Objective: To evaluate the clinical efficacy and safety of lower eyelid blepharoplasty combined with midface lift in facial rejuvenation of middle-aged and elderly patients.Methods: Sixty patients with facial aging treated from January 2024 to January 2025 were randomly divided into a control group and an observation group (30 cases each). The control group underwent conventional lower eyelid blepharoplasty, while the observation group received lower eyelid blepharoplasty combined with midface lift. Lower eyelid and midface smoothness scores, facial contour improvement, skin tightness, patient satisfaction, and postoperative complications were compared between the two groups at 6 months after surgery.Results: At 6 months postoperatively, the observation group showed significantly higher scores in lower eyelid and midface smoothness, facial contour improvement, and skin tightness than the control group (P<0.05). Overall patient satisfaction was also higher in the observation group (P<0.05). Postoperative complications mainly included local edema, ecchymosis, and transient lower eyelid tightness. The total complication rate was lower in the observation group, with no significant difference between groups (P>0.05).Conclusion: Lower eyelid blepharoplasty combined with midface lift can effectively improve periorbital appearance and elevate midface tissues, achieving superior overall facial rejuvenation with good safety, and is suitable for clinical application in middle-aged and elderly patients.