Objective To investigate the effect of facial thread lifting combined with autologous fat granule grafting on wrinkle severity in patients with facial aging. Methods A total of 60 patients with facial aging admitted to the Department of Plastic Surgery, Shanghai Pudong New Area Health Care Hospital for Women&Children from January 2024 to April 2025 were selected as the research subjects. According to different treatment plans, they were divided into the control group and the observation group, with 30 patients in each group. The control group received facial thread lifting alone, and the observation group received facial thread lifting combined with autologous fat granule grafting. The wrinkle severity, surgical effect, satisfaction and complication rate were compared between the two groups. Results The scores of FWS and WSRS in the observation group were lower than those in the control group (P<0.05). The total effective rate of the observation group (96.67%) was higher than that of the control group (76.67%) (P<0.05). The satisfaction rate of the observation group (93.33%) was higher than that of the control group (70.00%) (P<0.05). The incidence of complications in the observation group (13.33%) was lower than that in the control group (30.00%) (P<0.05). Conclusion For patients with facial aging, facial thread lifting combined with autologous fat granule grafting can improve surgical effect and patient satisfaction, effectively alleviate facial wrinkles, and reduce the incidence of complications, with satisfactory safety.