Objective To investigate the effect of double-layer tile-shaped orbicularis oculi muscle flap eyebag resection on eyebag removal efficacy and aesthetics. Methods A total of 114 patients with eyebag admitted to Xi'an Weiyang Fengcheng Second Road Medical Beauty Clinic from January 2022 to January 2025 were selected as the research subjects. According to different surgical methods, they were divided into the control group and the study group, with 57 patients in each group. The control group received four-step plastic surgery, and the study group received double-layer tile-shaped orbicularis oculi muscle flap eyebag resection. The eyebag removal efficacy, tear trough improvement, aesthetics, complications and satisfaction were compared between the two groups. Results The total effective rate of eyebag removal in the study group (94.74%) was higher than that in the control group(77.19%) (P <0.05). The tear trough improvement in the study group was better than that in the control group (P <0.05). The aesthetic excellent and good rate and satisfaction rate in the study group were higher than those in the control group, and the incidence of complications was lower than that in the control group (P <0.05). Conclusion The double-layer tile-shaped orbicularis oculi muscle flap eyebag resection can effectively remove the eyebag, improve the tear troughs, enhance the aesthetics and patient satisfaction, and have fewer postoperative complications.