Objective To study the effect of type A botulinum toxin injection combined with eye bag plastic surgery in patients with periocular skin relaxation. Methods From April 2023 to May 2024, 62 patients with periocular skin relaxation who were treated in Zhuhai Xinyan Medical Beauty Clinic were selected as the research objects. They were randomly divided into reference group and experimental group, with 31 patients in each group. The reference group was treated with eye bag plastic surgery, and the experimental group was treated with type A botulinum toxin injection on the basis of the reference group. The periocular state, aesthetic effect, psychological state and adverse reactions were compared between the two groups. Results After intervention, the scores of fishtail lines, baggy eye, skin color and aesthetic effect in the experimental group were higher than those in the reference group, and the differences were statistically significant (P <0.05). After intervention, the scores of SAS and SDS in the experimental group were lower than those in the reference group, the differences were statistically significant (P <0.05). The incidence of adverse reactions in the experimental group was 3.23%, which was lower than 22.58% in the reference group, and the difference was statistically significant (P <0.05). Conclusion For patients with periocular skin relaxation, type A botulinum toxin injection combined with eye bag plastic surgery can effectively improve the periocular condition, improve the aesthetic degree, alleviate their negative emotions, and the incidence of adverse reactions is low, which is worthy of clinical application.