Objective To analyze the effect of four-step eye bag plastic surgery in elderly patients. Methods A total of 68 elderly patients who underwent eye plastic surgery in our hospital from January 2022 to January 2024 were selected as the research objects. According to the different types of surgery, they were divided into control group and experimental group, with 34 patients in each group. The control group was treated with conventional eye bag plastic surgery, and the experimental group was treated with fourstep eye bag plastic surgery. The clinical efficacy, perioperative indicators, eye status scores and complications were compared between the two groups. Results The total effective rate of the experimental group was 97.06%, which was higher than 76.47% of the control group (P <0.05). The postoperative recovery time and blood loss in the experimental group were lower than those in the control group (P <0.05). After treatment, the scores of bloated, relaxed and drooping lower eyelid skin in the experimental group were lower than those in the control group (P <0.05). The incidence of complications in the experimental group was 2.94%, which was lower than 17.65% in the control group (P <0.05). Conclusion The application of four-step eye bag plastic surgery in elderly patients with eye plastic surgery has a definite effect, which can improve the postoperative recovery speed, and the incidence of postoperative complications is low.