Objective To explore the efficacy and safety of orbital septum fat transfer and filling technique in the treatment of patients with eye bag with lacrimal groove depression. Methods A total of 126 patients with eye bag with lacrimal groove depression admitted to Chongqing Huamei Plastic Surgery Hospital from January to December 2023 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 63 patients in each group. The control group underwent eye bag resection, and the observation group underwent orbital septum fat transfer and filling technique. The perioperative indexes, clinical efficacy, Tear Trough Rating Scale (TTRS) scores, complications and recurrence were compared between the two groups. Results The operation time and intraoperative blood loss in the observation group were better than those in the control group (P <0.05). The total effective rate of treatment in the observation group (98.41%) was higher than that in the control group (90.48%) (P <0.05). After treatment, the scores of tear trough depth, pigmentation degree, fat pad ptosis degree and skin crease degree in the observation group were all lower than those in the control group (P <0.05). The incidence of complications in the observation group (1.59%) was lower than that in the control group (7.94%) (P <0.05). The recurrence rate in the observation group (1.59%) was lower than that in the control group (7.94%) (P <0.05). Conclusion The effect of orbital septum fat transfer and filling technique in the treatment of eye bag with lacrimal groove depression is good, which can effectively eliminate the eye bag and lacrimal groove depression, help to improve perioperative indexes, and reduce the risk of postoperative complications and recurrence, with high application efficacy and safety.