To explore the clinical effect of small incision degreasing combined with continuous catgut embedding in the treatment of upper eyelid double eyelid asymmetry. Methods A total of 68 patients with upper eyelid and double eyelid asymmetry admitted to Yichang QianweiPlastic and Cosmetic Surgery Clinic from October 2021 to January 2023 were selected as the research objects. They were divided into control group and observation group by random numbertable method, with 34 patients in each group. The control group was treated with traditional incision double eyelid surgery, and the observation group was treated with small incision degreasing combined with continuous catgut embedding. The clinical efficacy, perioperative related indicators, treatment satisfaction, psychological status and complications were compared between the two groups. Results The excellent and good rate of treatment in the observation group was 97.06%, which was higher than 73.53% in the control group, and the difference was statistically significant (P <0.05). The operation time and postoperative healing time of the observation group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group, the differences were statistically significant (P <0.05). The treatment satisfaction of the observation group was 97.06%, which was higher than 70.59% of the control group, and the difference was statistically significant (P <0.05). The SCL-90 score of the observation group was lower than that of the control group, and the difference was statistically significant (P <0.05). The incidence of postoperative complications in the observation group was 5.88%, which was lower than 29.41% in the control group, and the difference was statistically significant (P <0.05). Conclusion The safety and feasibility of small incision degreasing combined with continuous catgut embedding in upper eyelid double eyelid asymmetric plastic surgery are at a high level. It can shorten the operation time, reduce the intraoperative blood loss, promote the healing of postoperative incision, and improve the treatment satisfaction and quality of life