This is an introduction to the subject of Facial Revitalisation Acupuncture (FRA) or Facial Rejuvenation Acupuncture, as it is commonly referred to in the United States and most other English speaking countries. FRA is a virtually painless method firmly rooted in the principles of oriental medicine. Like regular acupuncture, FRA involves differential diagnosis and the use of multiple needles to move or balance the qi, blood, and fluids within the body as well as restore or maintain harmony between the five elements, yin and yang, and the various zang fu. The visible aesthetic results on the face are generated from treating both the root (ben) and the branch (biao) reflecting the improvement in overall health that is simultaneously achieved. In China and in Chinese literature, it is referred to as mei rong, which translates as Chinese medical cosmetology.
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Facial revitalisation acupuncture  (FRA), or facial rejuvenation acupuncture, is a virtually painless method for reducing the signs of the ageing process with results far more profound than merely what is visible on the face. Although sometimes referred to as cosmetic acupuncture, an acupuncture facelift, or facial acupuncture, it is far more than a cosmetic procedure. For thousands of years, the Chinese have known that beauty originates from the inside and addressed the subject accordingly. There is a famous Chinese axiom, ‘Where qi goes, blood flows’. Thus even for those unfamiliar with the principles of Chinese medicine, it is known that increased circulation helps the body to look and feel better. Including the term revitalisation or rejuvenation when referring to this practice helps to reflect its inherent nature. In China and in Chinese literature you will find it referred to as mei rong, which translates as Chinese medical cosmetology. Mei rong, or FRA, relies upon and is a further development of traditional Chinese medicine (TCM) theory and practice. It can be likened to a new blossom of an ancient tree of knowledge.
Facial revitalisation acupuncture is a very thorough and effective process designed to help the whole body both look and feel younger. It involves the use of extra fine gauge filiform acupuncture needles and intradermals (preferably Seirin brand needles) . As with regular acupuncture, points are chosen according to the constitution of the individual and specific needs at
the time of treatment. The established parameters of diagnosis and treatment strategy will generally apply when practising FRA. Many local points on the face and head are also needled to obtain the extra cosmetic effects. Other than bruising and haematomas, there is virtually no risk or adverse side effects. Headaches and dizziness are possible if the precautions of grounding the qi and releasing any tight neck muscles are not exercised before administering FRA.
Thousands of years ago the Chinese discovered that many meridians either commence or terminate on the face and some have internal branches that go to the face, correlating the relationship of health and appearance. Changes and deterioration in the skin, muscle tone, and sense organs reflect the state of the zang fu, qi, blood, yin and yang. Different treatment methods are emphasised and specific points chosen according to how an individual is manifesting his or her ageing process or health imbalances. The whole person is treated and evaluated on the body-mind continuum – the foundation of Chinese medicine.
The use of acupuncture for ‘cosmetic’ purposes has already attracted great attention worldwide. The media have latched on to this trend, fuelled by the current cultural obsession with looking youthful and reports of celebrities receiving this treatment. It is not surprising that many seeking FRA treatment are those who have not received acupuncture before, or who would not seek acupuncture and Chinese medicine otherwise.
There are several different types of cosmetic acupuncture being practised in the West. Therefore, some of the benefits, findings, and suggestions may apply solely to the method of facial revitalisation acupuncture that I teach and practise.
Cosmetic acupuncture does not require the use of electro-acupuncture or e-stim that is so commonly used for this purpose. It has been my experience and that of many practitioners that a good protocol and precise technique actually work much better without the use of extraneous devices. My personal opinion is that technology, albeit useful in certain aspects of acupuncture treatment, is no substitute for skilled hands, the cultivated qi of the practitioner and attunement with the qi of the patient. In addition, the head is more susceptible to influences of pathogenic wind and I have seen many patients who have received electro-acupuncture or micro-current for this kind of treatment who have developed facial tics coinciding with their cosmetic acupuncture series. These modalities should be used with caution, especially for those patients that have an internal terrain that is predisposed to wind.
