【】 Objective: To analyze the cosmetic and reconstructive surgical treatment effect for senile lower eyelid laxity. Methods: 60 patients who underwent cosmetic surgery in our hospital from January 2025 to December 2025 were selected for the study. They were randomly divided into the control group and the experimental group, with 30 cases in each group. The control group underwent orbicularis oculi muscle resection; the experimental group underwent orbicularis oculi muscle resection combined with orbicularis oculi muscle shortening and lower eyelid muscle repositioning. The treatment effects, perioperative indicators, and symptom score (OSDI) of the patients were compared. Results: After providing different treatment plans for the two groups of patients, the treatment effect of the experimental group was better than that of the control group, p < 0.05. Compared with the perioperative indicators, the operation time of the experimental group was longer than that of the control group, p < 0.05. The swelling subsided time and postoperative suture removal time were lower than those of the control group, p < 0.05. The difference in bleeding volume was not significant, p > 0.05. The symptom score of the patients was better in the experimental group than in the control group, p < 0.05. Conclusion: For patients with senile lower eyelid laxity, providing orbicularis oculi muscle resection combined with orbicularis oculi muscle shortening and lower eyelid muscle repositioning for treatment can improve symptoms and has a significant aesthetic effect. It is worthy of promotion.