Tarsal fixation blepharoplasty vs skin excision blepharoplasty? (Photo)

I'm in my 20s and have eyelid asymmetry. I have one crease that is a slightly more strong than the other (it goes into the socket further). I'm told levator advancement is too unpredictable for my case. Is tarsal fixation blepharoplasty a good option to get my creases even? Is it predictable? I believe this is a type of asian eyelid surgery.

Doctor Answers 5

Tarsal fixation vs. levator advancement

It's a lot of difficult to say from the photos which would work better for you but I would probably favor an anchoring technique similar to what I use with my Asian eyelid surgeries.  Based on the way your orbit or eyesocket looks on the left side I would say either approach might be a little unpredictable. If I were to see you in person and I thought surgery would be of any benefit to you and worth the risks I probably perform something like an anchoring technique above the superior edge of the Tarsus as opposed to anchoring to the Tarsus itself. That being said when you're young and beautiful like you sometimes maybe it's best to do nothing until the issue is worse at a later age.  I'm suspicious that the volume and shape of the eyesocket on the two sides are bit different from one another making really good symmetry a little unpredictable as well.

Chase Lay, MD


Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 72 reviews

Left upper eyelid ptosis

Based on your photos, I believe that your left upper eyelid is slightly droopy (ptosis) that you are subconsciously compensating for by subtly raising your eyebrow. This has the effect of increasing your tarsal platform, the distance between your eyelid margin where the lashes come out, and the crease of your eyelid. 

An experienced oculoplastics surgeon should be able to determine whether this is in fact the case with a detailed in person consultation. I have a link below that shows you the effect of ptosis surgery on eyelids and eyebrows. Not all patients raise their brows in reaction to eyelid droop, but in my gallery you will find a few examples.

Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 33 reviews

Tarsal fixation or skin resection?

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A thorough in person exam is needed but from your photos it appears that a levator muscle repair would be necessary. Full function of your upper lids needs to be ascertained before any procedure. 

Please consult a board certified plastic surgeon 

Leon Goldstein, MD
Madison Plastic Surgeon
4.6 out of 5 stars 11 reviews

Lid asymmetry

All eyelid surgery, upper or lower, should begin with a thorough examination of your eyes and lids, including their dynamic movement. Based on your static photos it appears that you have a very common scenario with the levator muscle and tendon having detached from their insertion into your left eyelid.

Levator dehiscence causes a hollow upper lid with an increase in the surface area on your upper lid where you would put your eyeshadow. 

There are multiple options to resolve this levator dehiscence, and which is right for you will depend on your individual degree of dehiscence, which requires that dynamic lid examination to be fully elucidated.

I would be very cautious about anybody telling you that a very well-established procedure is unpredictable, is that lack of predictability is likely just in their hands. You need the procedure that is right for you, not necessarily just the one that they can offer you.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut
#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 77 reviews

Tarsal fixation surgery is not correct.

You have to be very careful what you are looking for as you might find it.  Surgeon do not really understand anchor blepharoplasty by and large.  It is a lost art.  It is a misnomer to call anchor blepharoplasty tarsal or supratarsal fixation.  This leads to bad surgical outcomes when surgeons try to do these maneuvers without really understanding what surgery needs to accomplish.  To make a hard crease, the eyelid platform and orbicularis muscle needs to have a firm attachment to the levator aponeurosis, the tendon of the muscle that raises the upper eyelid.  Regarding your specific eyelid, you have upper eyelid ptosis with anterior elevator aponeurosis disinsertion.  This makes your upper eyelid hollow, gives you the appearance of a very thin eyelid, causes upper eyelid lash ptosis, and deprives you of an upper eyelid fold.  In addition, you have a compensatory brow elevation.  If a surgeon tells you that the surgery is too unpredictable, generally they are saying that they can't satisfactorily accomplish it.  I routinely use these methods with great success.  Skin only blepharoplasty will not help you.  You need structure.  The right surgeon makes all the difference.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.