I’ve a Ventral Spin (not the Air version) in small, and at first I was surprised as to how high it sits on my head. I have a Smith helmet in Medium, so was a bit hesitant about a Small (54-55cm head) I’ve used it all season now and I’m blown away as to the comfort. Size small does sit a bit lower on my head than it seems to on your head, but I do have to tighten it approximately the same as you described. I’d be a bit wary about having to tighter the ratchet all the way on a medium …
I do wish I had the Air version as I find sweat pools in the forehead area and can drip, but I think a good part of that is to do with my extreme sweat rate and lack of ventilation around glasses.