Objective To observe the clinical effect of botulinum toxin type A injection and pouch plastic surgery in the treatment of periocular skin relaxation. Methods Fifty patients with periocular skin relaxation admitted to our hospital from May 2019 to May 2020 were selected and randomly divided into the reference group and the observation group, with 25 cases in each group. The reference group was treated with pouch plastic surgery, and the observation group was treated with botulinum toxin type A for injection combined with pouch plastic surgery. The improvement of postoperative skin condition, incidence of adverse reactions and treatment satisfaction were compared between the two groups. Results After six months of treatment, the scores of eye bag, fishtailand skin color in the two groups were higher than those before treatment, and those in the observation group were higher than the reference group, the differnce was statistically signifiant (P<0.05). There was no signifiant diffrence in the incidence of adverse reactions between the observation group (12.00%) and the reference group (20.00%) (P>0.05). The treatment satisfaction of the observation group (92.00%) was higher than that of the reference group (68.00%), and the difference was statistically significant(P<0.05). Conclusion The combined treatment of botulinum toxin type A for injection and eye bag plastic surgery for patients with periocular skin relaxation is effective,which can improve the patient's periocular skin state, improve the patient's satisfaction with treatment, and has less adverse reactions, its worthy of clinical application.