Objective To explore the effect of small-incision lipectomy combined with buried suture method on pain intensity and aesthetics in patients with asymmetric double eyelids. Methods A total of 80 patients with asymmetric double eyelids admitted to Taixing People's Hospital from July 2024 to July 2025 were selected as the research subjects, and they were divided into the control group and the observation group according to different treatment methods, with 40 patients in each group. The control group was treated with upper eyelid plasty, and the observation group was treated with small-incision lipectomy combined with buried suture method. The surgical indicators, pain intensity, inffammatory factor levels and aesthetics were compared between the two groups. Results The operation time, wound healing time and incision length of the observation group were shorter than those of the control group, and the blood loss was lower than that of the control group (P<0.05). The scores of pain in the observation group at 1, 6, 12 and 24 hours after operation were lower than those in the control group (P<0.05). The levels of C-reactive protein, interleukin-6 and tumor necrosis factor-α in the observation group at 1 day after operation were lower than those in the control group (P<0.05). The aesthetic satisfaction rate of the observation group (97.50%) was higher than that of the control group (80.00%) (P<0.05). Conclusion The application of small-incision lipectomy combined with buried suture method in the treatment of asymmetric double eyelids can reduce tissue trauma, shorten operation time, decrease blood loss, and promote postoperative healing. Meanwhile, this method can effectively relieve postoperative pain and inffammatory response, and ultimately achieve a natural and symmetrical aesthetic effect.