Redefining the Direct Brow Lift: The Key Role of Raising the ROOF

PURPOSE: The authors describe a novel modification to the direct brow lift technique that targets the descent of the retro-orbicularis oculi fat (ROOF). Dissection and repositioning of the ROOF superiorly directly addresses the underlying etiology of brow ptosis-related hooding, fullness of the superior sulcus, and heaviness on the eyelids. Superior placement of the ROOF may help restore youthful volume to the brow. METHODS: A case series of 9 male patients with age-related brow ptosis underwent bilateral direct brow lift with the described ROOF mobilization technique. RESULTS: Mean preoperative brow-reflex distance improved from 5.17 to 11.76 mm postoperatively. The temporal ROOF was elevated above the orbital rim, which improved temporal hooding in all patients. All patients reported resolution of brow heaviness, improved visual function, and high satisfaction without the need for revision. No cases of frontalis paresis or neural compromise were observed. CONCLUSIONS: This technique leverages the anatomical and functional role of the ROOF to enhance the outcomes of functional direct brow lifting in mature male patients by restoring volume and reducing heaviness while preserving natural brow mobility.