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Staying youthful: acupuncture vs surgery

Reading time: 13 minutes

Although increasingly women and men are going in for surgical and other “tweakments” to look younger, acupuncturists employ a 3,000-year-old alternative. Cate Montana investigates the latest in facial acupuncture.

Doctors working for the East India Company began learning and writing about acupuncture in the late 1700s. The ancient Eastern medical practice slowly began creeping into the West along with the increasing numbers of Chinese immigrants.

However, in the 17th century, talk about universal energy (qi), energy points, invisible energy meridians, and the energetic balance of yin and yang forces ran totally against Western scientific and medical knowledge. It wasn’t until The Beatles’ Asian tour in 1964 that widespread public interest in Eastern religions, philosophy and culture took off in the West. 

Then James Reston, columnist and editor for the New York Times, wrote an article on acupuncture titled “Now, about My Operation in Peking” from his hospital bed. It appeared on the front page the next day along with the Apollo 15 lift-off on July 26, 1971.

Public interest and response were immediate. By 1980, the British Medical Acupuncture Society had been established. In 1999, the National Institutes of Health created the National Center for Complementary and Alternative Medicine, and acupuncture was accepted as the most popular alternative medical modality in the US.

But it wasn’t until the 21st century that Western women learned what Chinese empresses were privileged to know 3,000 years ago: Acupuncture is not just effective for promoting health and longevity. It’s also a wonderful way to enhance beauty and stimulate facial rejuvenation.

“Early facial acupuncture in Chinese medicine was actually taken from the practice of facial diagnostics,” says Yvette Masure, a medical and facial acupuncturist in Guildford, UK (

“The face is the expression of the eternal state of affairs of your organs in your system. Those lines we all want to get rid of are seen in facial diagnostics as beauty lines. For example, the Sa Ling lines that run from the bottom of each nostril down to the corner of your lips are a sign of great willpower and strength of character.”

Masure says modern facial acupuncture, with its carte blanche “Get rid of all those wrinkles!” orientation, is quite funny considering where and why facial acupuncture actually started thousands of years ago.

“In China, people wanted to get men and women together who were suited to each other. Much like Westerners would have their palms read, they would read facial lines and say, ‘Oh, well, look, he saves money and she is very good in the kitchen,’ just from reading their faces. Facial acupuncture originated, really, as a way of enhancing facial lines to express the inner beauty that a healthy body can express.”

Trained as a medical acupuncturist, Masure says she got into doing facial acupuncture back in 2006. Her offices were in the Chelsea district of London, which was really fashion-crazy at the time. “Maturing ladies doing cosmetic surgery enhancements and Botox treatments were asking me for help,” she says. “And more and more clients started asking me about doing beauty treatments. So, that’s when I started. I didn’t bother telling them that facial acupuncture is really just another form of medical acupuncture supporting the health of the whole body.”

Supportive studies

Clinical research shows that facial acupuncture can eliminate and/or reduce wrinkles, reduce facial edema, increase the tone of facial muscles, improve skin texture, and produce an overall livelier skin effect.1 It improves microcirculation in the face and reduces inflammatory reactions, all with minimal side effects.2

It is also an effective therapy for creating greater facial elasticity3 and a highly effective treatment for acne.2 Acupuncture is effective for treating psoriasis4 and has been found to possibly work better than traditional medications for the itching and general symptoms of eczema.5 Both conditions can affect the face, causing acute physical, psychological and emotional upset.

Masure, who takes a holistic approach, says she starts with a regular medical acupuncture intake, questioning clients about their overall health and illness patterns. She listens to their goals for treatment and starts checking out the color, texture and overall moisture content of their skin. As with most facial acupuncturists, the vast majority of her patients are women. Because premenopausal skin is easier and quicker to treat, she asks patients whether they are pre- or postmenopausal.

She reads the facial lines as a map indicating the health of a patient’s internal organs, using them as guidelines to understand what internal circumstances need to shift to increase the patient’s overall health and beauty. She considers the weather and time of year—skin is drier in the winter and more moist during the summer, for example. Also, where a patient lives is another consideration. If they live in a city, pollution is a factor. If they live in a cold or hot climate or in a location that has four seasons or two, it’s a factor. “It all has an effect,” she says.

