Objective To explore the effect of modified myocutaneous flap method combined with orbital septum fixation on ocular aesthetics in eyebag plastic surgery. Methods A total of 60 patients undergoing eyebag plastic surgery in Zhuhai Zhenyan Medical Beauty Clinic from January 2023 to January 2025 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 30 patients in each group. The control group was given traditional myocutaneous flap surgery, and the observation group was given modified myocutaneous flap method combined with orbital septum fixation. The clinical indicators, ocular aesthetics and complications were compared between the two groups. Results The operation time and eye appearance recovery time of the observation group were (51.27±3.78)min and (7.86±1.27)d, respectively, which were shorter than (57.16±3.75)min and (10.55±2.08)d of the control group (P<0.05). The seores of lower eyelid skin wrinkles, blepharoptosis degree and tear trough depression degree in the observation group after plastic surgery were lower than those in the control group (P<0.05). The incidence of complications in the observation group was 3.33%, compared with 16.67% in the control group, the difference was not statistically significant (P >0.05). Conclusion The modified myocutaneous flap method combined with orbital septum fixation for eyebag plastic surgery can improve surgical efficiency, shorten postoperative recovery time, reduce lower eyelid skin wrinkles, improve tear trough depression and blepharoptosis, and reduce the incidence of complications.