A brief history of Chinese medical cosmetology
The quest for beauty and longevity is universal and has prevailed throughout the ages. Preoccupation with youth, appearance, and longevity is certainly not the exclusive domain of citizens of the modern Western world. Beauty seduces many to pursue healthful measures. Indeed, the earliest evidence for this in China dates back to 50,000 years ago (the late Paleolithic period) from relics of adornment found and materials believed to be for make-up and visual enhancement.
Before the Warring States period of Chinese history (475–221 BC) having acupuncture treatment for cosmetic concerns was primarily a luxury, generally reserved for the Empress and the imperial concubines to initiate the healing process for rejuvenation and longevity as well as health. Theory and treatment for aesthetic concerns can be found in the Huang Di Nei Jing (from the first or second century BC according to different sources). The Nei Jing describes the effects of age on the skin and appearance, conditions that relate to the aforementioned and techniques used to treat these including acupuncture, moxibustion, facial massage and qi gong. While laying the foundation of traditional Chinese medicine, the Huang Di Nei Jing also sets the stage for the formation of TCM cosmetology, though no one section of this Chinese medicine classic is specifically devoted to it. Pathological manifestions of the skin such as acne are discussed and their aetiology explained in the Sheng Qi Tong Tian Lun, a chapter of the Plain Questions in the Huang Di Nei Jing. The Nei Jing also describes the relationship between diet, health and appearance and has dietary recommendations, including the preparation of specific foods.
The first Chinese pharmacopoeia, the Shen Nong Ben Cao Jing (The Divine Farmer’s Materia Medica Classic) contains 43 herbal cosmetological references. The author, Shen Nong, is thought to have lived from 2737 BC to 2697 BC, his herbal knowledge compiled around 220 AD and then published around 500 AD during the latter Han Dynasty. Many other ancient Chinese sources and authors provide cosmetic prescriptions including the illustrious Sun Si Miao (581-682 AD) who included 105 mei rong formulas in his classic texts, Bei Ji Qian Jin Yao Fang and Qian Jin Yi Fang, as well as acupuncture and moxibustion treatments for cosmetic enhancement. The renowned Li Shi Zhen (1368-1644 AD) of the Ming Dynasty mentioned 270 cosmetic herbal drugs in his definitive and epic treatise, Ben Cao Gang Mu (Great Compendium of Herbs) which is said to be rivalled only by the Shang Han Lun in the field of Chinese herbology.
During the politically turbulent years of the middle and late periods of the Republic of China, the development of traditional Chinese medical cosmetology was arrested. In modern China however, mei rong is flourishing, in part due to the economic boom and rapidly increasing standards of living since the 1990s. Likewise TCM practitioners noticed with great interest when treating conditions like Bell’s palsy with local needling, that the surrounding area was visibly improved in the following ways: skin colour, texture, complexion, elasticity, sebaceous secretions, and the size and depth of wrinkles as well as the eyes becoming brighter. Currently you will find a mei rong department in most hospitals and universities in China.
FRA: the effects
A 1996 report in the International Journal of Clinical Acupuncture reported that among 300 cases treated in China with cosmetic facial acupuncture, 90% had marked effects with one course of treatment. Effects included: improvement in skin texture and colouring, increased elasticity, reduction of wrinkles and overall rejuvenation, not merely confined to the face.
The effects of FRA vary according to the prior condition and lifestyle of the patient, the techniques employed by the practitioner as well as the experience and skill level of the practitioner. Although one cannot promise or guarantee results or advertise as such, FRA may erase as many as five to fifteen years from the face, with some results apparent as early as the first treatment. The effects of acupuncture being cumulative, the results continue to progress throughout the course of treatment.
