Objective To analyze the effect of eyebrow incision brow lift combined with double eyelid plasty on the improvement effect of upper eyelid skin laxity in middle-aged and elderly patients. Methods A total of 80 middle-aged and elderly patients with upper eyelid skin laxity admitted to our hospital from April 2021 to April 2025 were selected, and they were divided into the reference group and the study group by the random number table method, with 40 patients in each group. The reference group was treated with eyebrow incision brow lift, and the study group was treated with eyebrow incision brow lift combined with double eyelid plasty. The facial wrinkle score, improvement effect of upper eyelid skin laxity, quality of life, complication rate and satisfaction were compared between the two groups. Results The facial wrinkle score of the study group at 1 month after surgery was lower than that of the reference group (P <0.05).At 1 month after operation, the improvement effects of upper eyelid skin laxity in the study group were better than those in the reference group (P <0.05). The scores of mental health, social function, physical function and material living conditions in the study group at 1 month after surgery were higher than those in the reference group (P <0.05). There was no statistically significant difference in the incidence of complications between the two groups (P >0.05). The satisfaction rate of the study group (97.50%) was higher than that of the reference group (82.50%) (P <0.05). Conclusion Eyebrow incision brow lift combined with double eyelid plasty has a good improvement effect in the treatment of upper eyelid skin laxity in middle-aged and elderly patients. It can effectively restore the periorbital facial shape and function, improve the quality of life and patient satisfaction, and does not increase complications.