Vertical V-Y Advancement Lifting Based on Fat Compartments: A New Approach for Lower Eyelid and Midcheek Rejuvenation.

ABSTRACT

BACKGROUND: Lower blepharoplasty techniques continue to improve over time. With discovery of the numerous fat compartments of the face, surgeons noticed that the appearance of the lower eyelid area through aging could be improved through midface lifting. This article introduces a vertical V-Y advancement lifting technique using the concept of fat compartments for lower lid and midcheek rejuvenation. METHODS: Eighty female patients were categorized into four age groups at 20 patients each from 20 to 59 years old. The average measurement for the lower lid length in each group was recorded. An additional 318 patients who underwent lower eyelid blepharoplasty combined with fat compartments advancement lifting for lid-cheek junction rejuvenation from April of 2015 to May of 2018 were included in this study. The postoperative effect was evaluated based on preoperative and postoperative photographs, lower lid length measurements, and three-dimensional facial analyses. RESULTS: Lower lid lengths gradually increased with age, with the greatest increase occurring in the 30- to 39-year-old group. A total of 318 Asian female patients (age range, 35 to 58 years) underwent the surgical procedure. Measurements of lower lid length showed an average reduction of 0.31 cm 6 months after surgery. Three-dimensional facial analysis indicated that midcheek volume increased at varying degrees after surgery. CONCLUSIONS: Lower eyelid blepharoplasty combined with vertical V-Y advancement lifting makes it possible to restore facial fat compartments. This procedure improves projection in the midcheek without fillers, thus achieving a more youthful appearance of the lower lid and lid-cheek contour in middle-aged women. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.