Objective To explore the effect of four-step eye bag plastic surgery in patients with periocular skin relaxation. Methods A total of 46 patients who underwent eye bag plastic surgery in the plastic surgery department of Hangzhou Zhen'ai Medical Cosmetology Clinic from May 2021 to May 2023 were selected as the research objects. They were divided into control group and experimental group by random number table method, with 23 patients in each group. The control group was treated with lower eyelid skin approach, and the experimental group was treated with four-step eye bag plastic surgery. The clinical efficacy, operation time, skin appearance recovery time, eye symptom score and complications were compared between the two groups. Results The total effective rate of the experimental group was 100.00%, which was higher than 82.61% of the control group (P<0.05). The operation time of the experimental group was (66.94±1.13)min, which was shorter than (79.34±1.59)min of the control group (P<0.05). The recovery time of skin appearance in the experimental group was (31.17±2.42)d, which was shorter than (36.62±3.58)d in the control group (P<0.05). The scores of lower eyelid skin ptosis, lower eyelid skin relaxation and lower eyelid skin bloated in the experimental group were lower than those in the control group (P<0.05). The incidence of complications in the experimental group was 4.35%, which was lower than 26.09% in the control group (P<0.05). Conclusion The effect of four-step eye bag plastic surgery in patients with periocular skin relaxation is ideal, which can shorten the operation time and skin appearance recovery time, reduce the eye symptom score, and reduce the incidence of postoperative complications. It is worthy of clinical application.