The process of facial acupuncture itself is quite straightforward. “If I’m working on a line in the face—perhaps a ‘marionette’ line (from the corners of the lips down to the chin) or lines on the forehead—I stretch the skin with one hand and insert an intradermal needle directly into the middle of the crease,” says Shreya Kane, a facial acupuncturist at London Facial Acupuncture Clinic in the UK ( “I use sterilized tweezers to hold the needles because they are so tiny you can barely hold them with your fingertips.”

The needles don’t go in very far, usually only about 0.5 to 1 mm. And they work by basically causing localized inflammation. “The needle is a foreign body going into your skin,” says Kane. “It’s telling your brain and the cells around the insertion point to send neutrophils and blood over to that spot to start repair work.”

Originally a physiotherapist and pain specialist, Kane got into facial acupuncture when she saw its amazing results on clients suffering from excruciating trigeminal pain—a neurological issue involving the fifth cranial nerve running from the forehead along the temple to the chin area.

“Patients were on heavy medications and couldn’t even open their mouths enough to put a spoonful of food in because of the pain,” she says. “Acupuncture worked wonders.” Clinical studies concur.6

Today Kane treats clients for wrinkles and sagging skin, acne, “turkey neck,” double chins, eczema, psoriasis and pigmentation problems. She also helps women who have had “Botox disasters.”

“I had one woman come in who’d had Botox treatments who’d lost the lymphatic drainage capacity of her muscles,” she says. “There was so much fluid accumulation under her eyes it was literally like she had bananas sitting under her eyes. Facial acupuncture helped the lymphatic drainage of her face and reeducated her muscles to be doing what they should have been doing in the first place . . . lifting!”

Facial acupuncture vs. microneedling

The main difference between facial acupuncture and microneedling is that facial acupuncture is highly specific, treating individual wrinkles and lines. Microneedling generally accesses the whole face without localized attention.

“Microneedling is more for patients who want skin re-texturing,” says acupuncturist Dr Claudia Sandoval, owner of The Point Acupuncture & Herbal Clinic in New Braunfels, Texas. “It’s a little more invasive in the sense that the needles go more deeply into the skin and we do have to numb your face. Microneedling can penetrate to depths of 1.5 mm or more (deeper than individual facial acupuncture needles usually go) and is effective for helping reduce acne and chickenpox scars.”

Sandoval recommends microneedling for people aged 30 to 55. “Once you get into your 60s, I tend to push people more toward facial rejuvenation,” she says. “Once you get over a certain age, micro-needling is not going to do so much as far as lifting and getting rid of those deeper lines. For that I recommend facial acupuncture.”

She says combining the two methods can give highly satisfying overall results.

A typical treatment plan

All the facial acupuncturists interviewed stress that every treatment plan is individually tailored to the unique needs of the patient. For example, two women aged 45 and 75 might come in worried about the same things: facial lines and over-pigmentation. Because of the difference in the age of their skin—older skin is thinner and dryer with capillaries closer to the surface—the number of needles used per session, the length and diameter of the needles, the number of sessions and the time period between sessions will vary.

“Older patients generally mean more needles done more gradually,” says Kane. “They might need more space between treatment sessions to avoid bleeding and bruising. But the beautiful thing is, from session to session, I can see the older skin getting stronger and thicker with each treatment.”

Four to eight sessions, usually done weekly, is a normal full-term treatment plan. How the person reacts determines the total number of treatments. Yvette Masure takes a minimalist approach when it comes to the number of needles she uses. “I begin with five in the face and probably five in the body in appropriate places for a total of 10 needles in the first treatment. I need to see how a patient is going to react and see how their pulses change during the treatment while the needles are in—which they do. The needles themselves stay in for about 20 minutes.”

On the opposite end is Romy Simone, a cosmetic acupuncturist in Santa Monica, California (, who developed her own technique over the years. “Most acupuncturists use fewer needles than I do, about 10 to 20 on the face,” she says. “And they’re usually much longer needles that go in deeper. In comparison, I use 100 needles, and they’re very, very small so I can get into the crevices with less bruising and bleeding and that sort of thing.”

At the end of a treatment, most practitioners perform gua sha (gwah-shah)—traditionally a light pressure scraping of the total face and neck using a jade, crystal or even plastic implement.

