Objective To explore the effect of percutaneous lower blepharoplasty combined with electrocision of palpebral orbicularis oculi muscle on ocular symptoms and satisfaction in middle-aged and elderly patients with eye bags. Methods A total of 100 middle-aged and elderly patients with eye bags seeking midfacial rejuvenation admitted to our hospital from March 2024 to March 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 50 patients in each group. The control group received traditional lower eyelid skin approach eye bag plastic surgery, and the observation group received percutaneous lower blepharoplasty combined with electrocision of palpebral orbicularis oculi muscle. The clinical efficacy, ocular symptom scores and complications were compared between the two groups. Results The total effective rate of treatment in the observation group (98.00%) was higher than that in the control group (76.00%) (P <0.05). After treatment, the scores of lower eyelid skin ptosis, lower eyelid skin laxity and lower eyelid skin edema in the observation group were lower than those in the control group (P <0.05). The incidence of postoperative complications in the observation group (2.00%) was lower than that in the control group (26.00%) (P <0.05). Conclusion Percutaneous lower blepharoplasty combined with electrocision of palpebral orbicularis oculi muscle shows good clinical efficacy in midfacial rejuvenation of middle-aged and elderly people. It can effectively improve aging manifestations such as lower eyelid laxity, ptosis and edema, with high safety.