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

Background: Lower blepharoplasty continues 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 study 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-year-olds. The average measurement for the lower lid length in each group was recorded. Additionally, 318 patients underwent lower eyelid blepharoplasty combined with fat compartments advancement lifting for lid-cheek area rejuvenation from April 2015 to May 2018 were included in this study. The postoperative effect was evaluated based on pre- and postoperative photographs, lower lid length measurements, and three-dimensional facial analyses. Results: The lower lid lengths gradually increased with age, and the greatest increase occurred in the 30- to 39-year-old group. 318 Asian female patients underwent the surgical procedure, with the patients’ age ranging from 35 to 58 years old. Measurements of the lower lid length showed an average reduction of 0.31cm 6 months post-surgery. Three-dimensional facial analysis also indicated that the patient's midcheek volume increased at varying degrees post-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 any kinds of fillers, thus achieving a more youthful appearance of the lower lid and lid-cheek contour in middle-aged women.