Objective To explore the effect of orbital myofascial tightening combined with orbicularis suspension in eye bag plastic surgery. Methods A total of 72 patients who underwent pouch plastic surgery in Ningbo Yinzhou Zhuomei Medical Beauty Clinic from January to December 2023 were randomly divided into control group and observation group, with 36 patients in each group. The control group was treated with orbicularis oculi muscle suspension, and the observation group was treated with orbital fascia tightening combined with orbicularis oculi muscle suspension. The plastic effect, aesthetics, satisfaction and complications were compared between the two groups. Results The total effective rate of the observation group was 94.44%, which was higher than 75.00% of the control group, and the difference was statistically significant (P <0.05). The aesthetic score of the observation group was higher than that of the control group, and the difference was statistically significant (P <0.05). The satisfaction rate of the observation group was 91.67%, which was higher than 72.22% of the control group, and the difference was statistically significant (P <0.05). The incidence of complications in the observation group was 8.33%, which was lower than 13.89% in the control group, but the difference was not statistically significant (P >0.05). Conclusion The application of orbital fascia tightening combined with orbicularis oculi muscle suspension in eye bag plastic surgery is effective, which can effectively improve the plastic effect and aesthetics. Meanwhile, it will not increase the incidence of postoperative complications, the patient satisfaction is high, which is worthy of clinical application.