Objective To analyze the effect of orbital septum fat ffap repositioning combined with autologous fat transplantation on ocular appearance satisfaction in patients after unfavorable double eyelid surgery. Methods A total of 350 patients treated at Nanjing Southeast Beauty Hospital Co., Ltd. from March 2023 to May 2025 were selected as the research subjects. According to different treatment methods, they were divided into the control group and the observation group, with 175 patients in each group. The control group received autologous fat transplantation, and the observation group received orbital septum fat ffap repositioning combined with autologous fat transplantation. The correction effect, ocular appearance satisfaction, eye socket depression and complication rate were compared between the two groups. Results The excellent and good rate of correction in the observation group (97.14%) was higher than that in the control group (90.86%) (P<0.05). The scores of various ocular appearance satisfaction indicators in the observation group were higher than those in the control group after treatment (P<0.05). The grading of eye socket depression in the observation group was lower than that in the control group after treatment (P<0.05). The incidence of complications in the observation group (4.00%) was lower than that in the control group (10.29%) (P<0.05). Conclusion The combined application of orbital septum fat ffap repositioning and autologous fat transplantation achieves good correction effects in patients after unfavorable double eyelid surgery. It can not only reduce the incidence of complications, but also improve patients' satisfaction with ocular appearance and alleviate the degree of eye socket depression.