Objective To explore the application effect of trapezoidal decortication double eyelid plasty in the correction of upper eyelid skin relaxation in middle-aged and elderly patients. Methods A total of 90 middle-aged and elderly patients with upper eyelid relaxation admitted to our hospital from January 2021 to September 2022 were selected as the research objects. They were divided into control group and observation group by random number table method, with 45 patients in each group. The control group was given traditional double eyelid plasty, and the observation group was given trapezoidal decortication double eyelid plasty. The clinical efficacy, periocular soft tissue swelling degree, eyelid width, eye crack height and satisfaction were compared between the two groups. Results The total effective rate of treatment in the observation group was 97.78%, which was higher than 75.56% in the control group (P<0.05). The scores of periocular soft tissue swelling in the observation group were lower than those in the control group at 1, 3 and 6 months after operation (P<0.05). The eyelid width of the observation group was lower than that of the control group at 1, 3 and 6 months after operation, and the height of the eye fissure was higher than that of the control group (P<0.05). The satisfaction rate of the observation group was 97.75%, which was higher than 77.78% of the control group (P<0.05). Conclusion The application of trapezoidal decortication double eyelid plasty in the correction of upper eyelid skin relaxation in middle-aged and elderly patients is effective, which can improve the correction effect, improve the swelling of soft tissue around the eye and the shape of the eyelid. Meanwhile, it has positive significance for the realization of eye rejuvenation, and the patient satisfaction is high, which is worthy of clinical application.