Michelle Gellis Thumb

AAC – Treating Cosmetic and Neuromuscular Facial Conditions with Facial Motor Points

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Hi, everyone. Welcome this afternoon. I want to thank the American Acupuncture Council for this opportunity to present on treating the face with facial motor points, and I appreciate everyone coming out in the middle of their afternoon or evening or early morning, depending on where you are. If we can go to the slides, little bit about myself, my name’s Michelle Gellis, and I teach cosmetic and neuromuscular facial classes, facial acupuncture classes, internationally. This is a picture of me teaching a class about a year ago in Maryland. What I wanted to talk about today were a couple of things that work with both cosmetic and neuromuscular facial conditions, but before I did that, I did want to talk a little bit about facial acupuncture in general.

When we use the term facial acupuncture, we are talking about a very large topic, so it encompasses anything having to do with a person’s appearance and/or a function of their face so things like wrinkles and sagging skin, and also neuromuscular facial conditions like Bell’s palsy, TMJ, trigeminal neuralgia, stroke, ptosis, and many other facial conditions. Facial acupuncture is actually the largest growing subspecialty in acupuncture right now and so getting trained is something I’m going to talk about in a moment, but it is very important if you are going to specialize.

Facial hair acupuncture can include everything from just needling to using facial cups, gua sha, or doing microneedling on the face, and facial acupuncture is not some new and trendy thing that the Kardashians are doing on social media. Yes, they are and it is really something that has been around a very long time. When they found the emperor and the empresses in their tombs, they had jade gua sha tools and there are records dating back to the Sung Dynasty and even before that of people talking about facial acupuncture throughout history. I have written two publications for the Journal of Chinese Medicine. I’ve written many publications, but to specifically of interest, one is on treating neuromuscular facial conditions with more of a multifaceted approach.

Today we’re going to be speaking about facial motor points, and this is part of a multifaceted approach to treating the face. I’m a classically trained 5-element acupuncturist. I have been teaching at the Maryland University of Integrative Health, formerly the Tai Sophia Institute since 2003, and my second publication was on the importance of clearing energetic blocks prior to doing any facial acupuncture, and links to both of these can be found on my website facialacupunctureclasses.com. As I mentioned, there have been quite a few studies on facial acupuncture. I’ve listed a few here, and some of them are pertaining to the cosmetic effects and some of these are pertaining to more of the functionality of the face.

These slides will be available on the AAC site and when I teach my classes, I go over these in a little more detail, but I just wanted to let you see that there actually has been researched done on facial acupuncture. When you’re thinking about your practice and how facial acupuncture can fit in, if you’re just looking at the cosmetic aspects, it’s great because you’re not dealing with insurance. It’s a very reliable stream of cash income. Again, you’re not dealing with insurance. You don’t have to bill the insurance companies, and one thing that we’ve learned during this pandemic is just how much people depend on having other people take care of them for their appearance, and people will spend money on vanity before they will spend money on their health.

If you think about some of the signs, the protest signs for things to open up, they were, “I want to get my haircut. I want to get my nails done.” No one was saying, “I want to go see my doctor or my dentist.” People do spend money on vanity and also, if you learn the neuromuscular foundations of a lot of this, it can open your scope of practice. You can see patients or patients will seek you out because you have this subspecialty or someone who will be known for being able to work on the face. A lot of us, we go to acupuncture school where we don’t spend a lot of time needling the face. We’re not comfortable with it. We didn’t really focus on learning those points.

It opened your scope of practice, will give you a very unique skillset. These are some pictures of me doing some microneedling in a class and some facial gua sha. That’s the benefits for you, for your patients done correctly. A facial acupuncture treatment should include body points and should bring chi and blood to the face, to the muscles, to the skin. Facial acupuncture because it is a full body treatment helps with digestion, immunity, circulation, and all of these things. Everything shows up right here, and it will carry nutrients to your cells and by doing that, it helps to stimulate collagen and elastin production.

Also if you’re using intradermal needles, which are very small needles which require some specialized training to be very effective, it will actually stimulate collagen and elastin production. Again, for your patients, if your patients is having any sort of… This patient of mine had ptosis where one eyelid was lower than the other. You could see her eyelid on our right, but her left was lower than her other eyelid, and she was getting married. She was very self-conscious about it and through treatment, I was able to get the levator muscle to function better and help so that her eyelids were even. On a more cosmetic level, people that have rosacea, facial acupuncture treats the hormones.

We do hormonal points if that’s an issue, and it can help with different skin conditions. This was a student of mine in one of my classes and just during the course of class, I worked on one side of her face and she had a rosacea, and you can see how the rosacea cleared after I had done the facial cupping. People asked me all the time, does facial acupuncture work, and these are just a few of my before and after photos. This person up in the center and the top, she had a scar right in her nasolabial fold and through treatment, the scar softened and ultimately, dissipated.

