Objective To analyze the efficacy of the orbital septum fat flap in the correction of lower eyelid bags combined with tear trough and palpebromalar groove depression deformity. Methods A total of 136 patients with lower eyelid bags combined with tear trough and palpebromalar groove depression deformity admitted to the Department of Plastic and Cosmetic Surgery, Tianjin Xiqing Kanghui Medical Cosmetic Hospital from May 2023 to May 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the study group, with 68 patients in each group. The control group was treated with traditional lower eyelid bags plastic surgery, and the study group was treated with orbital septum fat flap correction. The surgical effect, eye symptom improvement and complication rate were compared between the two groups. Results The total effective rate in the study group was 95.59%, which was higher than 73.53% in the control group (P <0.05). After treatment, the scores of lower eyelid bag protrusion, tear trough, lower eyelid skin relaxation and pigmentation in the study group were lower than those in the control group (P <0.05). The incidence of complications in the study group was 2.94%, which was lower than 13.24% in the control group (P <0.05). Conclusion The orbital septum fat flap is effective in the correction of lower eyelid bags combined with tear trough and palpebromalar groove depression deformity. It helps to improve the symptoms such as lower eyelid bag protrusion, tear trough, lower eyelid skin relaxation and pigmentation, and reduce the incidence of complications.