Objective To explore the efficacy and safety of minimally invasive small incision double eyelid surgery. Methods Totally 196 patients who underwent double eyelid surgery in the Skin Plastic Surgery Center, Air Force Medical Center from January to December 2023 were selected as the research subjects, and they were randomly divided into observation group (102 patients) and control group (94 patients). The control group was treated with traditional double eyelid surgery, and the observation group was treated with minimally invasive small incision double eyelid surgery. The postoperative recovery, complications and satisfaction were compared between the two groups. Results The postoperative swelling reduction time, eyelid curvature recovery time and scar recovery time in the observation group were shorter than those in the control group (P <0.05). There was no significant difference in the incidence of complications between the two groups (P >0.05). The satisfaction rate in the observation group was 94.12%, which was higher than 84.04% in the control group (P <0.05). Conclusion Compared with traditional double eyelid surgery, minimally invasive small incision double eyelid surgery has shorter postoperative recovery time, less risk of postoperative complications, and higher patient satisfaction.