Objective To study the application effect of four-step eye bag plastic surgery in elderly eye plastic surgery. Methods From September to December 2023, 130 elderly patients with eye plastic surgery in Jinhui Medical Beauty Clinic of Shizhong District in Zaozhuang City were selected as the research objects and randomly divided into conventional group (n =65) and observation group (n =65). The conventional group received lower eyelid skin approach eye bag plastic surgery, and the observation group received four-step eye bag plastic surgery. The eye symptom scores, complications and treatment satisfaction were compared between the two groups. Results After treatment, the scores of lower eyelid skin ptosis, lower eyelid skin relaxation and lower eyelid skin bloated in the two groups were lower than those before treatment, and those in the observation group were lower than those in the conventional group (P <0.05). The incidence of complications in the observation group was lower than that in the conventional group (P <0.05). The treatment satisfaction of the observation group was higher than that of the conventional group (P <0.05). The scores of each dimension of quality of life in the observation group were higher than those in the conventional group (P <0.05). Conclusion Four-step eye bag plastic surgery can effectively improve the eye state and appearance of elderly patients, improve the quality of life, reduce the incidence of complications, and patients have higher satisfaction with treat ment.