To explore the application effect of low small incision shear method in the treatment of neck and shoulder fat pad. Methods A total of 98 patients with neck and shoulder fat pad admitted to the Department of Plastic Surgery, Honghui Hospital, Dongyang City, Zhejiang Province from December 2020 to December 2021 were selected as the research objects. They were divided into control group (45patients) and observation group (53 patients) by random number table method. The control group was treated with laser fat melting combined with negative pressure fat suction, and the observation group was treated with low small incision shear method.The clinical efficacy, surgical indicators and complications were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.23%, which was higher than 82.22% in the control group, and the difference was statistically significant (P <0.05). The operation time of the observation group was shorter than that of the control group, and the scar length was longer than that of the control group, the differences were statistically significant (P <0.05). There was no significant difference in intraoperative blood loss and scar length between the two groups (P >0.05). The incidence of complications in the observation group was 1.89%, which was lower than 22.22% in the control group, and the difference was statistically significant (P <0.05). Conclusion The effect of low small incision shear method in the treatment of neck and shoulder fat pad is ideal, which can effectively shorten the operation time, control the amount of intraoperative blood loss, improve the quality of treatment, and reduce postoperative complications. It is worthy of clinical application.