Objective To observe the effect of type A botulinum toxin combined with self-crosslinked small molecule hyaluronic acid on improving facial skin texture. Methods A total of 86 patients who needed to improve facial skin quality in our hospital from June to December 2023 were randomly divided into control group and observation group, with 43 patients in each group. The control group was treated with self-crosslinked small molecule hyaluronic acid, and the observation group was treated with type A botulinum toxin combined with self-crosslinked small molecule hyaluronic acid. The clinical efficacy, facial skin index improvement and treatment satisfaction were compared between the two groups. Results The total effective rate of treatment in the observation group was 95.35%, which was higher than 76.74% in the control group (P <0.05). After treatment, the scores of elasticity and moisture in the observation group were higher than those in the control group, and the scores of dark spots and oil were lower than those in the control group (P <0.05). The treatment satisfaction of the observation group was 93.02%, which was higher than 72.09% of the control group (P <0.05). Conclusion Type A botulinum toxin combined with self-crosslinked small molecule hyaluronic acid has a good effect on improving facial skin quality, which can optimize facial skin indicators and improve patient satisfaction. It is worthy of clinical application.