Objective To study the effect of combined modified orbicularis oculi muscle shortening surgery and internal tarsal fixation surgery on aesthetic degree in patients with senile lower eyelid entropion. Methods A total of 100 patients with senile lower eyelid entropion who were treated in our hospital from May 2023 to April 2025 were divided into the control group (50 patients) and the study group (50 patients) according to the random number table method. The control group was treated with eyelid skin orbicularis oculi muscle resection, and the study group was treated with combined modified orbicularis oculi muscle shortening surgery and internal tarsal fixation surgery. The aesthetic degree, clinical efficacy, complications and treatment satisfaction were compared between the two groups. Results The aesthetic degree score in the study group after operation was higher than that in the control group (P <0.05). The proportion of good short-term efficacy in the study group was 62.00%, which was higher than 42.00% in the control group, and the proportion of long-term cure was 78.00%, which was higher than 58.00% in the control group (P <0.05). The incidence of complications in the study group was 8.00%, which was lower than 24.00% in the control group (P <0.05). The treatment satisfaction score in the study group was higher than that in the control group (P <0.05). Conclusion The combined treatment of modified orbicularis oculi muscle shortening surgery and internal tarsal fixation surgery for patients with senile lower eyelid entropion can effectively improve the short-term and long-term surgical effects, reduce the risk of complications, improve the aesthetic degree, and enhance patient satisfaction.