Objective To analyze the clinical effect of asymmetric double eyelid plastic repair surgery and its influence on patients' aesthetic satisfaction. Methods A total of 80 patients with asymmetric double eyelids who received treatment in Beijing Meiyi Xibahe Medical Cosmetology Hospital from April 2023 to February 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 40 patients in each group. The control group underwent conventional incision double eyelid plasty, and the observation group underwent asymmetric double eyelid plastic repair surgery. The clinical effect, aesthetic satisfaction and perioperative indicators were compared between the two groups. Results The excellent and good rate of clinical effect in the observation group (97.50%) was higher than that in the control group (85.00%) (P <0.05). The aesthetic satisfaction in the observation group (95.00%) was higher than that in the control group (77.50%) (P <0.05). The operation time, intraoperative blood loss and wound healing time in the observation group were better than those in the control group (P <0.05). Conclusion The application of asymmetric double eyelid plastic repair surgery in patients with asymmetric double eyelids has a definite clinical effect, which helps to improve patients' aesthetic satisfaction and perioperative indicators, and is worthy of clinical application.