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.

BACKGROUND: Conventional midface rejuvenation through temporal or preauricular incisions often fails to adequately restore the central midface and tear trough vector. We describe the "V3 midface lift"-a transcutaneous subciliary technique utilizing a three-vector physiologic repositioning system to address midface ptosis, lower eyelid bags, and lower lid-malar contour disharmony. METHODS: A consecutive cohort of 42 patients (38 females, 4 males; mean age: 46.2 ± 6.8 years) who underwent the V3 midface lift between January 2022 and December 2024 was retrospectively analyzed. The technique incorporates an extended subciliary incision, selective orbicularis oculi release, conservative septal fat management, and multi-point periosteal/fascial suspension anchored along three specific vectors: the medial canthal line, lateral canthal line, and the inferior boundary of the malar fat pad (adjacent to the melolabial fold). Quantitative outcomes were assessed using pre- and postoperative lower lid-malar distance (LMD), tear trough rating scales, and the Global Aesthetic Improvement Scale (GAIS). RESULTS: All 42 patients completed follow-ups ranging from 12 to 36 months (mean: 22.4 months). Significant reductions in lower lid-malar distance (mean reduction: 3.4 ± 0.8 mm, P < 0.001) and marked smoothing of the tear trough/malar groove were achieved. High patient satisfaction was recorded at 12 months (92.8% rated as "Very Much Improved" or "Much Improved" on GAIS). Postoperative complications were limited to transient chemosis (n = 3, 7.1%) and minor prolonged edema (n = 2, 4.8%), both resolving without secondary intervention. No permanent ectropion, hematoma, or facial nerve injury occurred. CONCLUSIONS: The V3 midface lift provides safe, stable, and durable midface elevation and lower lid-malar continuity through a minimalist subciliary access, representing an efficient option for central facial rejuvenation.