Though not a cure for wrinkles, fine lines may be eliminated while deeper wrinkles tend to diminish considerably. Other likely results include eyebags being reduced or eliminated, puffiness of the face reduced or banished, facial colouring equalised (whether too red or too pale), drooping eyelids lifted, and double chins minimized and in some cases eliminated. Drooping eyelids and eyebrows, jowls and ‘turkey necks’ can be observed as having lifted and toned. With the profound increase of local circulation of qi and blood to the face and stimulation of the movement of lymph, skin texture and colouring improves visibly, the moisture content of the skin improves, muscle tone improves, and pore size is regulated. Techniques can also be employed to eliminate broken capillaries. Rosacea may also respond to FRA treatment in certain cases that I have seen. Visible stress and habitual expressions from the face melt away. By balancing qi, blood, fluids, and yin and yang, the body is put into balance and optimum tone so that the ageing process and its causes are slowed down, halted or even reversed.
As with regular acupuncture, the results are manifold and include the improvement of circulation, digestion and hormonal balance, and empirically have been found to benefit the hair and the sense organs, thyroid and brain.
Acupuncture is known to have neuro-endocrine effects and benefit hormones. For many women oestrogen levels decline with age, accelerating the ageing process of the skin. Establishing hormonal balance will benefit many aspects of the body, including skin conditions such as hormonal acne and the dry skin that frequently accompanies menopause.
By addressing the shen or spirit of the individual, the eyes brighten and the skin develops a glow not possible by allopathic means. Treating at the spirit level allows the innate beauty and radiance of an individual to be brought forth for all to see. One does not have to be treating a psycho-spiritual condition exclusively to achieve these kinds of results. Intention is so powerful with an energetic medicine such as acupuncture.
FRA: possible underlying mechanisms
According to the Nei Jing, the hair and skin, including the complexion, are related to the state of the internal zang fu organs. The condition of the hair is governed by the kidneys and the lung rules the skin. Likewise a chapter of the Miraculous Pivot called the Yin Yang Er Shi Wu Ren also discusses the relationship of the channels and collaterals and appearance while the chapter called Ben Zang Pian elaborates on the importance of wei qi on skin and complexion. A likely ancillary benefit of FRA is increased immunity.
As the partner of the lung, the large intestine also affects the skin profoundly and thus many points on the large intestine meridian are used for affecting the skin of the face. The stomach meridian traverses much of the face and is often used to obtain local cosmetic effect. The stomach is the interior-exterior partner to the spleen and accordingly these points help to tone the flesh (the muscles and the fat underlying the skin). This communication of the lung and the spleen (zang organs) and the stomach and the large intestine (fu organs) allows them to act synergistically and to substitute for each other in their functions. Increased subcutaneous fat is a likely cumulative result of needling stomach points on the face coupled with tonification of distal spleen points.
One of the many explanations of the various mechanisms by which acupuncture works is that with needle insertion, the body endures a micro-trauma that in turn stimulates the injury repair system within the body. It is this natural healing process that stimulates the production of collagen at the site of the needle insertion. Regeneration of the dermis and epidermis produces new collagen and elastin proteins. New skin tissue essentially appears younger.
The University of California in San Francisco is undertaking a study on wound healing with acupuncture, based on a hypothesis that using acupuncture will facilitate wound healing, which is based on evidence that acupuncture causes increased blood circulation locally. Blood contains vital nutrients, hormones, oxygen and life force and will revitalise tissues that it infuses.
As we age, all our bodily systems decline: our circulation slows down and can become impeded, our hormonal levels drop, our ability to digest and absorb our food decreases so that we no longer operate at our peak levels as we may have in the past. FRA helps to bring all the bodily systems up to the optimum levels possible for that person while appeasing their appetite for a younger appearance.
