physiologic repositioning technique for midface rejuvenation, lower eyelid support, and lower lid-malar contour improvement

Overview

The authors describe the "V3 midface lift," a technique performed through the same subciliary incision used for lower eyelid surgery, aimed at midface sagging, under-eye bags and a poor lid-cheek contour. It combines an extended subciliary incision, partial release of the orbicularis oculi muscle, conservative fat handling and suspension along three vectors: the medial canthal line, the lateral canthal line and the lower edge of the malar fat pad.

Findings

• 42 patients (38 female, 4 male), mean age 46.2 ± 6.8 years, treated January 2022 to December 2024, reviewed retrospectively.
• Follow-up 12 to 36 months, mean 22.4 months, in all 42 patients.
• Lower lid-malar distance reduced by a mean 3.4 ± 0.8 mm (P < 0.001).
• 92.8% of patients rated "Very Much Improved" or "Much Improved" on the Global Aesthetic Improvement Scale at 12 months.
• Complications: transient chemosis in 3 patients (7.1%), minor prolonged edema in 2 patients (4.8%), both resolved without further treatment.
• No permanent ectropion, hematoma or facial nerve injury.

What it means for a patient

• This technique treats sagging midface, under-eye bags and the lid-cheek contour through a lower eyelid incision, rather than a separate midface incision.
• In this group, over 9 in 10 patients rated their result as much or very much improved a year later.
• Complications were limited to temporary eye redness or swelling in a small number of patients; no permanent lid pulling down or nerve damage was reported.
• This is a retrospective review of one surgeon's or center's consecutive cases, not a comparison against other midface lift techniques.

Why this paper matters

It reports measured lid-cheek distance improvement and a low, resolving complication rate for a three-vector midface lift done through a subciliary lower eyelid incision.

Terms

• Subciliary incision: an incision just below the lower eyelid lashes.
• Orbicularis oculi: the muscle that closes the eyelids and encircles the eye.
• Malar fat pad: the fat pad over the cheekbone.
• Lower lid-malar distance: the measured distance across the groove between the lower lid and the cheek.
• Chemosis: swelling of the clear membrane covering the white of the eye.
• Global Aesthetic Improvement Scale (GAIS): a standard scale patients or evaluators use to rate cosmetic improvement.