This person down here in the center, had some dark spots and again, through treatment and some intradermal needles through microneedling and I also work a bit in my classes with skincare, with skincare, I was able to really help her to get some of those dark spots to disappear. This other patient here had a tremendous amount of modeling in her chin, a lot of wrinkling and the corners of her mouth were very much turned down. As you can see in the bottom picture here on her left on our right, that the corners of her mouth, instead of being turned down, they were starting to lift up. With her, I definitely used some motor points, which is the topic of today’s conversation.

Again, another patient. This was actually someone who’d been coming to me for years with wrist pain, elbow pain, shoulder pain on and off. She saw that I specialize in cosmetic acupuncture and she was concerned because she was having some asymmetry where her one brow and lid was coming down a little more than the other. I said, “Just get on the table,” and I treated the left side, and the difference was remarkable just from one treatment. Again, I used motor points in that treatment. Getting trained is important. The American Acupuncture Council does require that if you are doing cosmetic acupuncture, that you get trained by one of their certified providers, and I am one of the few people on their list of people who do training.

The reason for that is because there is special documentation, there are precautions, there are red flags and you really need to prescreen your patients for different contraindications. If someone hasn’t been screened properly and you are doing cosmetic acupuncture, you can bring on things like headaches. If they are prone to high blood pressure, it can raise their blood pressure, and many other things. The other part about training is, as you can see, there are 43 muscles in the face. Many of them are very small and when you’re working with the musculature of the face, you really need to know what you’re doing so that you don’t cause asymmetry, overstimulate a muscle or the nerves and the blood vessels, the capillaries on the face.

Some of them are very close to the surface, and really knowing where they are and how to prevent bruising is important. I’ve made a list of some of the neuromuscular facial conditions that I see most often in my practice. When someone within a 20- to 30-mile radius of where I live is looking up acupuncture for one of these conditions, I’m going to come up because this is something I specialize in. Again, specializing in facial acupuncture can be very beneficial for your practice and when I’m treating any of these conditions, of course, I will treat the underlying condition and I do use a multifaceted approach. Meaning, I use some submuscular needling and facial cupping, some gua sha, some scalp acupuncture, but motor points are a big part of treating neuromuscular facial conditions.

Also when we’re working strictly with cosmetic conditions, if you think about our emotions and how they manifest on the face, really understanding each one of the emotions, either from a 5-element perspective or just from a TCM perspective, how these organs being out of balance, what kind of wrinkles that might cause on the face. Using some of the motor points to really as reset switches, and we’ll talk about that in a second, can really help with things like hooded eyelids, the frown lines, crow’s feet and Bell’s palsy. I found these pictures in a book for artists or sculptors. They are artists, but I love them because they show a face at rest and then four different emotions, which of the facial muscles are used.

As we age, these muscles become not as functional as when we get older. Now some of them get overused, some of them don’t work as well. Some of the muscles that we overuse are going to end up causing lines and sometimes early sagginess on our face. You can see here when someone is showing rage, just how many different muscles are involved, and the same thing with joy. Motor points are something that were discovered actually quite a long time ago. Medical doctors have used them. I found an old medical text, and they were using motor points with hypodermic needles and stimulating them. I’ve listed some of the researchers, some of the people that have done a lot of work in the motor point world and what a motor point is, it’s the most electrically excitable part of the muscle.

When you find the motor point, you can stimulate it, and it is where the motor nerve bundle is… The nerve is actually attached into the muscle. Fortunately for us, many of them are acupuncture points. We don’t have to have a deep knowledge of anatomy in order to find them because we have the acupuncture points as reference points. If a muscle is too flacid, it’s not firing properly and if it’s too tense, it’s not firing properly. By stimulating the motor point, you are helping the muscle to function properly, whether it’s to relax or to get back to doing its job that it should be doing. As I mentioned, many motor points are also acupuncture points, but they are not trigger points or ashi points.

A trigger point is really a sore spot and you press on it or you needle it, and it feels good. It could be like a knot, but motor points are different, and there are motor points on the face. All of them are innervated by the seventh cranial nerve, except for the temporalis and the masseter, and those are innervated by the trigeminal nerve. In order to figure out which motor point you should use, if you looked at those other drawings, there’s arrows going in every direction. You have to understand what the functions of the different 43 facial muscles are.

When I teach my neuromuscular class or I have an advanced cosmetic class, I go through every single one of the emotions or every single one of the issues that might come up with a particular, if someone had Bell’s palsy and which motor point to use, but we are going to talk about a couple of them today. Normally, you just needle straight in or slightly at a slight oblique angle, and you want a needle into the muscle, but not through the muscle. I think I just did this slide this morning. I think this is all of the facial motor points. I’ve got one dot for each. I got a little crowded on one side, so I put some on the other side.

As you can see, there are quite a few facial motor points, and then there are others for the platysma and for the temporalis and also for the SCM, but I don’t have those marked out on here. Let’s talk about a couple, and the first two would be the procerus and the corrugator, and they give you the angry eyes or the frown lines. Here’s the corrugator muscle and the motor point. This brings your eyebrows together. It works in conjunction with the procerus, which is right here, but for the corrugator, the motor point is just lateral to bladder two. For the procerus the motor point is actually Yintang, so it’s easy to find. Again, these two muscles work together to bring the eyebrows together.

