Objective To explore the effect of orbital septum fat release combined with levator aponeurosis folding in the treatment of upper eyelid depression. Methods A total of 389 patients with upper eyelid depression who were treated in Shanxi Incaier General Hospital from September 2017 to March 2025 were included. According to different treatment methods, they were divided into the control group (n =194) and the observation group (n =195). The control group was treated with simple particulate fat grafting, and the observation group was treated with orbital septum fat release combined with levator aponeurosis folding. The upper eyelid depression depth, overall aesthetic score, complication rate and aesthetic satisfaction were compared between the two groups. Results At 6 months after surgery, the upper eyelid depression depth of the observation group was lower than that of the control group (P <0.05). The overall aesthetic score of the observation group at 6 months after sur gery was higher than that of the control group (P <0.05). There was no statistically significant difference in the incidence of complications between the two groups (P >0.05). The aesthetic satisfaction rate of the observation group (99.49%) was higher than that of the control group (92.27%) (P <0.05). Conclusion Orbital septum fat release combined with levator aponeurosis folding has a good effect in the treatment of upper eyelid depression. It can reduce the depth of upper eyelid depression, improve the periorbital rejuvenation effect, and has fewer postoperative complications and higher aesthetic satisfaction, which is worthy of clinical application.