Objective To explore the application effect of modified myocutaneous flap combined with orbital septum fixation in pouch plastic surgery. Methods A total of 30 cases of patients who underwent pouch plastic surgery in our hospital from March 2019 to November 2020 were selected as the research objects. They were divided into control group and observation group by random number table method, with 15 cases in each group. The control group was treated with traditional myocutaneous flap, and the observation group was treated with modified myocutaneous flap combined with orbital septum internal fixation. The clinical efficacy, skin appearance recovery time, complications , satisfaction, and eye index scores. Results The total effective rate of the observation group was 86.67%, which was higher than 53.33% of the control group, and the difference was statistically significant (P＜0.05). The recovery time of skin appearance in the observation group was shorter than that in the control group, and the difference was statistically significant (P＜0.05). The incidence of complications in the observation group was 6.67%, which was lower than 40.00% in the control group, and the difference was statistically significant (P＜0.05). The satisfaction scores of incision scar, eyelid ectropion, lower eyelid skin wrinkles, bag recurrence, lower eyelid depression and nasolacrimal sulcus in the observation group were higher than those in the control group, and the differences were statistically significant (P＜0.05)；The eye bag degree, lower eyelid skin wrinkles of the observation group were lower than those of the control group, blepharolacrimal groove scores and the skin glossiness scores of the observation group were higher than those of the control group (P＜ 0.05) . Conclusion Compared with the traditional myocutaneous flap method, the improved myocutaneous flap method combined with orbital septum internal fixation has a better effect in the pouch plastic surgery, which can restore and retain the anatomical tissue of the lower eyelid to the maximum extent, maintain the ideal long-term effect after surgery, and promote the recovery of skin appearance of patients after surgery, Improvement in eye score，with low complications and high patient acceptance.