Objective To explore the effect of type A botulinum toxin injection combined with pouch plastic surgery in the treatment of periocular skin relaxation. Methods A total of 100 patients with periocular skin relaxation admitted to our hospital from June 2021 to June 2022 were selected as the research objects. According to different treatment methods, they were divided into control group and experimental group, with 50 cases in each group. The control group was treated with pouch plastic surgery. The experimental group was treated with type A botulinum toxin for injection on the basis of the control group. The clinical efficacy, improvement of eye bag, fishtail pattern and skin gloss, adverse reactions and nursing satisfaction were compared between the two groups. Results The total clinical effective rate of the experimental group was 98.00%, which was higher than 82.00% of the control group, and the difference was statistically significant (P<0.05). The improvement of eye bags, fishtail lines and skin color in the experimental group was better than that in the control group, and the difference was statistically significant (P<0.05). The incidence of adverse reactions in the experimental group was 4.00%, which was lower than 20.00% in the control group, and the difference was statistically significant (P<0.05). The satisfaction in the experimental group was 98.00%, which was higher than 84.00% in the control group, and the difference was statistically significant (P<0.05). Conclusion The clinical effect of type A botulinum toxin injection combined with pouch plastic surgery in the treatment of periorbital skin relaxation is definite, which can effectively improve the appearance of periorbital skin, and has high safety and satisfaction.