This study focuses on the optimization of cheongsam (qipao) patterns for middle-aged and elderly women, integrating principles of ergonomics with a multi-aesthetic perspective. The aim is to enhance the adaptability of the cheongsam to the body characteristics of this demographic while addressing their diverse aesthetic preferences. Findings indicate that the body shapes of middle-aged and elderly women differ significantly from those of younger women, necessitating targeted pattern adjustments such as increasing back width and reducing back armhole depth. At the same time, incorporating diverse aesthetic elements—such as traditional embroidery techniques and modern minimalist patterns—into cheongsam design not only satisfies the aesthetic preferences of middle-aged and elderly women but also enriches the cultural value of the garment. This research provides both theoretical support and practical approaches for optimizing cheongsam design, contributing to improved comfort and aesthetic experience while promoting the inheritance and development of cheongsam culture in contemporary contexts.