Objective To explore the effect of combined treatment of conjoint fascial sheath (CFS) suspension and levator muscle complex tension-free shortening in patients with moderate to severe ptosis. Methods A total of 64 patients with moderate to severe ptosis admitted to Huai'an Jiayan Beauty Hospital from February to October 2023 were selected as the study subjects, and they were divided into control group and experimental group, with 32 patients in each group. The control group underwent CFS suspension, and the experimental group underwent CFS suspension combined with levator muscle complex tension-free shortening, and the clinical efficacy, upper eyelid retraction value and range of motion, ocular surface function and complications were compared between the two groups. Results The total effective rate of treatment in the experimental group was 93.75%, which was higher than 75.00% in the control group (P <0.05). The upper eyelid retraction value of the two groups at 1 month after operation was lower than that at 1 week after operation, the range of motion was higher than that at 1 week after operation, and the upper eyelid retraction value of the experimental group was lower than that of the control group, the range of motion was higher than that of the control group (P <0.05). There was no significant difference in tear film rupture time and tear secretion test results between the two groups at 1 month after operation (P >0.05). The incidence of complications in the experimental group was 3.13%, which was lower than 18.75% in the control group (P <0.05). Conclusion CFS suspension combined with tension-free shortening of levator complex is effective in the treatment of patients with moderate to severe ptosis. After operation, the upper eyelid retraction and range of motion are improved, the ocular surface function is good, and the incidence of complications is low. It is worthy of clinical application.