Objective To study the effect of orbicularis muscle suspension combined with orbital myofascial tightening in pouch plastic surgery. Methods Sixty patients who underwent pouch plastic surgery in our hospital from May 2020 to October 2023 were selected as the research objects. They were divided into control group and study group by random number table method, with 30 patients in each group. The control group was treated with orbicularis muscle suspension, and the study group was treated with orbital myofascial tightening on the basis of the control group. The treatment effect, periocular index score, Vancouver Scar Scale (VSS) score, complication rate and treatment satisfaction were compared between the two groups. Results The total effective rate of treatment in the study group was 96.67%, which was higher than 76.67% in the control group (P <0.05). The degree of eyelid and lower eyelid skin wrinkles scores in the study group were lower than those in the control group, and the eyelid lacrimal groove and skin gloss scores were higher than those in the control group (P <0.05). The VSS scores of the two groups after treatment were lower than those before treatment, and the study group was lower than the control group (P <0.05). The incidence of complications in the study group was 6.67%, which was lower than 26.67% in the control group (P <0.05). The treatment satisfaction of the study group was 93.33%, which was higher than 70.00% of the control group (P <0.05). Conclusion Orbicularis muscle suspension combined with orbital myofascial tightening can improve the effect of pouch plastic surgery, reduce the incidence of complications, prevent scar formation, improve periocular symptoms, and patients' treatment satisfaction is high.