Objective To analyze the clinical effect of type A botulinum toxin assisted pouch plastic surgery in the treatment of periocular skin relaxation. Methods From September 2020 to September 2022,70 patients with periocular skin relaxation treated in the 969th Hospital of PLA Joint Logistic Support Force and Department of Plastic and Aesthetic Surgery, Qianhe Medical Cosmetic Hospital were selected as the research objects. They were randomly divided into control group and observation group, with 35 cases in each group. The control group was treated with pouch plastic surgery, and the observation group was treated with type A botulinum toxin. The clinical efficacy, satisfaction and adverse reactions were compared between the two groups. Results The incidence of fish tail wrinkle and pouch in the observation group was lower than that in the control group at dynamic and static state, and the improvement rate of skin color was higher than that in the control group (P<0.05). The satisfaction rate of patients in the observation group was higher than that in the control group (P<0.05). The incidence of adverse reactions in the observation group was slightly lower than that in the control group, but the difference was not statistically significant (P>0.05). Conclusion Type A botulinum toxin assisted pouch plastic surgery in the treatment of periocular skin relaxation can improve the fish tail wrinkle and pouch, improve the facial color of patients, and has high safety, which is worthy of clinical application.