Objective To explore the effect of orbital septal fat transposition during double eyelid surgery combined with fat granule filling for correction of mild-to-moderate upper eyelid depression with unfavorable double eyelid contour. Methods A total of 80 patients with mild-to-moderate upper eyelid depression with unfavorable double eyelid contour admitted to Suzhou Mylike Cosmetic Hospital from January 2022 to January 2023 were selected as the research subjects, 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 was treated with double eyelid surgery combined with fat granule filling, and the observation group was treated with orbital septal fat transposition during double eyelid surgery combined with fat granule filling. The surgical indicators, upper eyelid appearance, upper eyelid function and complications were compared between the two groups. Results The operation time of the observation group was longer than that of the control group, and the intraoperative blood loss was more than that of the control group (P <0.05). The scores of upper eyelid appearance and upper eyelid function in the observation group after surgery were better than those in the control group (P <0.05). The incidence of complications in the observation group (2.50%) was lower than that in the control group (15.00%) (P <0.05). Conclusion Orbital septal fat transposition during double eyelid surgery combined with fat granule filling can effectively correct mild-to-moderate upper eyelid depression with unfavorable double eyelid contour, improve the appearance and function of the upper eyelid, and has a low incidence of complications.