To analyze the clinical effect of type A botulinum toxin combined with eye bag plastic surgery in the treatment of periocular skin relaxation. Methods A total of 80 patients with periocular skin relaxation admitted to our hospital from August 2022 to August 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 40 patients in each group. The control group was treated with simple eye bag plastic surgery, and the observation group was treated with type A botulinum toxin combined with eye bag plastic surgery. The treatment effect, satisfaction, complications, aesthetic improvement and quality of life were compared between the two groups. Results The total effective rate of treatment in the observation group was 97.50%, which was higher than 82.50% in the control group (P <0.05). The satisfaction rate of the observation group was 95.00%, which was higher than 80.00% of the control group (P <0.05). The incidence of complications in the observation group was 12.50%, which was lower than 35.00% in the control group (P <0.05). The rate of grade Ⅰ wrinkles in the observation group was higher than that in the control group (P <0.05). The scores of quality of life in the observation group were higher than those in the control group (P <0.05). Conclusion Type A botulinum toxin combined with eye bag plastic surgery is effective in patients with periocular skin relaxation, which can improve the appearance, the symptoms of periocular relaxation, patient satisfaction and quality of life, reduce the incidence of complications.