Objective To explore the effect of transconjunctival eye bag removal combined with autologous fat derivative filling in the treatment of middle facial rejuvenation. Methods From January to December 2023, 60 patients who underwent eye bag plastic surgery in Hanmei Beauty Hospital, Xiashan District, Zhanjiang City were selected as the research objects. According to different treatment methods, they were divided into control group and observation group, with 30 patients in each group. The control group was treated with single transconjunctival eye bag removal, and the observation group was treated with transconjunctival eye bag removal combined with autologous fat derivative filling. The eye bag score, periocular skin status, midface rejuvenation degree and complications were compared between the two groups. Results After treatment, the eye bag score of the observation group was lower than that of the control group (P <0.05). After treatment, the scores of color and fishtail lines in the observation group were lower than those in the control group (P <0.05). After treatment, the scores of facial rejuvenation in the observation group were higher than those in the control group (P <0.05). The incidence of complications in the observation group was 6.67%, which was lower than 10.00% in the control group, but the difference was not statistically significant (P >0.05). Conclusion The application of transconjunctival eye bag removal combined with autologous fat derivative filling in the treatment of middle facial rejuvenation is effective, which can effectively improve the aging state of the middle face, improve the skin state around the eyes and the degree of middle facial rejuvenation, and will not increase the probability of complications. The treatment safety is high.