Learn Hardcore Latin: Ut primum tonsor forficem tollit, amicus ridet. - As soon as the barber picks up the shears, the friend laughs.

Breakdown of Ut primum tonsor forficem tollit, amicus ridet.

What does ut primum mean here, and how is it different from just ut?

Here ut primum means as soon as.

ut by itself can mean several things in Latin, such as as, when, so that, or that, depending on context.
When combined with primum, it forms a fixed expression meaning as soon as or the moment that.

So in this sentence, Ut primum tonsor forficem tollit means As soon as the barber lifts the scissors.

This is a temporal expression, not a purpose clause.

Why is tollit in the present tense if the English translation might use lifts or even something like lifted in a story?

Latin often uses the present tense in vivid narration where English might also use the present, especially in simple example sentences.

So:

This can describe:

a general repeated action: Whenever the barber lifts the scissors, the friend laughs
a vivid scene in the present: As soon as the barber lifts the scissors, the friend laughs

Nothing unusual is happening grammatically: both verbs are simply 3rd person singular present active indicative.

Why is forficem in the accusative case?