Objective To analyze the clinical effect of type A botulinum toxin injection combined with pouch plastic surgery in the treatment of lower eyelid skin relaxation. Methods A total of 60 patients with lower eyelid skin relaxation admitted to the Department of General Surgery of Beijing Water Conservancy Hospital from January 2022 to January 2024 were selected as the research objects. According to different treatment plans, they were divided into control group and observation group, with 30patients in each group. The control group was treated with pouch plastic surgery, and the observation group was treated with type A botulinum toxin injection combined with pouch plastic surgery. The periocular score, aesthetic score, satisfaction and complications were compared between the two groups. Results After treatment, the scores of eye bags, fishtail lines and skin color in the observation group were higher than those in the control group, and the differences were statistically significant (P <0.05). The aesthetic score in the observation group was higher than that in the control group, and the difference was statistically significant (P <0.05).The satisfaction in the observation group was 100.00%, which was higher than 83.33% in the control group, and the difference was statistically significant (P <0.05). The incidence of complications in the observation group was 3.33%, which was lower than 23.33% in the control group, and the difference was statistically significant (P <0.05). Conclusion Type A botulinum toxin injection combined with pouch plastic surgery has a better clinical effect in the treatment of lower eyelid skin relaxation. It can improve the problems of eye bags and fishtail lines, improve skin gloss, and obtain good aesthetic effects. Meanwhile, the patients are satisfied and the safety is high, which is worthy of clinical application