Objective To explore the clinical effect of dynamic ligament suspension technique combined with preservative eye bag plastic surgery in patients with eye bags. Methods A total of 130 patients with eye bags admitted to Ganzhou Qimingxing Eye Hospital from October 2023 to January 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 65 patients in each group. The control group was treated with orbital septal fat repositioning combined with orbicularis oculi muscle tightening, and the observation group was treated with dynamic ligament suspension technique combined with preservative eye bag plastic surgery. The incidence of lower eyelid ectropion, palpebromalar groove depth, midface laxity improvement, operation time, recovery period, fat surviva, satisfaction and complication rate were compared between the two groups. Results The incidence of lower eyelid ectropion in the observation group was 6.15% at 1 year after surgery, which was lower than 20.00% in the control group (P<0.05). At 1 year after surgery, the palpebromalar groove depth and midface laxity degree in the observation group were lower than those in the control group, while the improvement values of palpebromalar groove depth and midface laxity degree were higher than those in the control group (P<0.05). The operation time of the observation group was longer than that of the control group, and the recovery period was shorter than that of the control group (P<0.05). The effective fat fflling volume and fat survival rate in the observation group were higher than those in the control group (P<0.05). The satisfaction score of the observation group was higher than that of the control group (P<0.05). The incidence of complications in the observation group was 4.62%, which was lower than 26.15% in the control group (P<0.05). Conclusion For patients with eye bags, dynamic ligament suspension technique combined with preservative eye bag plastic surgery can reduce the incidence of lower eyelid ectropion, ameliorate palpebromalar groove depression and midface laxity, improve fat survival rate and patient satisfaction, with favorable safety, which possesses high clinical application value.