Tag Archives: Facial Acupuncture

Treating Facial Wrinkles with Intradermal Needling

And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name is Dr. Shelly Goldstein. Welcome to the American Acupuncture Council. Thank you so much for having me here today. And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started. We think of wrinkles on our face and we think of them as just wrinkles.

But in fact, there are many, types of wrinkles on the face, and they come from many different sources. We can get wrinkles from. Bone changes and over time, all of these changes occur on many different levels. So from the deepest level bone, as we age, bone resource, or starts to break down, bone is the underlying structure of our face.

And so when the bone starts to break down, so do the overlaying structures, including the skin or the surface, which is where the wrinkles. We can get wrinkles from muscle changes over time. We say muscles attenuate, which means they, they get stiff and stagnant and then they create different peaks and values increases in the face.

We can get wrinkles from fat changes. Over time, fat starts to break down and move primarily into the nasal labial fold, or that fold between the edge of the nose and the corner of the mouth and accentuates different types of wrinkling. And then of course, all of those wrinkles show up on the skin. So on top of the wrinkles that occur from the skin level.

Are those deeper wrinkles? So today we’re gonna focus on the wrinkles that we see that appear on the skin from skin changes. The skin is part of the Anta system. The anta system consists of that fat layer, the subcutaneous of the hypodermis. And then on top of that is, Dermal layer, which is the true health of the skin.

Skin cells start at the bottom of the dermis, make their way up to the epidermis, above the dermis, and then they float to the top and they come off. So the true health of the skin and the visible health of the skin reside in the epidermis and the dermal layer, and that is the layer that we’re going to talk about when we talk about intradermal needling.

Intradermal needling is one of many different types of needlings that occur when you go get an injection or a hypodermic shot if they go into the muscle. It’s called intramuscular need. If it’s at the slide slightly into the, that subcutaneous level that’s called subcutaneous needling, intravenous, lev needling goes right into the bloodstream, and then there is the intradermal needling, which goes between the.

Into the dermal layer. So we see on needling too deep is that it misses that middle dermis layer. If you needle too shallow, it stays too superficial at the epidermal level into, if it’s inserted properly, it goes into the dermis and you can actually see it creates a little swelling at the surface.

And that’s how you know if you are into the intradermal needling because you can actually see the surface of the skin popping. Why, intradermal needling into the dermal layer? What’s going on? Basically, and in a nutshell, we’re working in the connective tissue portion of the dermal layer. There are two types of connective tissue in the dermal layer of the tissue.

There’s the papillary layer. Which is that loose mesh work that we can see on the right, and this primarily provides the nutrients to the skin, and then there’s the rec particular level below, which is much thicker, and it provides the density of the tissue or density of that layer, the structure of that layer.

When we think about connective tissue, what are we talking about? The primary components that make up connective tissue are collagen. Collagen is the support system. It’s like the mattress that you lie on. It’s the firm structure that has enough balance in it to allow you to lie comfortably. But it also.

Has enough resilience and tension so that you have support. That’s collagen. It’s the mattress of the germal layer of the tissue and the mattress of connective tissue. In addition to connective tissue and collagen, we have elastic fibers. And as you can see in this slide, it’s a very thin vertical.

Structure and that’s gonna allow the snap or the ability for that dermal or the connective tissue to bounce back. So you lie on the mattress, it sinks in, you get up, it pops back up, and that’s due to the elastin fiber within the connect. Tissue and then also in the connective tissue. We have fibroblast cells.

And fibroblast cells are what stimulate the production of collagen, and then we, It’s all embedded in this aqueous solution of hyaluronic acid. And hyaluronic acid provides the moisture and the ability for cells to float around and receive the nutrients that they need to grow healthy. It’s also what keeps our skin nice and hydrated and moist.

Now as we age, what happens? We age, we start to lose the ability for the cells to mo migrate from the base of the germal layer up through the epidermis, and they lose their vitality. We start to lose the integrity of the collagen and the elastin in those layers. They begin to get disorganized or not line up properly.

