To investigate the effect of orbital septum fat release on improving the clinical symptoms and aesthetics of patients with lower eyelid relaxation and trichiasis. Methods A total of 70 patients with lower eyelid relaxation and trichiasis admitted to Wudi County People's Hospital from January to December 2022 were randomly divided into control group and observation group, with 35 patients in each group. The control group was treated with lower eyelid blepharoplasty, and the observation group was treated with orbital septum fat release. The eye indexes, aesthetic indexes and complications were compared between the two groups. Results The score of lacrimal groove in the observation group was higher than that in the control group, and scores of eyelid bag degree and lower eyelid skin wrinkle were lower than those in the control group (P <0.05). The aesthetic score of the two groups after treatment was higher than that before treatment, and that in the observation group was higher than that in the control group (P <0.05). The incidence of complications in the observation group was 8.57%, which was lower than 31.43% in the observation group (P<0.05). Conclusion After the treatment of orbital septum fat release in patients with lower eyelid relaxation and trichiasis, the clinical symptoms are improved, the aesthetics is better, and the safety is higher, which is worthy of clinical application.