Designed to release stagnant qi in the skin and underlying fascia, gua sha raises a lot of tiny rash-like dots under the skin called petechiae. This action brings more blood and oxygen to the surface of the skin, further stimulating elastin and collagen production and positively affecting circulation, facial tone and texture. Some practitioners use acupressure on the face and body as a post-treatment wrap-up instead.

Post-facial treatments like a collagen mask and/or hyalauronic acid and Chinese herbal treatments are frequently part of the service. But many facial acupuncturists don’t use them. “Putting substances on the skin before the needles are used or applying a mask afterwards brings the question up of ‘What is actually working? What is actually making the face look better?’” says Simone. “I have no problem with any of those things, but I don’t use anything else on the face. I like a clean slate.”

Overall, most facial acupuncture treatments last 60–90 minutes.

What to expect from facial acupuncture

Dr Romy Simone says that along with treatments, a large part of what she does is talk to women about what aging and beauty really mean to them and about their fears related to aging and becoming marginalized.

“I try to help empower women as to what beauty means,” she says. “I don’t tell them I’m going to make them look 10 years younger. I tell them I’m going to make them look like their best selves. That’s all.”

Here is a list of possible benefits that she lists on her website (

  • Reduced frown lines between the eyebrows
  • Reduced smile lines between the nose and mouth
  • Reduced horizontal lines across the forehead
  • Reduced “crow’s feet” wrinkles around outer corners of the eyes
  • Lessened dark circles and puffiness under the eyes
  • Reduced vertical lip lines around the mouth
  • Reduced chin and neck lines
  • Increased skin oxygenation and facial “glow”
  • More balance between oily and dry skin areas
  • Reduced acne
  • Reduced acne scars
  • Tightened pores
  • Tightened sagging eyelids
  • Diminished skin discolorations and age spots

How the face ages

Collagen is a protein that makes up as much as 75 percent of the dermis, the skin layer between the outer epidermis and the deeper subcutaneous tissues. As we age, collagen and elastin, proteins that provide fullness, structure and elasticity, break down faster than the body can produce them. Pollutants, stress, sun damage, smoking, poor diet and other factors reduce skin health and elasticity. The original smooth, fatty layer below the skin depletes and sags, especially around the chin and neck.

The traditional approach to countering these effects is the injection of the neurotoxin botulinum, better known as Botox, which works by partially paralyzing the facial muscles, keeping them from moving and forming expression lines. Sometimes the treatment involves injecting dermal fillers such as collagen and hyaluronic acid, a fluid substance found in the joints, tissues and eyes. Like botulinum toxin injections, dermal fillers wear out after several months, and treatments must be repeated to keep up “the look.”

“Unfortunately, using fillers like Botox eventually wears the muscles out,” says acupuncturist Dr Claudia Sandoval ( “After repeated treatments, you get even more saggy skin than you started out with because Botox tends to forget about the elastin part. Sure, you end up having no wrinkles because you’ve kept your face from moving and ‘making faces.’ The wrinkles are not there, but the sagging is still there and everything just starts to look droopy.”

Advantages over laser treatments

Both facial acupuncture and laser treatments use controlled skin damage as the way to stimulate the body’s natural production of new collagen and elastin. However, the “damage” done by facial acupuncture is much less because the technique is much more refined and pinpoints troubled areas.

Using hair-thin needles, usually around 0.12 mm in diameter and 3–6 mm long, facial acupuncture creates local inflammation in the skin, reeducating the skin to create more collagen and elastin and bring more oxygen to the surface—basically doing the things your skin would’ve done back in your 20s or 30s.

Laser treatments—fractional CO2 laser and CO2 laser light—or intense pulsed light (IPL) treatment use focused light to generate heat, and the damage it causes shrinks existing collagen, which tightens the skin and stimulates more collagen production. Laser treatments are ablative (an erosive process), removing the epidermal and superficial dermal layers of the skin and thus erasing the signs of aging

An enormous difference between the two approaches lies in facial acupuncture’s more holistic approach. Acupuncturists understand the interconnected nature of the body. In addition to working directly on the face, they frequently needle body points, targeting organs like the stomach, kidneys, liver and spleen—all of which affect facial skin health. Also targeted are acupuncture points for stress, especially along what’s called the Du Meridian. (The Du energy line runs from the top of the head down along the spine to the perineum.)

