Objective To investigate the effect of transcutaneous blepharoplasty combined with midface lift on facial aesthetics in patients with lower eyelid bulging caused by facial aging. Methods A total of 80 patients with lower eyelid bulging caused by facial aging admitted to the Department of Aesthetic Surgery, Beijing Albeid Medical Beauty Hospital from December 2020 to June 2025 were selected as the research subjects, and they were divided into the group A and group B by the random number table method, with 40 patients in each group. Group A was treated with transcutaneous blepharoplasty, and group B was treated with transcutaneous blepharoplasty combined with midface lift. The facial aesthetics, excellent and good rate of aesthetic effect, perioperative indicators and complication rate were compared between the two groups. Results The facial aesthetic score of the group B at 6 months after operation was higher than that of group A (P<0.05). The excellent and good rate of aesthetic effect in group B (97.50%) was higher than that in group A (82.50%) (P<0.05). The operation time, hospitalization time and postoperative swelling subsidence time of group B were shorter than those of group A, and the intraoperative blood loss was more than that of group A (P<0.05). The incidence of complications in group B (7.50%) was lower than that in group A (25.00%) (P<0.05). Conclusion For patients with lower eyelid bulging caused by facial aging, transcutaneous blepharoplasty combined with midface lift can improve aesthetic effect and facial appearance, optimize perioperative time indicators, and reduce the incidence of various complications.