Objective To explore the clinical effect of modified myocutaneous flap combined with orbital septum fixation in eye bag plastic surgery. Methods A total of 70 patients who underwent eye bag plastic surgery in Chongqing Huamei Plastic Surgery Hospital from January to December 2023 were selected as the research objects. According to the different surgical methods, they were divided into control group and observation group, with 35 patients in each group. The control group was treated with traditional myocutaneous flap method, and the observation group was treated with modified myocutaneous flap method combined with orbital septum fixation. The clinical related indexes, clinical efficacy, eye related indexes, complications and patient satisfaction were compared between the two groups. Results The operation time of the observation group was longer than that of the control group, the intraoperative blood loss was more than that of the control group, and the suture removal time was shorter than that of the control group (P <0.05). The total effective rate of the observation group was 97.14%, which was higher than 80.00% of the control group (P <0.05). The degree of eyelid bag and lower eyelid wrinkle score in the observation group were lower than those in the control group, and the skin aesthetics score was higher than that in the control group (P <0.05). The incidence of complications in the observation group was 5.71%, which was lower than 22.86% in the control group (P <0.05). The satisfaction of patients in the observation group was 97.14%, which was higher than 77.14% in the control group (P <0.05). Conclusion The use of modified myocutaneous flap combined with orbital septum fixation in eye bag plastic surgery can shorten the recovery time of patients, improve the clinical efficacy, improve the relevant indicators of patients' eyes, reduce the risk of complications, and improve p atient satisfaction.