Objective To investigate the effect of type A botulinum toxin combined with eye bag plastic surgery in patients with periocular skin relaxation. Methods A total of 72 patients with periocular skin relaxation admitted to our hospital from July 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 36 patients in each group. The control group was treated with eye bag plastic surgery, and the observation group was treated with type A botulinum toxin for injection combined with eye bag plastic surgery. The clinical efficacy, skin condition of the corner of the eye, plastic satisfaction and complications were compared between the two groups. Results The scores of fishtail lines, eye bags and skin color in the observation group were lower than those in the control group (P <0.05). After intervention, the wrinkle area of the observation group was lower than that of the control group, and the skin thickness was higher than that of the control group (P <0.05). The satisfaction rate of the observation group was 97.22%, which was higher than 83.33% of the control group (P <0.05). The incidence of complications in the observation group was 13.89%, which was lower than 25.00% in the control group, and the difference was not statistically significant (P >0.05). Conclusion Type A botulinum toxin combined with eye bag plastic surgery is effective in the treatment of patients with periocular skin relaxation, which can improve the skin condition of the corner of the eye and improve the satisfaction of plastic surgery. Meanwhile, the incidence of adverse reactions is low, which is worthy of clinical application.