Objective To study the effect of orbital septum fat flap transposition combined with ptosis tissue repositioning on the treatment effect of midfacial ptosis tissue and patient satisfaction. Methods A total of 100 patients with midfacial ptosis tissue who were treated in Xi'an Yue Xinyan Medical Cosmetology Clinic from July 2021 to July 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 50 patients in each group. The control group was treated with simple blepharoplasty for pouch correction, and the observation group was treated with orbital septum fat flap transposition combined with ptosis tissue repositioning. The treatment effect, satisfaction, complications and aesthetic improvement were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.00%, which was higher than 84.00% in the control group (P<0.05). The satisfaction rate in the observation group was 94.00%, which was higher than 78.00% in the control group (P<0.05). The incidence of complications in the observation group was 0, which was lower than 10.00% in the control group (P<0.05). The scores of the overall aesthetic improvement scale in the observation group immediately after operation and at 6 months after operation were both higher than those in the control group (P <0.05). Conclusion Using orbital septum fat flap transposition combined with ptosis tissue repositioning for patients with midfacial ptosis tissue can effectively help to improve the midfacial aging, reduce the impact of surgery on patients, enhance the satisfaction, and achieve an ideal aesthetic effect, which is worthy of clinical application.