Objective To explore the effect of microdroplet botulinum toxin combined with platelet-rich plasma (PRP) in the treatment of alopecia. Methods A total of 60 patients with alopecia admitted to the Department of Medical Cosmetology, Qingyang People's Hospital from March 2024 to January 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 30 patients in each group. The control group was treated with PRP, and the observation group was treated with microdroplet botulinum toxin combined with PRP. The hair growth, aesthetic effect, satisfaction and adverse reaction rate were compared between the two groups. Results After treatment, the hair density, vellus hair density, terminal hair density, hair count and hair diameter in the two groups were better than those before treatment, and those in the observation group were better than those in the control group (P <0.05). The GAIS score of the two groups after treatment was higher than that before treatment, and that of the observation group was higher than that of the control group (P <0.05). The satisfaction rate of the observation group was 93.33%, which was higher than 60.00% of the control 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 microdroplet botulinum toxin combined with PRP in the treatment of alopecia can further improve the therapeutic effect, promote hair growth, help to enhance the aesthetic effect and satisfaction, and has good safety.