To analyze the clinical effect of eye bag plastic surgery with external incision combined with type A botulinum toxin injection in the treatment of periocular skin relaxation. Methods A total of 80 patients with periocular skin relaxation admitted to our hospital from January 2019 to December 2021 were selected as the research objects and randomly divided into control group and observation group, with 40 patients in each group. The control group was treated with eye bag plastic surgery with external incision, and the observation group was treated with eye bag plastic surgery with external incision combined with type A botulinum toxin injection. The clinical efficacy, psychological status, quality of life and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 97.50%, which was higher than 85.00% in the control group (P <0.05). After treatment, the SAS score and SDS score of the observation group were lower than those of the control group (P <0.05). The incidence of adverse reactions in the observation group was 7.35%, which was lower than 10.00% in the control group, but the difference was not statistically significant (P＞ 0.05). After treatment, the scores of social function, psychological function, physical function and role function in the observation group were higher than those in the control group (P <0.05). Conclusion For patients with periocular skin relaxation, eye bag plastic surgery with external incision combined with type A botulinum toxin injection can effectively improve the patient's periocular skin relaxation, which is conducive to the rejuvenation of the periocular skin, relieve the patient's anxiety and depression, improve their quality of life, and the incidence of postoperative complications is low.