Objective To investigate the clinical effect of small incision asymmetric double eyelid repair and plastic surgery. Methods A total of 82 patients with asymmetric double eyelid treated in our hospital from April 2020 to April 2021 were randomly divided into control group and study group, with 41 patients in each group. The control group was treated with conventional plastic repair, and the study group was treated with small incision repair and plastic surgery on the basis of the control group. The surgical indexes, clinical efficacy and incidence of adverse reactions were compared between the two groups. Results The healing time and operation time of the study group were shorter than those of the control group, and the intraoperative blood loss was lower than that of the control group, the differences were statistically significant (P<0.05). The total effective rate of the study group was higher than that of the control group, and the difference was statistically significant (P<0.05). The incidence of adverse reaction in the study group was lower than that in the control group, the difference was statistically significant (P<0.05). Conclusion The application of small incision asymmetric double eyelid repair and plastic surgery in patients with asymmetric double eyelid is more effective, which can effectively reduce the incidence of complications and intraoperative blood loss, shorten the operation time. Meanwhile, it can improve the treatment effect, promote the rehabilitation of patients, and shorten their healing time, which is worthy of clinical application.