Objective To investigate the effect of botulinum toxin type A for injection combined with eye bag plastic surgery in the treatment of periocular skin relaxation. Methods A total of 50 patients with periocular skin relaxation who were treated in the First Affiliated Hospital of Nanhua University from October 2023 to October 2024 were selected and randomly divided into study group and control group, with 25 patients in each group. The control group was treated with eye bag plastic surgery, and the study group was combined with botulinum toxin type A for injection on the basis of the control group. The aesthetics score, periocular condition, treatment satisfaction rate and complication rate were compared between the two groups. Results After treatment, the aesthetics score, as well as the scores of skin color, fishtail lines and eye bag in the study group were higher than those in the control group (P <0.05). The total satisfaction rate of treatment in the study group was higher than that in the control group, and the incidence of complications was lower than that in the control group (P <0.05). Conclusion For patients with periocular skin relaxation, the combination of eye bag plastic surgery and botulinum toxin type A for injection can enhance the aesthetics effect, patient satisfaction, improve the periocular condition, and reduce the incidence of complications, which is worthy of clinical application.