Objective To investigate the effect of pouch plastic surgery combined with type A botulinum toxin in patients with periocular skin relaxation. Methods A total of 60 patients with periocular skin relaxation admitted to our hospital from January 2021 to June 2023 were randomly divided into control group and study group, with 30 patients in each group. The control group was treated with pouch plastic surgery, and the study group was treated with pouch plastic surgery combined with type A botulinum toxin. The aesthetic effect, complications and related parameters of corneal skin were compared between the two groups. Results The reduction rate of eyelid bags, the improvement rate of "fishtail lines and lower eyelid lines" and the enhancement rate of skin color in the study group were higher than those in the control group, and the differences were statistically significant (P <0.05). The incidence of complications in the study group was 10.00%, which was lower than 16.67% in the control group, the difference was statistically significant (P <0.05). The skin elasticity R2 value and skin thickness of the study group were higher than those of the control group at 6 months after operation, and the wrinkle are a and skin tightness F4 value were lower than those of the control group, the differences were statistically significant (P <0.05). Conclusion Pouch plastic surgery combined with type A botulinum toxin can improve the aesthetic effect and reduce the incidence of complications in patients with periocular skin relaxation. It is beneficial to improve the relevant parameters of the skin of the patient's eyes, which is worthy of clinical app lication.