Objective To investigate the effect of high-frequency electrosurgical knife assisted double eyelid surgery with preservation of subcutaneous venous network on early rehabilitation and aesthetic effect in patients with ptosis. Methods A total of 116 patients with ptosis admitted to Jiaojiang Weichenguang Medical Aesthetic Clinic from January 2023 to June 2025 were selected as the research subjects. According to different surgical regimens, they were divided into the control group and the observation group, with 58 patients in each group. The control group received incision double eyelid plasty, and the observation group received high?frequency electrosurgical knife assisted double eyelid surgery with preservation of subcutaneous venous network. The early rehabilitation status, eyelid morphology and aesthetic effect were compared between the two groups. Results The scores of swelling, ecchymosis and pain in the observation group at 7 days after operation were lower than those in the control group (P<0.05). The eyelid width of the observation group at 14 days after operation was lower than that of the control group, while the palpebral fissure height and levator palpebrae muscle strength were higher than those of the control group (P<0.05). The scores of bilateral symmetry, smoothness of double eyelid line and patient satisfaction in the observation group at 14 days after operation were higher than those in the control group (P<0.05). Conclusion High-frequencyelectrosurgical knife assisted double eyelid surgery with preservation of subcutaneous venous network can effectively relieve postoperative swelling, ecchymosis and pain in patients with ptosis, promote natural recovery of eyelid morphology and improve aesthetic effect.