Objective To analyze the effect of double eyelid surgery combined with lacrimal gland prolapse reduction on aesthetic effect in patients with upper eyelid skin ptosis. Methods A total of 36 patients with upper eyelid skin ptosis admitted to our hospital from January 2021 to February 2024 were selected as the research subjects. According to different treatment methods, they were divided into the control group and the observation group, with 18 patients in each group. The control group was treated with double eyelid surgery, and the observation group was treated with double eyelid surgery combined with lacrimal gland prolapse reduction. The clinical efficacy, aesthetic effect, tear circulation and complications were compared between the two groups. Results The total effective rate in the observation group (94.44%) was higher than that in the control group (55.56%) (P <0.05). After surgery, the MRD, MCMFD, MPMFD and LCMFD in the observation group were all shorter than those in the control group, and the wrinkle score was lower than that in the control group (P <0.05). The tear secretion amount in the observation group after surgery was less than that in the control group, and the tear film break-up time was shorter than that in the control group (P <0.05). The incidence of complications in the observation group (5.56%) was lower than that in the control group (38.89%) (P <0.05). Conclusion For patients with upper eyelid skin ptosis, double eyelid surgery combined with lacrimal gland prolapse reduction is clinically effective and safe, and can achieve better aesthetic effect, reduce the prolapsed lacrimal gland, and help improve the appearance of the upper eyelid, which is suitable for clinical application.