Objective To explore the efficacy and safety of modified transcutaneous incision blepharoplasty. Methods A total of 68 patients who underwent blepharoplasty at Xiamen Siming Huamei Medical Cosmetology Clinic from October 2023 to October 2024 were selected as the research subjects. According to the random number table method, they were divided into the reference group and the research group, with 34 patients in each group. The reference group received musculocutaneous flap blepharoplasty, and the research group received modified transcutaneous incision blepharoplasty. The surgical effect, complications, satisfaction and pain level were compared between the two groups. Results The total effective rate of the research group was 97.06%, which was higher than 82.35% of the reference group (P <0.05). The incidence of complications in the research group was 5.88%, which was lower than 23.53% in the reference group (P <0.05). The satisfaction rate of the research group was 97.06%, which was higher than 79.41% of the reference group (P <0.05). The VAS scores of the research group at 1, 3, and 7 days after surgery were all lower than those of the reference group (P <0.05). Conclusion The modified transcutaneous incision blepharoplasty has a definite therapeutic effect, with a low risk of postoperative complications and a mild pain level. It is beneficial for improving patient satisfaction and has high application efficacy and safety.