Objective To explore the effect of personalized preoperative design based on double eyelid aesthetics in the correction of mild to moderate upper eyelid laxity. Methods A total of 82 patients with mild to moderate upper eyelid laxity admitted to Kunshan Lingmei Oriental Medical Cosmetology Clinic from January 2024 to January 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 41 patients in each group. The control group was treated with conventional double eyelid surgery, and the observation group was treated with personalized preoperative design scheme based on double eyelid aesthetics. The surgical effect, complication rate, pain degree and satisfaction were compared between the two groups. Results The proportions of natural and smooth double eyelid shape, excellent bilateral symmetry, and effective improvement of upper eyelid laxity in the observation group were higher than those in the control group (P <0.05). The incidence of complications in the observation group was 4.88%, which was lower than 21.95% in the control group (P <0.05). The VAS score of the observation group was lower than that of the control group (P <0.05). The satisfaction rate in the observation group was 95.12%, which was higher than 82.93% in the control group (P <0.05). Conclusion The application of personalized preoperative design based on double eyelid aesthetics in the correction of mild to moderate upper eyelid laxity can improve the surgical effect, reduce the incidence of complications, help to alleviate postoperative pain of patients, and enhance their satisfaction, which has definite clinical application value.