Background: Despite the use of cosmetic acupuncture in clinical fields, there is little evidence regarding its effects and safety for cosmetic use. Objective: Objectives of this article are to review the literature and systematically evaluate the effects and current use of acupuncture for cosmetic purposes. Methods: We searched 15 English, Chinese, Japanese, and Korean databases by using relevant keywords. All prospective studies on acupuncture for cosmetic use were considered; we conducted literature analyses to determine the current status of cosmetic acupuncture use and extracted data related to its effects. Results: Two randomized controlled trials and 5 single-armed prospective trials with 216 participants (150 from randomized controlled trials, 66 from single-armed studies) were included. All 7 studies reported positive results for at least one of the following: total effective rate (n=2), squares and counts of wrinkles (n=1), facial blood circulation (n=1), facial size reduction and improvement of skin condition (n=1), anti-aging by a patient-oriented self-assessment of facial elasticity scale (n=1), and water and oil content of facial skin (n=1). Four studies reported itching, dry desquamation, bruising, bleeding, pain, and swelling as adverse events. Six of 7 trials reported statistical flaws, and specific information regarding acupuncture rationale (42.9%), other components of treatment (57.1%), and practitioner background (0%) were rarely reported. However, details regarding patient indications for treatment, treatment regimen, and control interventions were consistently reported (100%) in the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) reporting guideline. Conclusion: This systematic review suggests that a few trials regarding acupuncture for cosmetic use have incorporated rigorous designs. Although the studies reported generally positive results with tolerable safety, the methodology of the trials should be updated in a rigorous manner, including the use of randomized, sham-controlled studies with standardized interventions, in order to provide sufficient evidence regarding the effects of cosmetic acupuncture.