Objective To analyze the effect of orbicularis oculi muscle wedge resection combined with orbital septum release in middle-aged and elderly eyelid plastic surgery. Methods A total of 223 middle-aged and elderly patients who underwent eyelid plastic surgery in Nanjing Victoria Beauty Hospital from January 2021 to January 2024 were selected as the research objects. They were divided into control group (n =111) and observation group (n =112) by random number table method. The control group was treated with traditional eyelid plastic surgery, and the observation group was treated with orbicularis oculi muscle wedge resection combined with orbital septum release method. The therapeutic effect, eyelid improvement and complications were compared between the two groups. Results The therapeutic effect score of the observation group at 1, 3 and 6 months after treatment was higher than that of the control group (P <0.05). After treatment, the scores of skin relaxation, lower eyelid wrinkles and eye bags in the observation group were lower than those in the control group (P <0.05). The incidence of complications in the observation group was 1.79%, which was lower than 9.01% in the control group (P <0.05). Conclusion The application effect of orbicularis oculi muscle wedge resection combined with orbital septum release method in eyelid plastic surgery for middle-aged and elderly patients is exact, which can effectively improve the problem of eyelid skin relaxation and eliminate eye bags, with fewer complications and higher surgical safety.