Objective To investigate the clinical efffcacy of orbital septum fat release combined with tear trough fflling in periorbital rejuvenation. Methods A total of 60 patients with periorbital aging admitted to Miluo Weifu Medical Aesthetic Clinic from January 2024 to March 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 30 patients in each group. The control group received conventional tear trough fflling, and the observation group was treated with orbital septum fat release on the basis of the control group. The tear trough depression severity, lower eyelid ffatness score, aesthetic score of periorbital rejuvenation, clinical efffcacy, satisfaction and complication rate were compared between the two groups. Results The TTRS score of the observation group at 3 months after operation was lower than that of the control group (P<0.05). The lower eyelid ffatness score of the observation group at 3 months after operation was higher than that of the control group (P<0.05). The aesthetic score of periorbital rejuvenation in the observation group at 3 months after operation was higher than that in the control group (P<0.05). The total effective rate of the observation group (93.33%) was higher than that of the control group (76.67%) (P<0.05). The satisfaction rate of the observation group (93.33%) was higher than that of the control group (76.67%) (P<0.05).The incidence of complications in the observation group (13.33%) was lower than that in the control group (56.67%) (P<0.05). Conclusion The combination of orbital septum fat release and tear trough fflling can effectively improve periorbital depression and unnatural lower eyelid junction in aging patients, and improve the aesthetic effect of periorbital rejuvenation, with high satisfaction and safety.