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Evidence From a Randomized Controlled Trial”","","Letter to the editor assessing a randomized waitlist-controlled trial on combined facial and body acupuncture for glabellar (frown) lines. The commentary highlights reported gains in glabellar lines, patient satisfaction, and social functioning, with minimal adverse effects, and frames acupuncture as a potentially safe alternative. It also critiques bias risks from non-blinded patients and acupuncturist, age differences between groups, lack of sham control, reliance on subjective GAIS/SSS outcomes, and inability to isolate the effects of facial, body, and intradermal components. It recommends controlling confounders, adding objective biomarkers, and conducting multicenter component-specific trials.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/comment-on-is-acupuncture-effective-in-diminishing-frown-lines-evidence-from-a-randomized-controlled-trial/455334/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/comment-on-is-acupuncture-effective-in-diminishing-frown-lines-evidence-from-a-randomized-controlled-trial/455334.png","ImageObject",300,407,{"name":92,"@type":93},"LangkahRina","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What evidence does the trial report for acupuncture on frown lines?","Question",{"text":112,"@type":113},"The commentary notes significant improvements in glabellar lines, patient satisfaction, and social functioning, with minimal adverse effects.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which methodological issues could confound the trial’s results?",{"text":117,"@type":113},"The letter points out a younger control group, lack of blinding for patients and the acupuncturist (introducing expectation/performance bias), and absence of a sham acupuncture control to address placebo effects.",{"name":119,"@type":110,"acceptedAnswer":120},"Why does the letter say biological mechanisms are not well validated?",{"text":121,"@type":113},"It argues that the study relies on subjective outcome scales (GAIS, SSS) without objective measurements such as skin elasticity or collagen density to support collagen and muscle-relaxation claims.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},455334,1790869806,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},962090893776,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Journal of Cosmetic Dermatology  \nComment on “Is Acupuncture Effective in Diminishing Frown Lines? Evidence From a Randomized Controlled Trial”  \nZihan Gao1 | Xiaoman Liu1 | Jiachun Xu2   \n1Tianjin University of Traditional Chinese Medicine, Tianjin, China | 2The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China  \nCorrespondence: Jiachun Xu ([xujiachunzhu@163.com](xujiachunzhu@163.com))  \nReceived: 4 December 2025 | Revised: 4 December 2025 | Accepted: 27 December 2025  \nDear Editor,  \nHaghir et al. conduct a pioneering randomized waitlistcontrolled trial investigating the efficacy of combined facial and body acupuncture for frown lines, providing valuable evidence for this understudied cosmetic intervention [1] . The study demonstrates significant improvements in glabellar lines, patient satisfaction, and social functioning, with minimal adverse effects, supporting acupuncture as a safe alternative to invasive or toxin-based treatments.  \nHowever, several methodological considerations warrant attention. First, the control group was significantly younger than the intervention group (p = 0.03), a confounding factor given that younger age may inherently favor better skin condition and wrinkle improvement. Second, while outcome assessorsand analysts were blinded, patients and the acupuncturist were not, introducing potential performance and expectation biases that could inflate efficacy outcomes. Third, the use of a waitlist control group does not account for placebo effects, which are particularly significant in nonpharmacological, perceptible interventions like acupuncture. The absence of a sham acupuncture control substantially limits the ability to attribute observed benefits specifically to the physiological effects of needling.  \nControversially, the study attributes improvements to mechanisms like collagen synthesis and muscle relaxation but lacks objective measurements (skin elasticity, collagen density) to validate these biological claims, relying instead on subjective scales  \n(GAIS, SSS). Additionally, the combined use of facial, body, and intradermal acupuncture prevents delineation of each component's specific contribution to outcomes.  \nOverall, this work advances evidence for acupuncture in facial rejuvenation, with strengths in blinded assessment and long-term follow-up. Addressing confounding variables, incorporating objective biometric measures, and testing component-specific effects in future multicenter trials will strengthen conclusions. Nevertheless, the study provides a compelling foundation for considering acupuncture as a safe, patient-centered option for frown line reduction.  \nAuthor Contributions  \nAll authors wrote the manuscript text. All authors have read and approved the final version of the manuscript.  \nAcknowledgments  \nThe authors have nothing to report.  \nFunding  \nThe authors have nothing to report.  \nEthics Statement  \nThe authors have nothing to report.  \n\n| Zihan Gao and Xiaoman Liu shared co-first authorship. |\n| --- |\n| This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.\u003Cbr>© 2026 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC. |\n\nJournal of Cosmetic Dermatology, 2026; 25:e70663 1 of 2  \n[https://doi.org/10.1111/jocd.70663](https://doi.org/10.1111/jocd.70663)  \nConsent  \nThe authors have nothing to report.  \nConflicts of Interest  \nThe authors declare no conflicts of interest.  \nData Availability Statement  \nThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.  \nLinked Articles  \nIs acupuncture effective in diminishing frown lines? Evidence from a randomized controlled trial, [https://doi.org/10.1111/jocd.70144](https://doi.org/10.111","cbCaio0N5HERCXYl","https://ap.wps.com/l/cbCaio0N5HERCXYl","pdf",239452,"English","# Letter to the Editor\n## Key findings and perceived safety\n## Methodological limitations and bias risks\n## Missing objective measurements and component attribution\n## Overall assessment and recommendations","[{\"question\":\"What evidence does the trial report for acupuncture on frown lines?\",\"answer\":\"The commentary notes significant improvements in glabellar lines, patient satisfaction, and social functioning, with minimal adverse effects.\"},{\"question\":\"Which methodological issues could confound the trial’s results?\",\"answer\":\"The letter points out a younger control group, lack of blinding for patients and the acupuncturist (introducing expectation/performance bias), and absence of a sham acupuncture control to address placebo effects.\"},{\"question\":\"Why does the letter say biological mechanisms are not well validated?\",\"answer\":\"It argues that the study relies on subjective outcome scales (GAIS, SSS) without objective measurements such as skin elasticity or collagen density to support collagen and muscle-relaxation claims.\"}]","Comment on “Is Acupuncture Effective in Diminishing Frown Lines? Evidence From a Randomized Controlled Trial” | PDF",1790742639]