We start to lose the VAs, the blood vessels that iva that area and nourish the, area as well. When all of this happens, we start to lose that plumpness, the plumpness of the. The connective tissue and the dermal layer itself. When it starts to, when we lose the integrity of that it starts to dry out, we start losing hyaluronic acid in within that area.

And then we start to see not only as it dries out, but that dermal layer in that epidermal layer start to thin and separate. Creates more dryness. And then as we lose that suppleness of disorganization of collagen, an elastin, we start to see pitting. And you can actually see in this image, you can see the surface of the skin starting to pit.

Sometimes we call that wrinkle. Sometimes we call it skin pitting. For our purposes, There are multiple types of wrinkles. There are fine lines are primarily due. They’re not wrinkles. They’re due to the loss of hyaluronic acid in the tissue or dehydration. And the key is to just drink more water.

We are apply more hyaluronic acid or hydration to the surface of your skin. For our purposes, we are going to look today at shallow wrinkles. Shallow wrinkles, you’ll see in a moment are very superficial wrinkles. When the collagen starts to move up and down, or the elastin starts to snap back we, lose the creases.

So the creases come when we’re activating our muscles or textures of the skin, and then they relax as they, as the shallow wrinkles become more sedentary, they move into deep wrinkle. And this is when we are actually start to see changes in the architecture and integrity of collagen in the skin tissue and, also lattin so it becomes more visible when the faces at Russ and then static wrinkles are are a different type of wrinkle.

They’re actually. Deep wrinkles that have been around for a while. And in this situation actually starts to create damage into the tissue via the loss of elasticity within an elastin within that skin tissue. And then again, this too is visible at when the faces rest. And then we have dynamic wrinkles.

And these have more to do with muscle as opposed to skin create, although they may. Static wrinkles and deep wrinkles and cello wrinkles. When you treat dynamic wrinkles, you actually have to treat the muscle as opposed to the skin. So here’s an example. Here’s shallow wrinkles are on the left. And as you can see in this image, the person on the left or the figure on the left is probably in her thirties.

The middle is probably in there, her fifties and sixties. And then the on the right is, older. Most shallow wrinkles occur earlier in. And as you can see, say particularly in this image starting at the nasal labial full dot full between the edge of the nose and the corner of the Mac, you start to see the creasing there.

You’ll start to see it in between the eyebrows, Ella creasing, and possibly across the forehead. As they move into deeper wrinkles, you can start to see the changes of the architectural changes in the face. You can start to see a deeper creasing between the eyebrows, the nasal labial, fo maybe around the mouth, starting to see a change in the mental crease, which is between.

The chin and the lower lips and the marionette lines, which are between the corner of the mouth and the jaw area. And then as they move into more static wrinkles, they create a number of changes in the architecture of the face. And you can see the visible difference here. In fact, it’s just a progression from left to right and most of it has to do with age and lifestyle.

And diet. What’s interesting about needling at different layers of the tissue, particularly at the epidermal level and the germal level, is the references to it that we’ve seen in the classics, notably the ling shoe over time. In the classics, they talk about numerous, there are numerous discussions about needling guidelines specific to the layers of the face, the skin, the flesh.

The channels around the muscles, and then at the layer of the bone. So there are constant references throughout time about different ways and the importance of kneeling at all of those different levels. Also in the Ling shoe, in chapter one, it says The skin, the flesh, the muscles, the tendons and the meridians occupy different places in the body and that different diseases respond to different methods of treatment.

In chapter seven, it talks about the illnesses. If illness is superficial and needling is deep, it will penetrate and injure the good flesh. If illness is deep and needling is superficial, results will not be obtained. So again, there’s the references to the changes, the importance of needling at different different layers, and then the results that can be obtained when properly kneeling into those different levels.

Intradermal needles is superficial needling, obviously, and it’s sim very similar to Japanese needling technique. We know in Japanese needling technique that the insertion is superficial, that the manipulation, if there is any manipulation occurs at the surface of the skin. We’re not needling for Dutch.

And the needle gauges. The needles themselves are different. They’re very thin, and the length varies, say between a very short needle and say a 30 millimeter, which is like an inch long. When we are needling for the purpose of intradermal needling, what’s going on? There are multiple theories as to why this works.

