Objective: To investigate the removal effect of double layered tile closure orbicularis muscle flap eye bag resection and four step plastic surgery on eye bags. Methods: 114 patients with eye bags admitted from January 2022 to January 2025 were included in the study. The subjects were divided into two groups according to different surgical procedures. 57 patients who received four step plastic surgery and 57 patients who received double layered orbicularis muscle flap eye bag resection were respectively set as a control group and a study group, and the surgical effects of the two groups were compared. Results: The study group had a higher total effective rate in removing eye bags compared to the control group (P<0.05); The two groups of patients showed significant improvement in Barton grading after surgery, and the group with more prominent improvement was the study group (P<0.05); The study group had a higher overall aesthetic excellence rate compared to the control group (P<0.05); The study group had a lower incidence of postoperative complications compared to the control group (P<0.05); The study group had a higher level of patient satisfaction compared to the control group (P<0.05). Conclusion: The double layered tile closure orbicularis muscle flap eye bag resection surgery is more beneficial than the four step plastic surgery in improving tear troughs and enhancing the aesthetic effect of eye bag removal. It also has fewer postoperative complications and higher patient satisfaction, and is worthy of clinical recommendation.