Objective To analyze the efficacy and safety of small incision degreasing continuous buried suture double eyelid plasty in the repair of patients with asymmetric double eyelids. Methods A total of 46 patients with asymmetric double eyelids admitted to our hospital from May 2022 to May 2024 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 23 patients in each group. The control group received traditional incision surgery, and the observation group received small incision degreasing continuous buried suture double eyelid plasty. The surgery related indexes, repair effect, complications and aesthetic effect were compared between the two groups. Results The operation time, intraoperative blood loss and postoperative wound healing time in the observation group were better than those in the control group (P <0.05). The total effective rate of repair in the observation group (95.65%) was higher than that in the control group (65.22%) (P <0.05). The incidence of complications in the observation group (8.70%) was lower than that in the control group (34.78%) (P <0.05). The aesthetic degree scores of double eyelids and eyes in the observation group were higher than those in the control group (P <0.05). Conclusion The application of small incision degreasing continuous buried suture double eyelid plasty in the repair of patients with asymmetric double eyelids has a good effect, which can effectively improve the surgery related indexes, increase the total effective rate of repair, and is beneficial to reducing the incidence of complications. It has higher aesthetic degrees of double eyelids and eyes after surgery, with high efficacy and safety in application.