Objective To explore the effect of type A botulinum toxin combined with sodium hyaluronate gel on wrinkle improvement in patients with nasolabial fold aging. Methods A total of 60 patients with nasolabial fold aging admitted to Suzhou Industrial Park Mulan Qingyan Medical Cosmetology Clinic from January 2023 to June 2024 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 sodium hyaluronate gel, and the observation group was treated with type A botulinum toxin combined with sodium hyaluronate gel. The wrinkle improvement, skin elasticity, skin thickness and adverse reaction rate were compared between the two groups. Results After 3, 6 and 12 months treatment, the grade of nasolabial fold wrinkles in the observation group was lower than that in the control group (P <0.05). After 3, 6 and 12 months treatment, the R0 value in the observation group was lower than that in the control group (P <0.05). After 6 and 12 months of treatment, the skin thickness in the observation group was higher than that in the control group (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The application of type A botulinum toxin combined with sodium hyaluronate gel in patients with nasolabial fold aging can improve nasolabial fold wrinkles, enhance skin elasticity and thickness, and has good safety.