One that’s the most popular and actually the foundation of say Derma rolling or microneedling, is the fact that when you insert a needle into the surface of the skin, it actually creates a little wound. Wound healing results. When you put something in or you damage the surface of the skin fibroblasts, circle that area and immediately start to stimulate the production of collagen and elastin within that tissue to actually heal the wound from the inside.

This was what we called a wound healing cascade, and which case again? We insert the needle, it creates a micro damage into the surface of the skin or under the surface of the skin. Fibroblasts come in, they stimulate the production of collagen. Collagen starts to line up, as well as elastin into the dermal layer of the skin.

And you can actually see in this image, In the first image, you see where the damage was created, and then you start to see the abundance of fibroblasts building collagen and elastin at the dermal and epidermal layer to start to thicken and to heal this microtrauma. Another theory is in doing so, what we’re doing is actually enhancing not just the collagen, but also the elasticity as well.

So we’re building collagen, building elastin under the skin, stimulated by the trauma that was created by inserting a needle into the surface of the skin. And there’s also something else that’s going on, and that’s called Paso Electric. Collagen is the primary component in connective tissue, which we just learned, and it also is capable of transmitting electrical signals throughout the bottom.

So it has an electric energy, call it, she call it electro Paso. Call it whatever you want, but it creates a vibration or an electricity. that then signals throughout surrounding area. And it’s both mechanical. So inserting in the needle stimulates this Paso electricity. It creates both the mechanical and electrical properties that vibrate out into the surface and connect with other systems.

So when. Insert the needle as a form of an external influence. The electrical current in that tissue created by the collagen radiates out into neighboring structure. It’s a, it’s somewhat the foundation of acupuncture in our culture is creating some type of an energetic that then spreads, not just stays at the center where we’re need.

It begins to spread out throughout surrounding tissue. And in our world, the meridians that, that connected these points. So we need and put the needle in. Intradermal needling, it stimulates that wound healing cascade. It excites that collagen Paso electricity. And it also releases fascial tension, which is the tension that is created by holding that tissue in this stagnant place now for so long.

The slide in this presentation or in this PowerPoint is histological slide. So they take pieces of skin or where there are wrinkles, they put ’em on the slide and, they put them they put a little piece of glass on top of it and they slide it under a microscope and, then you actually get an, a larger image or a magnified image of what’s going on.

So here we see a wrinkle. And it looks like a little divot like this. This is another slide. The wrinkle is actually very, shallow. This would be considered a shallow wrinkle. This is very minor or more minimal wrinkle, moving into a deeper wrinkle. Here’s a deeper wrinkle. You can see it’s not just a, dip or, but more of a plummet, a little deep area.

So that’s a different kind of wrinkle. So as you can see, we’re going to see all different types of wrinkles, and we’re gonna needle them differently as well, depending upon the. The, wrinkle itself. So we can’t really look at a magnifying glass in our practice. We’re not gonna take a slide and put it under my magnifying glass.

So you have to start to train your eye to see what does a wrinkle look like? Is it very shallow? Does it look a little bit deeper? Does it look like it’s petted? And then we’re going to decide how to needle it, and we’re gonna decide which type of needles to. Most of the intradermal needles today are either the straight intradermal needles, the Japanese one, or the press tax.

And they’re good. They don’t give you a lot of flexibility if you, they’re very tiny. You have to use a pair of tweezers if you’re using an intradermal needle and just slide it in. And you get a very short distance of, being able of insertion the press tax. There’s only one way to needle it and it’s down.

So that is somewhat limiting. EUS is a new serum needle and I think it’s a really good needle, and it’s ones that I choose to use. They’re stainless steel needles. They’re triple polished. They’re similar to serum needles. They’re high. The, quality of them is great. They come in a bolt pack of four.

They’re really easy to use and they’re a little bit longer. Some, they range between they’re all about seven millimeters, but then the thickness of them is varies. Different sizes. So depending upon the type of needle you choose you can affect different types of wrinkles. All of them work. It’s just a matter of personal preference.

