Objective To explore the efficacy of eye bag plastic surgery combined with autologous fat grafting for patients with senile eye bags and tear trough deformity and its influence on tear trough severity and satisfaction with ocular appearance. Methods A total of 40 patients with senile eye bags and tear trough deformity admitted to our hospital from January 2022 to December 2025 were divided into the control group and the observation group by the random number table method, with 20 patients in each group. The control group was treated with conventional eye bag plastic surgery, and the observation group was treated with eye bag plastic surgery combined with autologous fat grafting. The tear trough severity, satisfaction with ocular appearance, overall aesthetic improvement rate and complication rate were compared between the two groups. Results The Barton tear trough grading of the observation group at 3 months after operation was better than that of the control group (P<0.05). The FACE-Q score at 3 months after operation in the observation group was (79.60±5.85)points, which was higher than (68.45±6.12)points in the control group (P<0.05). The overall aesthetic improvement rate of the observation group (95.00%) was higher than that of the control group (65.00%) (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups (P >0.05). Conclusion Eye bag plastic surgery combined with autologous fat grafting can alleviate tear trough depression in patients with senile eye bags and tear trough deformity, improve periocular aesthetic effect and satisfaction with ocular appearance, without significantly increasing the incidence of complications.