Objective To explore the effects of poly-L-lactic acid (PLLA) bidirectional zigzag sutures and botulinum toxin type A (BTX-A) injection on facial rejuvenation patients. Methods A total of 84 facial rejuvenation surgery patients from May 2024 to April 2026 who were admitted to Chengdu High-Tech Shengzhiyu Medical Aesthetic Clinic were selected, and randomly divided into both groups, the control group (n=42) treated with BTX-A injection and the study group (n=42) treated with PLLA bidirectional zigzag sutures and BTX-A injection. The facial laxity status, improvement in facial wrinkles, skin condition, and adverse reactions in both groups were compared. Results 3 months after operation, in comparison of the control group, the ABC arc, pupil point to nasolabial fold distance, and C spacing in the study group were lower (P<0.05). 3 months after operation, in comparison of the control group, the Facial Wrinkle Scale (FWS) and Wrinkle Severity Rating Scale (WSRS) scores in the study group were lower (P<0.05). 3 months after operation, in comparison of the control group, the skin hydration, elasticity, sebum, and pigmentation scores in the study group were superior (P<0.05). In the incidence of adverse reactions, both groups were no statistically differences (P>0.05). Conclusion The combined treatment of PLLA bidirectional zigzag sutures and BTX-A injection can effectively improve skin laxity in patients undergoing facial rejuvenation surgery, positively contribute to the reduction of facial wrinkles, enhance overall skin condition, and feature a low incidence of adverse reactions.