Objective To analyze the therapeutic effect of forehead small incision rhytidectomy combined with elastic line midface lifting in skin aging. Methods A total of 72 patients with facial aging admitted to Shanghai Laiyan Medical Beauty Clinic from January 2022 to January 2024 were randomly divided into control group and observation group, with 36 patients in each group. The control group underwent forehead small incision rhytidectomy, and the observation group was combined with elastic line midface lifting on the basis of the control group. The cosmetic satisfaction, facial relaxation [Facial Laxity Rating Scale (FLRS)], wrinkles [Wrinkle Severity Rating Scale (WSRS)], and incidence of adverse reactions were compared between the two groups. Results The scores of facial fullness, appearance aesthetics and skin tightness in the observation group were higher than those in the control group, and the differences were statistically significant (P <0.05). The FLRS score and WSRS score of the observation group were lower than those of the control group at 1 week, 1 and 2 months after operation, and the differences were statistically significant (P <0.05). The incidence of adverse reactions in the observation group was lower than that in the control group, but the difference was not statistically significant (P >0.05). Conclusion Forehead small incision rhytidectomy combined with elastic line midface lifting can improve wrinkles and facial relaxation symptoms in patients with facial aging, improve patients ' satisfaction with beauty, and do not increase the incidence of adverse reactions.