Background: Eyebrow ptosis and hooding gives the eye a sad, heavy look that often disturbs the visual field. Objective: A direct extended scalpel-shaped brow lift is proposed to correct this functional and aesthetic disfigurement. This manuscript reviews our experience with the presented technique and evaluates the clinical results in the light of ongoing concerns regarding the appearance of the postoperative scar. In addition, the indications and patient selection criteria are elaborated.Methods: An incision was made along the superior border of the brow, extending laterally and downward, often within a "crow's feet" crease. The upper border of the incision joined the 2 extremities of the skin outline of the lower incision in a gentle convex curve. The general outline of the incision resembled the shape of a No. 20 scalpel blade, in which the maximal width is located laterally at the temple "crow's feet" area. Results: Fourteen patients, including 8 males (48-74 yrs of age) and 6 females (67-71 yrs of age) underwent this procedure. The surgical scar was hardly noticeable after 6 to 9 months, and often fell within a preexisting crow's feet crease. Elimination of some of the crow's feet occurred in all the patients. Subjective and objective functional relief with respect to the vision field and the heavy-feeling brow and satisfaction with the aesthetic result were reported by all patients.Conclusions: The most appropriate candidates for the direct extended scalpel-shaped brow lift are patients older than 50 years of age, with eyebrow ptosis accompanied with lateral hooding, well developed crow's feet, and forehead skin laxity; long, dense eyebrows, and low transverse forehead wrinkles aid in concealment of the scar.
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