Objective To assess the improvement effect of eye bag plastic surgery combined with type A botulinum toxin injection on skin aging and wrinkles in patients with periocular skin relaxation. Methods A total of 70 patients with periocular skin relaxation admitted to our hospital from June 2023 to June 2024 were selected as the research subjects, and they were divided into control group and experimental group according to the random number table method, with 35 patients in each group. The control group was treated with eye bag plastic surgery alone, and the experimental group was treated with eye bag plastic surgery combined with type A botulinum toxin injection. The periocular skin aging, periocular wrinkles improvement, pain and complications were compared between the two groups. Results After treatment, the improvement of periocular skin aging in the experimental group was better than that in the control group, and the difference was statistically significant (P <0.05). After treatment, the improvement of periocular wrinkles in the experimental group was better than that in the control group, and the difference was statistically significant (P <0.05). The VAS score of the experimental group at 5 and 30 min after treatment was slightly higher than that of the control group, but the difference was not statistically significant (P >0.05). The incidence of complications in the experimental group (11.43%) was slightly higher than that in the control group (5.71%), but the difference was not statistically significant (P >0.05). Conclusion The application of eye bag plasty surgery combined with type A botulinum toxin injection in patients with periocular skin relaxation can effectively improve periocular skin aging and reduce periocular wrinkles, with mild pain and high safety.