Objective To analyze the effect of type A botulinum toxin combined with triamcinolone acetonide on scar repair effect in patients with keloid. Methods A total of 68 patients with keloid admitted to General Hospital of Ningxia Medical University from February 2022 to February 2025 were selected. According to different treatment methods, they were divided into the the reference group and the study group, with 34 patients in each group. The reference group was treated with triamcinolone acetonide, and the study group was treated with type A botulinum toxin combined with triamcinolone acetonide. The scar repair effect, scar score, clinical efficacy and adverse reactions were compared between the two groups. Results After treatment, the lesion thickness and area in the study group were smaller than those in the reference group, and the tactile pain score and scar color score were lower than those in the reference group (P <0.05). After treatment, the scores of scar color, thickness, vascular distribution and softness in the study group were lower than those in the reference group (P <0.05). The total effective rate of treatment in the study group was 97.06%, which was higher than 79.41% of the reference group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The application of type A botulinum toxin in combination with triamcinolone acetonide has a good effect in the treatment of keloid patients, which can improve the scar repair effect, ameliorate scar symptoms, and reduce the incidence of adverse reactions, which is worthy of clinical application.