Objective To investigate the effect of transconjunctival blepharoplasty combined with orbital septal fat repositioning in patients with tear trough deformity combined with eyelid bags. Methods A total of 98 patients with tear trough deformity combined with eyelid bags admitted to Xi'an Beilin Hemei Medical Beauty Clinic from November 2022 to November 2025 were selected. According to the random number table method, they were divided into the control group and the study group, with 49 patients in each group. The control group received transconjunctival lower blepharoplasty, and the study group received transconjunctival blepharoplasty combined with orbital septal fat repositioning. The eye bag removal effect, tear trough deformity improvement, complication rate and satisfaction were compared between the two groups. Results The total effective rate of eyelid bag removal in the study group (93.88%) was higher than that in the control group (79.59%) (P<0.05). The Barton grade of the two groups was improved after operation, and the improvement in the study group was better than that in the control group (P<0.05). The incidence of complications in the study group (2.04%) was lower than that in the control group (14.29%) (P<0.05). The satisfaction rate in the study group (95.92%) was higher than that in the control group (81.63%) (P<0.05). Conclusion Transconjunctival blepharoplasty combined with orbital septal fat repositioning is effective in patients with tear trough deformity combined with eyelid bags. It can effectively remove eyelid bags and correct tear trough deformity, with a low postoperative complication rate and high patient satisfaction, which is worthy of clinical application.