Objective To evaluate the clinical effect and safety of small incision levator palpebrae superioris suture shortening combined with minimally invasive double eyelid surgery in elderly patients with ptosis. Methods A total of 78 elderly patients with ptosis admitted to Kunshan Jiamei’ao Medical Cosmetic Clinic from April 2023 to July 2024 were selected, and they were divided into the conventional group and the combined group, according to the random number table method with 39 patients in each group. The conventional group was treated with minimally invasive double eyelid surgery, and the combined group was treated with minimally invasive double eyelid surgery combined with small incision levator palpebrae superioris suture shortening. The clinical effect, aesthetic degree, complications and quality of life were compared between the two groups. Results The total effective rate of treatment in the combined group was 97.44%, which was higher than 79.49% in the conventional group (P <0.05). The scores of eyelid symmetry, double eyelid line naturalness and scar aesthetics in the combined group were higher than those in the conventional group (P <0.05). The incidence of complications in the combined group was 5.13%, which was lower than 23.08% in the conventional group (P <0.05). After surgery, the scores of visual function, appearance satisfaction and daily activity ability in the combined group were higher than those in the conventional group (P <0.05). Conclusion Small incision levator palpebrae superioris suture shortening combined with minimally invasive double eyelid surgery can improve the symptoms of elderly patients with ptosis, enhance their facial aesthetics degree, reduce the incidence of complications, and thus improve their quality of life.