Objective To compare the clinical efficacy of autologous fat grafting and type Ⅰ collagen combined with sodium hyaluronate composite solution for injection in the correction of upper eyelid depression. Methods A total of 100 patients with upper eyelid depression admitted to our hospital from January 2023 to January 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 50 patients in each group. The control group received layered fflling with type Ⅰ collagen combined with sodium hyaluronate composite solution for injection, and the study group was treated with autologous fat grafting. According to different surgical procedures, the study group was further subdivided into the free fat grafting subgroup and the orbital septum fat transfer subgroup, with 25 patients in each subgroup. The aesthetic effect, aesthetic satisfaction and complications were compared among all groups. Results At 3 months after surgery, the scores of upper eyelid depression improvement, symmetry and naturalness in the study group were higher than those in the control group, and those in the orbital septum fat transfer subgroup were higher than those in the free fat grafting subgroup (P<0.05). The aesthetic satisfaction score of the study group was higher than that of the control group, and the incidence of complications was lower than that of the control group (P<0.05). Conclusion Autologous fat grafting achieves better morphological improvement, higher aesthetic satisfaction and superior safety than type Ⅰ collagen combined with sodium hyaluronate composite solution for injection in the correction of upper eyelid depression. Among different surgical methods, orbital septum fat transfer has more prominent advantagesin improving facial symmetry and naturalness.