Objective To explore the effect of type A botulinum toxin for injection combined with blepharoplasty on orbital fat protrusion in patients with eye bag. Methods A total of 70 patients with eye bag who were diagnosed and treated in our hopspital from February 2022 to January 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the experimental group, with 35 patients in each group. The control group was treated with conventional blepharoplasty, and the experimental group was treated with type A botulinum toxin for injection combined with blepharoplasty. The orbital fat protrusion, treatment satisfaction, skin laxity and complications were compared between the two groups. Results The orbital fat protrusion score in the two groups at 6 months after treatment was lower than that before treatment, and that in the experimental group at 6 months after treatment was lower than that in the control group (P <0.05). The treatment satisfaction rate in the experimental group at 6 months after treatment was 100.00%, which was higher than 85.71% in the control group (P <0.05). The skin laxity score in the two groups at 6 months after treatment was lower than that before treatment, and that in the experimental group at 6 months after treatment was lower than that in the control group (P <0.05). There was no significant difference in the incidence of complications between the two groups (P >0.05). Conclusion The application of type A botulinum toxin for injection combined with blepharoplasty in patients with eye bag is highly safe. It can also improve the orbital fa t protrusion and skin laxity of patients, thereby increasing patient satisfaction.