{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:02:21Z","timestamp":1781002941466,"version":"3.54.1"},"reference-count":21,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Despite the rise of endoscopic approaches, the direct brow lift remains one of the most effective procedures for correcting brow ptosis for both functional and cosmetic indications. It continues to offer superior control when correcting brow shape, height, and asymmetry. However, visible scarring remains a concern. This systematic review was conducted to synthesize recent evidence on strategies that minimize visible scarring in direct brow lift surgery. Methods: A systematic literature search was performed to retrieve English-language publications from the past decade, discussing scar-minimization strategies in direct brow lift. A total of 124 records were identified through database searches in Ovid MEDLINE and Embase. Records were screened manually according to predetermined criteria, and those not in English, not addressing scarring, or not focused on direct brow lift were excluded. After this process, ten publications were included in the final qualitative synthesis. Results: The qualitative synthesis of all included publications (together comprising data on approximately 900 patients) revealed several strategies for scar minimization. (1) Incision beveling: A shallow cranially directed bevel between 20\u00b0 and 45\u00b0 preserves brow hair follicles and allows hair regrowth through the scar, providing natural camouflage. (2) Undermining: Gentle subcutaneous undermining in a limited 1\u20132 cm field, while preserving subcutaneous fat, allows tension-free advancement and maintains brow volume. (3) Periosteal suspension: Anchoring the mobilized brow flap to the frontal periosteum redistributes tension away from the dermal closure, maintaining elevation and improving scar quality. (4) Layered closure: Two- or three-layered wound closure with deep dermal anchoring and fine everting skin sutures minimizes dermal traction and scar widening. (5) Adjunctive measures: Evidence for topical silicone gel was inconclusive, whereas postoperative laser therapy and perioperative neuromodulator use demonstrated improved scar appearance. Across studies, outcomes were consistent, with high patient satisfaction, inconspicuous scars in over 85% of cases, and low complication or revision rates. Conclusions: Direct brow lift has historically been criticized for conspicuous scarring, contributing to the popularity of endoscopic techniques. Nevertheless, the traditional direct brow lift remains a fundamental skill in the oculofacial plastic surgeon\u2019s armamentarium, offering unmatched accuracy in brow repositioning, reliability, and symmetry. Contemporary evidence demonstrates refinements that can markedly minimize scar visibility. This systematic review and qualitative synthesis allow us to continue to refine and improve our techniques to minimize scarring in direct brow lift to the benefit of our patients.<\/jats:p>","DOI":"10.3390\/jcm15124445","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:46:54Z","timestamp":1780998414000},"page":"4445","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Contemporary Concepts and Techniques for Scar Minimization in Direct Brow Lift: A Literature Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Ayyad Zartasht","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, \u00d8stfold Hospital Trust, 1535 Moss, Norway"},{"name":"Department of Ophthalmology, S\u00f8rlandet Hospital Trust, 4838 Arendal, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4111-2857","authenticated-orcid":false,"given":"Lars Christian","family":"Boberg-Ans","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital of Southern Denmark, 5230 Vejle, Denmark"},{"name":"Department of Ophthalmology, Innlandet Hospital Trust, 2413 Elverum, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3835-8772","authenticated-orcid":false,"given":"Fredrik Andreas","family":"Fineide","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, \u00d8stfold Hospital Trust, 1535 Moss, Norway"},{"name":"Department of Plastic and Reconstructive Surgery, Oslo University Hospital, 0450 Oslo, Norway"},{"name":"Department of Medical Biochemistry, Oslo University Hospital, 0450 Oslo, Norway"},{"name":"The Norwegian Dry Eye Clinic, Ole Vigs Gate 32 E, 0366 Oslo, Norway"},{"name":"Department of Computer Science, Oslo Metropolitan University, 0176 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard Cutler","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elin","family":"Bohman","sequence":"additional","affiliation":[{"name":"Oculoplastic and Orbital Services, St. Erik Eye Hospital, 171 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, 171 65 Solna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5696-9652","authenticated-orcid":false,"given":"Kim Alexander","family":"T\u00f8nseth","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Oslo University Hospital, 0450 Oslo, Norway"},{"name":"Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, 0371 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hania Nadeem","family":"Karamat","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, Ysbyty Gwynedd Hospital, Bangor LL57 2PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor Paaske","family":"Utheim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, \u00d8stfold Hospital Trust, 1535 Moss, Norway"},{"name":"Department of Ophthalmology, S\u00f8rlandet Hospital Trust, 4838 Arendal, Norway"},{"name":"Department of Plastic and Reconstructive Surgery, Oslo University Hospital, 0450 Oslo, Norway"},{"name":"Department of Medical Biochemistry, Oslo University Hospital, 0450 Oslo, Norway"},{"name":"The Norwegian Dry Eye Clinic, Ole Vigs Gate 32 E, 0366 Oslo, Norway"},{"name":"Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway"},{"name":"Department of Ophthalmology, Stavanger University Hospital, 0101 Oslo, Norway"},{"name":"Department of Ophthalmology, Vestre Viken Hospital Trust, 3004 Drammen, Norway"},{"name":"Department of Ophthalmology, Vestfold Hospital T\u00f8nsberg, 3103 T\u00f8nsberg, Norway"},{"name":"Department of Life Sciences and Health, Oslo Metropolitan University, 0176 Oslo, Norway"},{"name":"Department of Clinical Medicine, Faculty of Medicine, University of Bergen, 5007 Bergen, Norway"},{"name":"Department of Quality and Health Technology, The Faculty of Health Sciences, University of Stavanger, 4021 Stavanger, Norway"},{"name":"Department of Oral Biology, Faculty of Dentistry, University of Oslo, 0371 Oslo, Norway"},{"name":"National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health Sciences, University of South-Eastern Norway, 3679 Kongsberg, Norway"},{"name":"Department of Health and Nursing Science, The Faculty of Health and Sport Sciences, University of Agder, 4630 Grimstad, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.asj.2008.07.009","article-title":"Brow lift for the correction of visual field impairment","volume":"28","author":"Gil","year":"2008","journal-title":"Aesthetic Surg. 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Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4445\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T10:50:45Z","timestamp":1781002245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":21,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124445"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124445","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}