If I have V-line surgery, do I 'need' to have zygoma reduction along with it?

Manuka,I do v-line surgery more often than anyone that I am aware of worldwide, as we do this several times each week.  You do not need to have zygoma reduction with it.  The skin will sag, of course, as you age, but it should not sag abnormally.  Having an overall saggy face is more likely with zygoma reduction than without it.You won't need to look puffy so long as as everything is done in a normal balanced fashion.  Best of luck!

If, currently, your cheekbone is the most protruded part of the face, then doing a v-line surgery and reducing the lower face too much could end up making your cheekbone relative appears more protruded. The most important thing about doing facial contouring surgery is considering the overall balance of the face. As a result, if the cheekbone is the widest and the most protruding part of your face, then you might need to consider having the cheekbone reduction as well.

I would suggest that you get V-Line jaw surgery first and then see what you think. There is no way any doctor can predict how the patient will interpret their facial aesthetics until they 'wear it for awhile'. Never do a procedure unless you are completely convinced it is needed, particularly a companion or secondary procedure to the primary one.