Objective To compare the effects of subbrow incision upper blepharoplasty and double eyelid surgery in patients with moderate to severe upper eyelid skin laxity. Methods A total of 88 patients with moderate to severe upper eyelid skin laxity treated in the Department of Cosmetic Surgery, Nanjing Star-Studded Medical Cosmetic Hospital from April 2023 to September 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 44 patients in each group. The control group was given double eyelid surgery, and the observation group was given subbrow incision upper blepharoplasty. The surgical effect, upper eyelid skin coverage, bilateral symmetry difference, scar quality, average visual acuity of upper visual ffeld, complication rate and satisfaction were compared between the two groups. Results The excellent and good rate of surgery in the observation group (95.45%) was higher than that in the control group (81.82%) (P<0.05). At 6 months after surgery, the upper eyelid skin coverage and bilateral symmetry difference in the observation group were better than those in the control group (P<0.05). The scores of VSS and POSAS in the observation group at 3 and 6 months after surgery were lower than those in the control group (P<0.05). At 3 months after surgery, the average visual acuity of upper visual ffeld in the two groups was higher than that before surgery, and that in the observation group was higher than that in the control group (P<0.05). The incidence of complications in the observation group (6.82%) was lower than that in the control group (25.00%) (P<0.05). The overall satisfaction score of the observation group was higher than that of the control group (P<0.05). Conclusion Compared with double eyelid surgery, subbrow incision upper blepharoplasty has better effects in patients with moderate to severe upper eyelid skin laxity, and has advantages in improving visual ffeld and scar concealment, which is conducive to reducing the incidence of complications and improving patient satisfaction.