Objective To analyze the effect of lower eyelid bag resection combined with orbital septum fat release on facial and ocular aesthetic effect in patients undergoing eyelid bag repair. Methods A total of 60 patients undergoing eyelid bag repair admitted to Qinghai Red Cross Hospital from January 2022 to January 2025 were selected. According to the random number table method, they were divided into the control group and the observation group, with 30 patients in each group. The control group was treated with conventional eyelid bag resection, and the observation group was treated with lower eyelid bag resection combined with orbital septum fat release. The clinical efffcacy, facial aesthetic effect, ocular aesthetic effect and complications were compared between the two groups. Results The total effective rate of the observation group (96.67%) was higher than that of the control group (76.67%) (P<0.05). The pupil height and cheek-lid junction ptosis of the observation group were better than those of the control group (P<0.05). There were no statistically signiffcant differences in facial lateral canthus height and eyebrow-eye distance between the two groups (P>0.05). The eyelid bag severity score and lower eyelid wrinkle score of the observation group were lower than those of the control group, while the WES score was higher than that of the control group (P<0.05). The incidence of complications in the observation group (3.33%) was lower than that in the control group (20.00%) (P<0.05). Conclusion In patients undergoing eyelid bag repair, the application of lower eyelid bag resection combined with orbital septum fat release has a deffnite clinical effect, which can effectively improve the pupil height, cheek-lid junction ptosis and overalleye appearance, and the incidence of complications is low. The two groups of methods showed ideal clinical effects in improving the facial lateral canthus height and eyebrow-eye distance.