To investigate the clinical effect of malar fat pad bidirectional suspension in midface lifting through eyelid margin incision. Methods A total of 65 patients with middle facial aging admitted to the medical cosmetology department of the First Hospital of Qinhuangdao from June 2020 to June 2022 were randomly divided into group A (n =32) and group B (n =33). Patients in group A underwent a midface lifting with bidirectional suspension of the malar fat pad through eyelid margin incision, patients in group B were given a midface lifting with unidirectional suspension of the malar fat pad. The severity of nasolabial fold wrinkles, overall facial cosmetic effect and complications were compared between the two groups. Results There was no significant difference in the severity of wrinkles between the two groups at 1 week after operation (P >0.05). At 6 months after operation, the proportion of grade 2 in group A was higher than that in group B and the proportion of grade 4 was lower than that in group B (P<0.05). The GAIS score of group A was better than that of group B at 6 months after operation (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion A better cosmetic effect can be achieved by malar fat pad bidirectional suspension midface lifting through eyelid margin incision, and the postoperative scar is hidden, trauma is small, recovery is fast, it is safe and reliable, and it can effectively improve the rejuvenation of the midface cosmetic effect.