Facial revitalisation acupuncture is contraindicated for some pituitary disorders such as a pituitary tumour, heart disorders, individuals who have a problem with bleeding, such as haemophiliacs, or those who are extraordinarily prone to bruising. Administering FRA to anyone with high blood pressure or diabetes is forbidden even if these conditions are said to be ‘controlled’ through medications. For those who would be described in TCM as being of a livery nature, caution and extra efforts should be applied to prevent headaches and dizziness. Administering FRA to people who suffer with migraines should be avoided. For those patients who are diagnosed as being HIV positive or having developed AIDS, this type of acupuncture should be avoided. Caution should be exercised if the patient has had hepatitis previously. Judiciousness should be exercised if facial lymphoedema is present as these patients are far more prone to infection. If the patient is prone to wheezing as in the case of asthmatics, or in the presence of a serious cough, one must consult the patient as to the frequency and severity of the condition and judge if the patient can comfortably and safely receive a long and perhaps intense treatment. Facial revitalisation acupuncture should not be administered to a pregnant woman as there are points used that are forbidden in pregnancy besides the obvious difference in treatment strategy of bringing so much qi to the surface. Similarly, FRA would not be advisable during any acute illness or any chronic illness that is serious in nature, when a headache or nausea is present, during a bout of cold or ‘flu, or during an acute allergic reaction or in the presence of an acute herpes outbreak, hangover or intoxication of any sort. Regular forms of acupuncture are generally recommended and found to be beneficial for the above contraindications to FRA. Great caution should be exercised with those patients who are undergoing or have had plastic surgery, botulinum toxin injections and similar allopathic cosmetic procedures.
FRA: patient suitability
Almost everyone could benefit from this type of acupuncture provided they possess no contraindications. Ideal subjects for FRA treatment are both male and female subjects in middle age. The more out of balance, emotionally distressed or aged a person looks, the increased likeliness for more dramatic results. Obviously someone aged 25 will not look 15 years younger from FRA. If potential patients in their twenties or thirties request FRA treatment, one should try to convey to them the results may not be as dramatic as if they were to embark upon a treatment series in their forties, fifties, or sixties for example. If however, they are satisfied with looking perhaps only five years younger and helping to maintain the way they look now for a longer period along with using the treatments as preventative medicine, not just for ageing signs but also for overall health, then one can proceed in treating them. Patient expectations have to be addressed before a series of treatment is embarked upon. For some patients in their sixties or older, they are more prone to have contraindications, or might not be able to tolerate such a strong treatment without modification. Age limits will ultimately depend on the individual seeking treatment.
The course of treatment
I recommend a treatment series consisting of 12 treatments, although I have seen instances in books from China where 20-60 acupuncture sessions are employed for this purpose. Treatments may be administered once or twice a week with a day off or more between treatments. Optimally, it is better to do more treatments scheduled closer together initially. Twice a week for the first three weeks and once a week for six weeks after that would be even more effective than once a week for twelve weeks. It is my experience that performing a longer (approximately 90 minute session) and more thorough treatment will not only give better results to the outcome of your work, but also will help create and maintain a good reputation for this specialty of acupuncture and, to some extent, the field at large. Quality treatments preclude the need for such large quantities of treatment.
The aesthetic benefits are usually observed in the first session in most subjects. Acupuncture benefits are cumulative in effect and with FRA tend to become significantly more noticeable and lasting midway through the series. The subsequent treatments help to ensure the magnitude and duration of the effects from the FRA treatment series.
Following the initial course of treatment, maintenance sessions administered seasonally or monthly will prolong the results for many years. How long the effects will last is difficult to know and will depend on the quality and quantity of the treatments performed as well as the age, lifestyle, emotional state and internal health of the patient.
Although highly effective when facial revitalisation acupuncture is employed exclusively, results are magnified when FRA is augmented with herbal and nutritional supplements, facial massage and/or acupressure, facial exercises, therapeutic grade essential oils and aromatherapy blends for the skin, lifestyle counselling and a healthy balanced diet. I have found it to be vital to treat the psycho-spiritual issues that often surround the ageing process and for self-esteem, particularly when the self-esteem is based on body image and appearance. Acupuncture, minute doses of Chinese herbs, homeopathy or the utilization of vibrational remedies such as flower essences can all be used for this objective if they are within your professional training and scope of practice.
