Objective To investigate the effect of minimally invasive small incision double eyelid surgery on cosmetic effect and pain intensity in patients undergoing double eyelid surgery. Methods A total of 82 patients who underwent double eyelid surgery in the Department of Burn and Plastic Surgery, Nantong Third People’s Hospital from January 2023 to June 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 41 patients in each group. The control group received conventional double eyelid surgery, and the observation group received minimally invasive small incision double eyelid surgery. The cosmetic effect, perioperative indicators, pain intensity and complication rate were compared between the two groups. Results The excellent and good rate of the observation group (97.56%) was higher than that of the control group (80.49%) (P<0.05). The operation time and wound healing time in the observation group were shorter than those in the control group, and intraoperative blood loss was less than that in the control group (P<0.05). The VAS scores at 1, 2 and 3 hours after operation in the observation group were lower than those in the control group (P<0.05). The incidence of complications in the observation group (4.88%) was lower than that in the control group (21.95%) (P<0.05). Conclusion The application of minimally invasive small incision double eyelid surgery in double eyelid surgery can improve cosmetic effect, optimize perioperative indicators, relieve postoperative pain, and reduce the incidence of complications.