Objective To observe the effect of type A botulinum toxin combined with eye bag plastic surgery in the treatment of periocular skin relaxation. Methods A total of 108 patients with periocular skin relaxation admitted to the People's Hospital of Qiannan Buyi and Miao Autonomous Prefecture from December 2020 to December 2021 were selected as the research objects, and they were divided into observation group (54 cases) and control group (54 cases) by random number table method. 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 degree of skin relaxation, treatment-related indicators, adverse reactions and satisfaction were compared between the two groups. Results The skin relaxation score of the two groups after treatment was higher than that before treatment, and that in the observation group was higher than that in the control group, the difference was statistically significant (P<0.05). The effective rate of skin color enhancement, eye bag reduction and periorbital wrinkle reduction in the observation group were higher than those in the control group (P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). The scores of service attitude, treatment comfort, aesthetics, operation technology and facial function in the observation group were higher than those in the control group, and the differences were statistically significant (P<0.05). Conclusion Type A botulinum toxin combined with eye bag plastic surgery for patients with periocular skin relaxation can effectively improve the degree of skin relaxation, reduce the incidence of adverse reactions, enhance skin color, avoid the reformation of eye bag and periorbital wrinkle, and have high patient satisfaction, which is worthy of clinical application.