Objective To study the effect of type A botulinum toxin combined with 10 600 nm fractional laser in the treatment of fishtail lines. Methods A total of 50 patients with fishtail lines treated in our hospital from January to December 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 25 patients in each group. The control group was treated with 10 600 nm fractional laser, and the observation group was treated with type A botulinum toxin on the basis of the control group. The clinical efficacy, fishtail lines score, pain degree, adverse reactions and treatment satisfaction were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.00%, which was higher than 80.00% in the control group (P <0.05). After treatment, the fishtail lines score of the two groups was lower than that before treatment, and that of the observation group was lower than that of the control group (P <0.05). There was no significant difference in VAS score between the two groups on the 1st and 2nd day of treatment (P >0.05). The incidence of adverse reactions in the observation group was 8.00%, which was lower than 12.00% in the control group, but the difference was not statistically significant (P >0.05). The treatment satisfaction of the observation group was 100.00%, which was higher than 84.00% of the control group (P <0.05). Conclusion Type A botulinum toxin combined with 10 600 nm fractional laser is effective in the treatment of fishtail lines, which can improve the total effective rate of treatment, dilute fishtail lines, improve treatment satisfaction, and will not increase the risk of pain and adverse reactions. It is a safe and effective treatment plan.