Objective To explore the effect of levator muscle plication combined with double eyelid blepharoplasty in the treatment of senile ptosis. Methods A total of 50 patients with senile ptosis admitted to the People's Hospital of Tinghu District from January 2022 to December 2024 were selected as the research subjects, and they were divided into the control group and the observation group according to the random number table method, with 25 patients in each group. The control group was treated with levator muscle shortening surgery combined with double eyelid blepharoplasty, and the observation group was treated with levator muscle plication combined with double eyelid blepharoplasty. The clinical effect, upper lid margin to corneal light reflex distance, eyelid ptosis amount, perioperati ve indicators and complications were compared between the two groups. Results The total effective rate of the observation group was 96.00%, compared with 92.00% of the control group, the difference was not statistically significant (P >0.05). After operation, the upper lid margin to corneal light reflex distance in the observation group was higher than that in the control group, and the amount of eyelid ptosis was lower than that in the control group (P <0.05). The operation time and total hospitalization time of the observation group were shorter than those of the control group, and the intraoperative blood loss was lower than that of the control group (P <0.05). The incidence of complications in the observation group was 0, which was lower than 24.00% in the control group (P <0.05). Conclusion Levator muscle plication combined with double eyelid blepharoplasty can be the first choice for the clinical treatment of senile ptosis. The effect is comparable to that of levator muscle shortening surgery combined with double eyelid blepharoplasty, and it has faster postoperative recovery, less harm to patients, and fewer postoperative complications.