Objective To explore the clinical effect of type A botulinum toxin combined with eye bag plastic surgery in patients with periocular skin relaxation. Methods Fifty patients with periocular skin relaxation admitted to our hospital from January 2022 to October were selected as the research objects. They were divided into control group and observation group by random number table method, with 25 cases in each group. The control group was treated with eye bag plastic surgery, and the observation group was treated with type A botulinum toxin combined with eye bag plastic surgery. The clinical efficacy, periocular skin condition, complications and treatment satisfaction were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.00%, which was higher than 80.00% in the control group (P<0.05). The scores of skin color, periorbital wrinkle and eye bag in the two groups after operation were higher than those before operation, and those in the observation group were higher than those in the control group (P<0.05). The incidence of complications in the observation group was 8.00%, which was lower than 20.00% in the control group (P<0.05). The treatment satisfaction of the observation group was 100.00%, which was higher than 84.00% of the control group (P<0.05). Conclusion The application of type A botulinum toxin combined with eye bag plastic surgery in patients with periocular skin relaxation is effective, which can effectively improve the periocular skin condition of patients, and the risk of postoperative complications is low, and the patient satisfaction is high.