Objective To analyze the effect of orbicularis oculi resection combined with orbicularis oculi shortening and lower eyelid retractor repositioning in the treatment of elderly patients with lower eyelid laxity. Methods A total of 60 elderly patients with lower eyelid laxity who received cosmetic plastic surgery in the Department of Plastic Surgery, Shanghai Pudong New Area Health Care Hospital for Women&Children from January to October 2025 were selected, and they were divided into the control group (n=30) and the experimental group (n=30) by the random number table method. The control group was treated with orbicularis oculi resection alone, and the experimental group received orbicularis oculi resection combined with orbicularis oculi shortening and lower eyelid retractor repositioning. The clinical efficacy, perioperative indicators and Ocular Surface Disease Index scores were compared between the two groups. Results The total effective rate of treatment in the experimental group was 96.67%, which was higher than 80.00% in the control group (P<0.05). Compared with the control group, the operation time of the experimental group was longer, the swelling regression time and the postoperative suture removal time were shorter (P<0.05). There was no signiffcant difference in intraoperative blood loss between the two groups (P>0.05). Compared with the control group, the scores of OSDI eye symptoms, visual function and environmental inducement in the experimental group were better after intervention (P<0.05). Conclusion For elderly patients with lower eyelid laxity, combined surgery of orbicularis oculi resection, orbicularis oculi shortening and lower eyelid retractor repositioning can improve clinical efffcacy, accelerate swelling subsidence,and shorten postoperative suture removal time, without increasing intraoperative blood loss.