Objective To investigate the effect of four-step eye bag plastic surgery in the treatment of elderly eye plastic surgery. Methods A total of 70 elderly patients who underwent eye plastic surgery in our hospital from May 2020 to October 2022 were selected as the research objects and divided into control group and observation group according to the random number table method, with 35 cases in each group. The control group was treated with lower eyelid skin approach, and the study group was treated with four-step eye bag plastic surgery. The clinical efficacy, operation time, recovery time of eye appearance, complications and treatment satisfaction were compared between the two groups. Results The total effective rate of treatment in the study group was 94.29%, which was higher than 77.14% in the control group (P