Objective To compare the effect of traditional pouch plastic surgery and modified pouch plastic surgery. Methods A total of 62 patients with pouch plastic surgery admitted to Shanghai Jinghe Medical Outpatient Department from June 2022 to October 2023 were randomly divided into control group and observation group, with 31 patients in each group. The control group was treated with traditional patients plastic surgery, and the observation group was treated with modified patients plastic surgery. The periocular score, clinical efficacy, pain degree, self-efficacy score, symptom improvement score and complication rate were compared between the two groups. Results The periocular scores of the observation group were higher than those of the control group (P <0.05). The total effective rate of treatment in the observation group was 96.77%, which was higher than 80.65% in the control group (P <0.05) The VAS score of the observation group was lower than that of the control group at 1 and 3 months after operation, and the GSES score was higher than that of the control group (P <0.05). The scores of ptosis, epiphora, foreign body sensation and lower eyelid ectropion in the observation group were lower than those in the control group (P <0.05). The incidence of complications in the observation group was 3.23%, which was lower than 19.35% in the control group (P <0.05). Conclusion The modified pouch plastic surgery can improve the treatment effect, reduce the pain, improve the symptoms, improve the cosmetic degree, and has high safety, which is worthy of clinical application.