“Stress majorly affects the skin of the face,” says Dr Romy Simone. “We can be eating perfectly and exercising perfectly and still be aging faster than we should be if we aren’t managing our stress levels.”

Facial acupuncture advantages

  • Can be used on patients with varying skin tones without risk of discoloration
  • Hardly any visible damage (some occasional bruising) and much faster recovery
  • Few to no side effects
  • Less expensive than laser treatments

Acupuncture, acne and rosacea

Poor diet, stress, excess oil production, hair follicles that get clogged with oil, bacteria, air pollution—they can all add up to facial acne vulgaris. Once considered an adolescent cosmetic problem, adult acne issues commonly extend well into our 60s and 70s.

“I see a lot of patients with acne,” says Shreya Kane. “Acupuncture works beautifully for it.” She says it works so well because directly needling problem areas downregulates the production of the sebum (oil) glands. She also treats specific body points to help regulate hormones and the meridian system, both of which affect the complexion.

Acupuncture is also effective for treating facial rosacea, a condition commonly confused with acne, in which blood vessels in the face “flush,” often producing small, pus-filled bumps.7 Studies also show that acupuncture may work effectively to reduce scars.8 Although some facial acupuncturists defer to microneedling for healing scars from acne, chickenpox and other causes, practitioners like Kane say regular facial acupuncture works great.

“For old acne scars and pitting that’s been there for a long time, I do what’s called facial pecking to break up the old scar tissue. The face has many layers—skin, fascia and muscle. I go into the fascia with needles—almost like sewing stitches on a garment—feeling for the areas of most resistance, going around from different angles, breaking down the scar tissue underneath. The fascia immediately starts creating new networks. It’s absolutely amazing.”

Dr Simone describes treating a young woman in her 20s for a pigmentation condition with her own facial acupuncture protocol. “I didn’t know anything about her before I started treating her,” she says. “But after several treatments, during a session she burst into tears.

“When I asked her what was going on, she said, ‘You know, my pigmentation was so bad that I wore heavy makeup that they use for actors in the movies—heavy makeup that covers everything. I felt so insecure about myself, since I was 16, there’s not a day where I left my house that I didn’t put that makeup on, even if it was just to go to the grocery store. Since these treatments with you, I don’t wear any makeup at all anymore.’

“How freeing and life-changing is that, for a person to gain such a sense of self-worth and confidence? For me that story was just a wow.”

According to traditional Chinese medicine, the body’s outer appearance reflects its inner health. Therefore, certain facial traits can reveal internal health states and problems.

Healing acne with acupuncture

Geetanjali Tuli, 42, London

Geetanjali moved to London from India. She had severe acne issues because her skin is very oily, which didn’t suit the climate in the UK at all. She had some acne scarring and growing concerns about pigmentation problems around the sides of her mouth and on her chin. “My color had become very dark around my chin area and around my mouth,” she says. “I’m already dusky, but these areas were getting really dark. I was really concerned it would never go away.” In addition, some sensitive areas around her mouth hurt a lot.

She went to see facial acupuncturist Shreya Kane, first talking for about an hour and responding to Kane’s background questions about her family, health history, diet and stress levels. Next came the initial treatment, which was a detox treatment. 

“When a patient comes in, I always do points for detox the first session,” says Kane. “It’s a preparation for the body to take on the acupuncture and have a better patient response to the treatment.”

Geetanjali had a couple more facial acupuncture treatments, at which point Kane realized a lot of her skin problems were related to toxins in the body. So, the last two sessions she started off with detox points both times before getting into the facial points.

“I had a total of five sessions with her in four months,” says Geetanjali. “The needles didn’t hurt me, but where I had pain around my mouth, the thicker needles were actually easier for me to handle and were not painful at all. She did a few points on my head as well for de-stressing. I had amazing results!”

Geetanjali says her acne improved by around 75 percent. The pain went away and so did the pigmentation problems.

“I was not using any facial products during those four months because we wanted to see what the acupuncture would do. The color came back into my skin and the acne scars have also gone. I did use some topical ointments on the scars at the same time, so maybe that was a combination thing. But what an overall difference!”

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