Objective: To investigate the clinical efficacy of lower blepharoplasty combined with autologous fat grafting in older patients with tear trough deformity and lower eyelid bags. Methods: Forty older patients with tear trough deformity and lower eyelid bags admitted between January 2022 and December 2025 were selected and randomly assigned to a control group and an observation group using a random number table, with 20 patients in each group. The control group underwent conventional lower blepharoplasty, while the observation group received autologous fat grafting in addition to the procedure performed in the control group. The Barton tear trough grade, FACE-Q Satisfaction with Eyes score, overall aesthetic improvement rate, and incidence of complications were compared between the two groups before surgery and at 3 months after surgery. Results: At 3 months after surgery, the Barton tear trough grade in the observation group was superior to that in the control group, while the FACE-Q Satisfaction with Eyes score and overall aesthetic improvement rate were higher than those in the control group, with statistically significant differences (P<0.05). No statistically significant difference was observed in the incidence of complications between the two groups (P>0.05). Conclusion: Lower blepharoplasty combined with autologous fat grafting can alleviate tear trough depression, improve periocular aesthetic outcomes, and increase satisfaction with eye appearance in older patients with tear trough deformity and lower eyelid bags without significantly increasing complications.