Objective To explore the effect of multi-project combined therapy via lower eyelid skin incision on aesthetic effect and safety in patients with eyelid bags and midface aging. Methods A total of 82 patients with eyelid bags and midface aging admitted to the Department of Plastic and Aesthetic Surgery, Xi'an Yestar Medical Aesthetic Hospital from November 2023 to October 2025 were selected as the research subjects, and they were divided into the reference group and the observation group by the random number table method, with 41 patients in each group. The reference group received lower eyelid blepharoplasty via lower eyelid skin incision, and the observation group received multi-project combined therapy via lower eyelid skin incision. The aesthetic effect, complication rate and satisfaction were compared between the two groups. Results After treatment, the BARTON grade of the observation group was lower than that of the reference group, and the IGAIS score was higher than that of the reference group (P<0.05). The incidence of complications in the observation group (2.44%) was lower than that in the reference group (17.07%), while the satisfaction rate in the observation group (97.56%) was higher than that in the reference group (80.49%) (P<0.05). Conclusion For patients with eyelid bags and midface aging, multi-project combined therapy via lower eyelid skin incision can improve aesthetic effect, reduce the risk of complications such as ecchymosis and conjunctival edema, and enhance patient satisfaction, which is worthy of clinical application.