Another muscle group is the frontalis, which helps to raise your eyebrows, like if you’re surprised or inquisitive. For each wrinkle just about, there is an underlying emotion and it’s a topic for a whole nother conversation, but I just wanted to bring that up. I could talk about this for six hours so I’m trying to squeeze everything in in a half an hour as much as I can so. The frontalis again causes these horizontal wrinkles. The frontalis is two muscles right here and the motor point is gallbladder 14, and I have a little video. I had needle this on a patient and just stimulated it. You could see that her issue was a drooping eyelid on one side, and the frontalis is connected to your eyebrows so I had needled that.

As you can see, it really woke the muscle up. The orbicularis oculi is something that can be affected if a person has Bell’s palsy or a stroke, and the way you would test for it, can the person close their eyes and open their eyes. From a strictly cosmetic point of view, it is involved and these are called crow’s feet. Here is where the orbicularis oculi is, and there’s two motor points. One is between Qiuhou 23 and gallbladder one, and the other one is the extra point right here, which is more or less between stomach two and gallbladder one. Another motor point and this is something that is important for pursing your lips, bringing your top lip up.

If someone had some sort of paralysis around their mouth, if they put their lips together and they blew out, air would come out. If you or I did it, it would come out evenly, or it wouldn’t come out at all, but if someone had paralysis on one side, the air would only come out on the weak side, and it can also cause lip wrinkles. You can see a picture right here of how all of this works, and the name of the muscle is the mentalis. It makes your lip go down. There’s actually three different muscles that are involved in getting your bottom lip up to your top lip, but it can cause wrinkles on your lower chin and wrinkles all around the lips, and here is a video.

I had a student in class who had had Bell’s palsy years ago, and she said she still could not close her lips completely. I went ahead and needled the mentalis, and I noticed immediately that the muscle started twitching. I stimulated it, and you can see what happens. This was a muscle that wasn’t functioning at all. One of the things that comes up right now during this time, we’re in the middle of a pandemic, and our patients should be wearing masks in our treatment room. There was a lot of questions that have come up. I teach my classes now via livestream webinar, and my students have asked, “Well, how am I going to do my job?” Well, I just started back to work last week, and I gave a lot of thought to I can certainly protect myself, but I want to keep my treatment space protected as well.

The first thing I did was I took a box of surgical masks, and I did a little video. If you go to my Facebook group, I have a Facebook group. It’s called facial acupuncture, or my Instagram is also facial acupuncture. If you go to either one of these, you will see I have hundreds of short demonstration videos, articles and this was I think last week. I just took a surgical mask and so anyway, I have a demo video of how I made this, but I just took a regular surgical mask, cut the elastic, folded it. I use some hemming tape, like seamstress might use, or you might use if you wanted to hem your pants without the needle and thread. I just use the tape on the inside, and then I just reattached the elastic.

You can see the front and the back, and this wasn’t the best version. This was a version that I did. I hadn’t tucked the sides in, but other than LI20 and right around the top and bottom of my lip, if someone is wearing this mask, you can get to their entire face and neck. If they were to cough or sneeze or whatever, it’s still contained under a mask which works. I used one six times last week and I just give it to my patients, and then throw it out. Surgical masks are easy enough to get on Amazon right now. They’re inexpensive too. The next level that I’m working on, I saw this idea on the right, which was designed for aestheticians, and it’s a lucite box. I actually ordered one, but for my purposes, it was too open.

I was concerned that it was just too open, so I’ve actually been working with the manufacturer. I have designed this box on the left. I don’t have a photo of it, until I let them know how many I want. I’m not going to be selling these for profit. I’m going to probably order five or 10 or a hundred, and then just have them shipped to acupuncturists, so they can safely treat their patient’s face. Your patient’s head would go here. There’s holes for your arm. It’s very high up. It’s 15 inches, so your patient doesn’t feel claustrophobic, and I angled this part. When you’re sitting and working on their face, you can lean over and get a little closer. The little dots here, these boxes are actually collapsible.

When it comes in the mail, it’s whatever five pieces, and then you just put it together, and that way you can take it apart if you’re traveling or if you just want to store it, you don’t need it, but it was my extra level of sneeze guarding because a large part of my practice is treating people’s faces. That is my very quick talk on facial motor points, and I am going to open it up for questions. Alan, if you’re there, I don’t know what to do with my slides while we’re doing questions though. I see. Something in the chat box, leave the slides. Okay. I left the slides. No questions. Yeah. If you have questions, you can put them in the comments, and I will answer them later.

If you have questions afterwards, you can just put them in the comments and I can answer them. Okay. Thank you again for tuning in, and you can visit my website, facialacupunctureclasses.com. There’s information about my livestream and my recorded webinars, and I want to thank the American Acupuncture Council again for giving me this opportunity. Thank you so much.

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