Objective To explore the effect of type A botulinum toxin in the treatment of keloids. Methods A total of 60 patients with keloids admitted to the Department of Plastic Surgery, the First Affiliated Hospital of Xinjiang Medical University from March 2023 to March 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 30 patients in each group. The control group was treated with compound betamethasone injection, and the observation group was treated with type A botulinum toxin. The keloid area, keloid thickness, Vancouver Scar Scale (VSS) score, clinical efficacy and adverse reactions were compared between the two groups. Results At 3 and 12 months after treatment, the keloid area, keloid thickness and VSS score of the observation group were lower than those of the control group (P <0.05). The total effective rate of treatment in the observation group (93.33%) was higher than that in the control group (73.33%), and the incidence of adverse reactions was lower than that in the control group (P <0.05). Conclusion Local injection of type A botulinum toxin has a definite effect in the treatment of keloids. It can effectively reduce the keloid area and thickness, improve the keloid appearance, and has a low risk of adverse reactions.