Objective To investigate the effect of hyaluronic acid combined with type A botulinum toxin on periorbital skin aesthetics and severity of periorbital wrinkles in patients with periorbital wrinkles. Methods A total of 66 patients with periorbital wrinkles admitted to Handan Ceramics (Group) General Company Hospital from January to December 2023 were selected. They were divided into the control group and the observation group according to the random number table method, with 33 patients in each group. The control group was treated with type A botulinum toxin, and the observation group was treated with hyaluronic acid combined with type A botulinum toxin. The clinical efficacy, periorbital skin aesthetics, severity of periorbital wrinkles, satisfaction and complications were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.97%, which was higher than 75.76% in the control group (P <0.05). The scores of skin hydration and skin elasticity in the observation group at 6 months after treatment were higher than those in the control group (P <0.05). The score of WSRS scale in the observation group was lower than that in the control group, and the satisfaction score was higher than that in the control group (P <0.05). The incidence of complications in the observation group was 6.06%, which was lower than 21.21% in the control group (P <0.05). Conclusion The combination of hyaluronic acid and type A botulinum toxin has a definite effect in the treatment of periorbital wrinkles. It can improve the aesthetics of periorbital skin, reduce the severity of wrinkles, and decrease the incidence of complications, with high safety.