Objective To explore the effect of external blepharoplasty with skin ffap preservation of eyelid platform on patients' aesthetics. Methods A total of 43 patients who underwent blepharoplasty in our hospital from February to August 2025 were selected, and they were divided into the control group (n=22) and the observation group (n=21) by the random number table method. The control group was treated with traditional external blepharoplasty with skin ffap, and the observation group was treated with external blepharoplasty with skin ffap preservation of eyelid platform. The perioperative indicators, aesthetics, complications and treatment satisfaction were compared between the two groups. Results The time for eye appearance to return to normal in the observation group was shorter than that in the control group, and the intraoperative blood loss was less (P<0.05). At 3 months after operation, the scores of eyelid bag degree and lower eyelid wrinkles in the two groups were lower than those before operation, and those in the observation group were lower than those in the control group (P<0.05). The postoperative POSAS score of the observation group was lower than that of the control group (P<0.05). The incidence of complications in the observation group (4.76%) was lower than that in the control group (27.27%) (P<0.05). The satisfaction rate in the observation group (95.24%) was higher than that in the control group (68.18%) (P<0.05). Conclusion External blepharoplasty with skin ffap preservation of eyelid platform can optimize perioperative indicators, achieve higher postoperative aesthetics, reduce the risk of complications, and help to improve patient satisfaction.