Objective To analyze the effect of minimally invasive small incision on pain and negative emotions in patients undergoing double eyelid cosmetic surgery. Methods A total of 200 patients who underwent double eyelid cosmetic surgery in Shanghai BeauCare Medical Aesthetic Clinic from March 2022 to March 2023 were selected as the research subjects, and they were divided into the control group and the observation group according to different treatment methods, with 100 patients in each group. The control group was treated with conventional double eyelid incision, and the observation group was treated with minimally invasive small incision double eyelid incision. The pain, negative emotions, perioperative related indicators and complications were compared between the two groups. Results The VAS scores of the observation group at 1 h, 2 h and 3 h after surgery were lower than those of the control group, and the differences were statistically significant (P <0.05). The scores of anxiety and depression in the observation group after surgery were lower than those in the control group, and the differences were statistically significant (P <0.05). The intraoperative blood loss, operation time, wound healing time, first ambulation time and hospitalization time in the observation group were better than those in the control group, and the differences were statistically significant (P <0.05). The incidence of postoperative complications in the observation group (1.00%) was lower than that in the control group (8.00%), and the difference was statistically significant (P <0.05). Conclusion The application of minimally invasive small incision in double eyelid cosmetic surgery can reduce patients' pain and the incidence of complications, improve the negative emotions, and is beneficial to promoting the recovery of patients.