The WHO recommends bilamellar
tarsal rotation (BLTR), or lid rotation surgery, for all patients with TT, but it remains unclear if surgery is needed for patients with less severe TT, who tend to epilate the affected lashes and wait until the disease progresses before undertaking the surgery [33, 34].
Tenzel flaps, also known as rotational or semicircular flaps, are appropriate for patients with moderate bilamellar
defects, little eyelid laxity, and normal lid snap back.
The technique reveals the bilamellar
structure of the nail plate with a well-hydrated deep layer, the matrix, a clear subungual space, and bone.