Objective To explore the value of small incision degreasing combined with catgut embedding in the treatment of patients with asymmetric double eyelid. Methods A total of 90 patients with asymmetric double eyelids admitted to Huanghua Shennongju Hospital from January 2023 to January 2024 were selected as the research objects. They were divided into control group and study group by random number table method, with 45 patients in each group. The control group was treated with conventional incision double eyelid surgery, and the study group was treated with small incision degreasing combined with catgut embedding. The perioperative indicators, inflammatory factor levels, complication rates and aesthetics were compared between the two groups. Results The intraoperative blood loss, operation time and postoperative incision healing time of the study group were better than those of the control group, and the differences were statistically significant (P <0.05). The levels of IL-6, CRP and TNF-α in the study group were lower than those in the control group at 3 days after operation, and the differences were statistically significant (P <0.05). The incidence of complications in the study group was 2.22%, which was lower than 17.78% in the control group, the difference was statistically significant (P <0.05). The excellent and good rate of aesthetics in the study group was 97.78%, which was higher than 82.22% in the control group, the difference was statistically significant (P <0.05). Conclusion Small incision degreasing combined with catgut embedding is more effective in the treatment of asymmetric double eyelids, which can promote the reduction of local inflammatory response, shorten the postoperative recovery time, and have better aesthetics and safety.