Effectiveness of orofacial myofunctional intervention to mitigate facial aging signs: a clinical trial.

There was no untreated control group. Both groups received the full active programme, so this study cannot show that the programme works better than no treatment at all, only that adding biofeedback does not help. The authors themselves recommend a control group in future work. Only 30 women took part, all aged 50 to 60, and most had only slight facial aging signs to begin with, so there was little room to show an improvement. The results may not apply to older women or to those with more marked wrinkles. Participants saw their own before-and-after photographs after the second assessment, partway through the study, which may have influenced how they rated their later results and their satisfaction. The authors flag this as a problem to avoid in future studies. Home exercise was not monitored. The researchers inferred that participants did the exercises from improvements within sessions and from the fall in wrinkle scores after the washout, so adherence is assumed rather than measured. The programme addressed only the facial muscles, one of several structures that change with age; the authors suggest combining it with dermatological treatments for better results. Satisfaction was measured only once, after the first nine sessions, and before participants compared their own photographs, so it reflects the first stage of treatment only.

Financial support: nothing to declare. The authors state no conflicts of interest (the declaration is given in both English and Portuguese).

Do not read the fall in facial aging sign scores in the therapy group as evidence that this programme reverses facial aging. Scores dropped only during the nine weekly sessions, rose above baseline once treatment stopped for eight weeks, and were back at baseline after the six monthly sessions; the authors' own conclusion is that the later changes were not significant.