So I’m gonna show you these slides. So this is a shallow wrinkle, which means it’s going to show up and then disappear. So when the model lifts her eyebrows and cringes her forehead, then you’re gonna start to see them. And I’ve actually had her do this in this image. And so we’re gonna look at these needles.

It’s pretty good. It’s a little blurry, but basically she doesn’t have a lot of wrinkles. And the wrinkles that she does have moose. One way to find out whether it’s a shallow wrinkle list, actually, to have your patient lift their eyebrows, drop them further eyebrows, and see what stays, and see what goes away.

So in this situation, what I’m gonna do is I’m actually gonna spread. The tissue and needle very shallowly into the needle. So in this situation, when you’re spreading the needle it’s a very shallow insertion at the upper level of the dermal level. You open the wrinkle, slide the needle into the surface, and you can line them up because most of these are fairly long needles.

So this is a good technique to use if you’re doing, if you’re treating a very shallow. Let’s see. This is more of a deeper ecstatic wrinkle, and this is the nasal labial fold right here. It’s the different, it’s from the corner of the nose to the sock corner of the mouth. A lot of it has to do with tissue that has fat that has moved down, or gravity muscle attenuation.

Has some effect in it. But in this situation, you’re gonna actually treat the wrinkle itself. Now, it’s hard to spread this because it’s a deeper wrinkle and it’s static. You can see it, it will stay there whether the person is smiling or frowning or either or making any other muscle expression. So rather than trying to spread this, wrinkle, what you’re gonna do is you’re gonna actually grab.

Like this and pinch, and then slide the needle into the crease. So let’s take a look at this. So I’m pinching, it, and slide. Okay. I’ll show you. This is a closer version of it. This is a, and it’s a little bit blurry, but I think you get the image. You’re gonna pinch and slide. Okay. It takes little practice.

It’s almost as if you want to take that area, start further out, pinch it, and let’s do this one more time so that you can see it. You’re pinching, you’re starting f pretty far out. In order to pop it, pop the tissue up so that the only thing that you can actually see is the wrinkle. Perfect. Let’s keep going.

Okay. Now, we’re gonna talk about deep wrinkles for a moment. On top of the changes of the architecture that occur within the derma layer, when A wrinkle has been around for a long time, it starts to affect the tissue around it very similar to that of a. Scar tissue is composed of the same collagen protein as healthy skin tissue similar to this, but because of the trauma or because of the static nature of the wrinkle, the tissue around it starts to change.

So similar to a scar where during tissue healing, the collagen cells group together. Like this and bunch up. This is sometimes what a deep wrinkle looks like. We’re gonna look at one in a minute. The way to treat this is not to slide the needle in because that’s not gonna really break up the tissue is and not to pop it and go into.

Base, but actually to go into the wall of the tissue to start to break up the fibrous tissue that is starting to develop, to create this, that stagnant nature, that depth of, the wrinkle itself. So here we go. Take a look. This is, if you look at the, let’s look up here. This is what we’re gonna treat.

This where the red arrow is. But if you look at, and it’s right here on the large image. Now look at this wrinkle. This wrinkle starts at the, in the lip. It starts at the base of the bottom lip and actually projects all the way down, but right. This is the depth of the wrinkle. This is probably where it started, began to spread.

So here’s where the damage is. Here’s where potential scar damage is, what we’re calling scar damage, but it’s really not a scar. It’s basically tissue that has been in one position for a very, long time. So in order to affect this, we actually need to break this, tissue up and around it. So we’re gonna take.

And I’m gonna needle into the wall. You can either needle from the outside in or you can needle from the inside out, but the object is to actually get into the wall of that wrinkle as opposed to the base of the wrinkle itself.

So just as a recap, we have fine lines. Fine lines are basically due to creases in the skin surface caused by dehydration. And the way to treat it is to enhance water consumption or to apply it or both. We have shallow wrinkles, which have to do with creases that are just beginning, and they change so they’re not stagnant.

Over time, you spread the wrinkles and needle into the crease. We have deep wrinkles where the crease is caused by the beginning of. In a lack of integrity of collagen and elastin in the tissue itself, and they stma, they’re starting to show up and stay there, stay at the face, or stay visible when the face is at rest.

