Objective: To retrospectively analyze the clinical efficacy and safety of acupuncture-based cosmetic therapy as an adjunctive treatment for chloasma. Methods: From January 2022 to September 2026, a total of 469 patients with melasma admitted to our hospital were selected. Among them, 143 patients who received adjunctive acupuncture therapy for aesthetic purposes were assigned to the observation group, while 143 patients who received oral administration of traditional Chinese herbal paste (Melasma-Removing and Skin-Nourishing Formula) during the same period were assigned to the control group. The observation group received additional acupuncture therapy in addition to the treatment regimen administered to the control group. The clinical efficacy, MASI scores, TCM syndrome scores, and adverse reactions of the two groups were then compared.Results: The overall effective rate in the observation group was significantly higher than that in the control group (P<0.05); after treatment, the MASI scores and TCM syndrome scores in the observation group were significantly lower than those in the control group (P<0.05); the overall incidence of adverse reactions was comparable between the two groups (P>0.05). Conclusion: Combining oral administration of traditional Chinese herbal pastes with acupuncture for cosmetic purposes can enhance the clinical efficacy of treatment for chloasma, alleviate symptoms, and demonstrate favorable safety profiles.