Objective To explore the effect of modified lower eyelid bag plastic surgery on aesthetic outcome in patients with lower eyelid ptosis. Methods A total of 80 patients with lower eyelid ptosis admitted to our hospital from January 2023 to December 2024 were selected, and they were divided into the control group (n =40) and the observation group (n =40) based on the random number table method. The control group underwent traditional lower eyelid bag plastic surgery, and the observation group underwent modified lower eyelid bag plastic surgery. The aesthetic outcome, complication rate and satisfaction were compared between the two groups. Results The scores of lower eyelid smoothness, skin firmness, overall coordination and scar visibility in the observation group were higher than those in the control group (P <0.05). The incidence of complications in the observation group (7.50%) was lower than that in the control group (32.50%) (P <0.05). The satisfaction rate in the observation group (95.00%) was higher than that in the control group (80.00%) (P <0.05). Conclusion The application of modified lower eyelid bag plastic surgery in patients with lower eyelid ptosis has a good effect. It can effectively eliminate eyelid bags, improve the aesthetic outcome, with a lower risk of complications and high patient satisfaction.