From clinical experience, I have found the order of insertion and removal of needles both on the face and the body to be important. I recommend the following order of insertion: auricular points followed by points on the body, starting with points to ground the qi on the feet, moving up the body using points on the legs, hands, arms, trunk, neck, and scalp before needling points on the face itself. The face is very sensitive to needle insertion and thus commencing with needling of ear points can release endorphins and has something of an anaesthetizing effect on the face. While the mechanism is not exactly clear, needling ear points gives a much greater glow to the face and must in some way be affecting the shen as well as reflexively treating specific areas of the face. I actually use many of the identical points when administering acupuncture for dental anaesthesia as I do when performing FRA. Since so much qi, blood and yang are stimulated to ascend to the head with this protocol, I have found it essential to use points on yang meridians on the feet such as GB 41 (zu lin qi) and St 44 (nei ting) to anchor the qi, especially that of the gall bladder meridian. These points are highly efficacious in preventing headaches and dizziness from the treatment. While I have not found it to be a problem when giving treatments in my own practice, I have found it to be problematic in the clinical component of the workshops which may stem from having the needles retained too long in a class situation, as can sometimes happen when people are nervous and learning a new technique.
There are some styles of acupuncture that embrace using a lot of needles and there are clearly those that do not. Like many aspects of the Daoist art that we practise, there are many anomalies as to how to practise acupuncture. I do not think anybody would say that more needles are better in principle. This treatment, however, requires a lot of needles because you are treating all the internal causes of the signs of their ageing process as well as lots of local needling. If the constitutional points were not used, the treatment would be only symptomatic in nature and the results temporary at best. Extra points to ground the qi are essential to prevent headaches or dizziness. If you want to see an aesthetic result you must also insert a needle locally in most instances. Otherwise, why do not patients look years younger from regular acupuncture without the use of so many local needles? Patients can easily tolerate lots of face needles when there is a gentle insertion with virtually no stimulation or manipulation of the needles. The face is highly vascular and bruises much more easily than other parts of the body. Utilising a thicker gauge needle increases the discomfort level and risk of bruising. For most points an even insertion is advisable. Manipulating the needles during insertion or once they are in can create more risk of bruising and possible over-stimulation of the patient. Rather, points can be tonified or dispersed through intention. For the majority of body points, the intention would be to tonify. Obtaining de qi sensation is not necessary for effective results or recommended for FRA, especially on the face points. Despite theories of needle technique regarding the speed of inserting and removing needles, I highly recommend a slow removal of the needles with gentle pressure afterwards for a few seconds. These extra measures will greatly reduce the risk of bruising. It is essential to have anti-bruising agents on hand to prevent and treat any possible haematomas that could occur.
FRA: the advantages
As acupuncture practitioners, we know that treating the underlying cause of why someone is ageing is preferable to masking the outward symptoms and allowing further decline and dysfunction to continue within the body. Acupuncture is an excellent alternative for cosmetic surgery, and potentially dangerous cosmetic procedures such as botox. Far less costly than cosmetic surgery, it is safe, having no risk of disfigurement or side effects other than bruising. Unlike those kinds of procedures which may require an extended recovery period with swelling and discolouration, there
is no trauma from facial revitalisation acupuncture. Obviously, facial revitalisation acupuncture cannot reshape one’s nose, but it can achieve a more subtle rejuvenation that takes years off one’s face, safely and naturally while most importantly, improving overall health.
1. In the United States the terms rejuvenation and revitalisation are used interchangeably in common use without distinction as they are in the United Kingdom. The British Acupuncture Council has specified the use of Facial Revitalisation Acupuncture to be utilised to describe this practice in accordance with the guidelines of the Advertising Standards Agency.
2. I have found Seirin brand needles help to minimise the sensation of the insertion and are less likely to cause any adverse reactions such as erythema and leaving marks on the skin, which is possible with poor quality needles where the coating of the needle is more apt to come off and irritate the skin. Spinex intradermals are also of good quality and come from Seirin.
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