[Abstract] Objective To explore the effects of levator palpebrae superioris shortening combined with tarsal plate partial resection on the restoration rate of palpebral fissure height, binocular symmetry, ocular surface function, and aesthetic satisfaction in patients with moderate to severe ptosis. Methods A retrospective study was conducted, involving 60 patients with moderate to severe ptosis treated from January 2022 to January 2025. Based on different surgical approaches, they were divided into a control group (30 cases, undergoing levator palpebrae superioris shortening alone) and an observation group (30 cases, undergoing levator palpebrae superioris shortening combined with tarsal plate partial resection). The postoperative restoration rate of palpebral fissure height, binocular symmetry index, ocular surface function indicators, and aesthetic satisfaction were compared between the two groups. Results At 3 months postoperatively, the observation group showed a palpebral fissure height restoration rate of (92.47±4.18)% versus (83.65±5.23)% in the control group (P<0.05). The binocular symmetry index in the observation group was (0.89±0.06), superior to that of the control group (0.78±0.09) (P<0.05). The observation group also exhibited better tear film break-up time (11.82±1.94 s), Schirmer test (12.45±2.13 mm/5 min), and corneal fluorescein staining score (0.73±0.28) compared to the control group (P<0.05). The total aesthetic satisfaction rate in the observation group was 93.33%, higher than the 70.00% in the control group (P<0.05). Conclusion Levator palpebrae superioris shortening combined with tarsal plate partial resection can effectively improve the restoration rate of palpebral fissure height, enhance binocular symmetry, protect ocular surface function, and increase aesthetic satisfaction in patients with moderate to severe ptosis, demonstrating high clinical value.