To investigate the effect of small incision levator palpebrae superioris suture shortening combined with minimally invasive double eyelid surgery in the treatment of senile ptosis. Methods A total of 105 elderly patients with ptosis admitted to our hospital from January 2021 to December 2022 were randomly divided into control group (n =55) and observation group (n =60). The control group was treated with minimally invasive double eyelid surgery. The observation group was treated with small incision levator palpebrae superioris muscle suture shortening combined with minimally invasive double eyelid surgery. The clinical efficacy, recurrence rate, complication rate and satisfaction were compared between the two groups. Results The total effective rate of treatment in the observation group was 93.33%, which was higher than 80.00% in the control group (P <0.05). The recurrence rate of the observation group was 1.67%, which was lower than 10.91% of the control group (P <0.05). The incidence of complications in the observation group was 5.00%, which was lower than 16.36% in the control group (P <0.05). The satisfaction rate of the observation group was 96.67%, which was higher than 87.27% of the control group (P <0.05). Conclusion The effect of small incision levator palpebrae muscle suture shortening combined with minimally invasive double eyelid surgery in the treatment of senile ptosis is good, the recurrence rate and complication rate after treatment are low, and the safety is high. Meanwhile, the patients are satisfied with the treatment effect and the clinical application value is accurate.