Objective To explore the application effect and safety of lower eyelid blepharoplasty combined with midface lift in facial rejuvenation treatment of middle-aged and elderly patients. Methods A total of 60 middle-aged and elderly patients with facial aging admitted to the Department of Cosmetic Surgery, Changsha Kaifu Boya Medical Beauty Clinic from January 2024 to January 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 30 patients in each group. The control group was treated with lower eyelid blepharoplasty, and the observation group was treated with lower eyelid blepharoplasty combined with midface lift on the basis of the control group. The facial rejuvenation effect, skin ffrmness, satisfaction and complications were compared between the two groups. Results The scores of lower eyelid ffatness, midface fullness, lifting degree and facial overall contour coordination in the observation group were higher than those in the control group (P<0.05). The proportion of skin ffrmness grades in the observation group was better than that in the control group (P<0.05). The satisfaction of the observation group was higher than that of the control group (P<0.05). The incidence of complications in the observation group (23.33%) was lower than that in the control group (43.33%), but the difference was not statistically significant (P>0.05). Conclusion Compared with simple lower eyelid blepharoplasty, lower eyelid blepharoplasty combined with midface lift for facial rejuvenation in middle-aged and elderly patients can more effectively improve facial rejuvenation effect and skin ffrmness, enhance patient satisfaction, and has good safety, which is of high clinical application value.