And then we have static wrinkles. And these result from a loss of elasticity, tissue damage, we see that build up or the change in the architecture of collagen elastin around those needle wrinkles. And the treatment is to, the intradermal, kneeling treatment is to needle into the crease of the wall. And then we have dynamic wrinkles, often known as ride tides.

And these develop from repeated facial movements, in which case we need to treat the muscle as well as the. So thank you for today’s presentation. If you have any other questions or want to know more about facial acupuncture or cosmetic facial acupuncture you can visit me@hamptonsacupuncture.com, my website.

You can email me@infohamptonsacupuncture.com or follow me on Instagram at Shellie underscore Goldstein. So thank you again everyone. Thank you, the American Acupuncture Council. It’s always a pleasure to be with you and next week stay tuned for Chen Yen she’s very exciting and a wonderful lecture. I’m sure you’ll enjoy her presentation as well.

Facial Fascia: Appearance and Function

And I am going to talk to you today about facial fascia and what it is and how it can affect your facial acupuncture treatments and how it can affect your patient’s appear.

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Hi, my name’s Michelle Gillis. I am an acupuncture physician and I teach facial and cosmetic acupuncture classes internationally. And I am going to talk to you today about facial fascia and what it is and how it can affect your facial acupuncture treatments and how it can affect your patient’s appear.

So I wanna thank the American Acupuncture Council for this opportunity, and I need to see the first slide.

So what is facial fascia? That is going to be the first thing we talk about today, and after that we will discuss how it affects your facial appearance. and the movement of your face. So it’s not just about cosmetic, but also how your face functions, and then some treatment modalities, things we can do in order to affect the function of the face by treating the fascia.

So facial fascia is composed of two layers, and the first is the superficial facial fascia, and that is On the outer layer, and that is, it’s right underneath your skin and it helps to support your face and hold everything up, and it’s responsible for giving you a youthful appearance and. It also can carry a lot of tension in it and restrict circulation to the face so things can get trapped, whether it’s lymphatic fluid or blood.

And even some of the superficial nerves. Then we have the deep fascia layer, and that kind of forms a girdle and it is called the mass layer, the superficial muscular epi neurotic system. So the superficial layer itself. Has the superficial fascia itself has two layers. It has the outer layer, which is this kind of fatty layer, and then we have the mass layer, which is right here and.

That is what allows us to make facial expressions. It takes the nerve impulses from deep and sends them out to the muscle, which then translates out to our skin.

So the superficial. Fasha layer is what is responsible for our facial expressions. And the deep fascia layer, which includes the fascia of the temporalis because the temporalis is connected to the face the parotid fascia, which goes down into the neck. The periosteum, which works around the part of the skull that connects to the face.

and the septum, the area around the orbit or the eye area. And this is where the deep fascia exists on the face. So here’s a. Pictorial representation of a piece of bone and a muscle and the skin. And the reason why this is important is because our face is the only part of our body where the skin is connected.

To the skin layer is connected to the bone through muscle, which is why you can move the skin on your face without having to move. Any part of your face so you don’t have to move joint in order to move the skin on your face, everywhere else on your body, if you wanna move the skin, one of your body parts has to move.

The skin can’t move Separate from the the body part.

So one of the things that can happen is, so here’s the bone and here’s the fat and the muscle and the skin. And what can happen is, so as the muscle contracts, the skin gets pulled towards the bone and we can get. Kind of wrinkling of the skin, right? If you smile, if you raise your eyebrows, if you pull your eyebrows together, if you purse your lips right, you can purse your lips without having to move any bone at all.

Just by moving the muscle, the ais ORs, and what can happen is, We can get these fossil adhesions, which are like scar tissue. They can happen as we age. They can happen through injury, they can happen through overuse or underuse. And it’s this very fibrous collagen fibers. It’s like if you think about, if you have like a chicken.

And you pull the chicken away from the bone. There’s that layer. It almost looks like really a strong cobwebs, and those fibers can. Trap nerves and blood and other things. And they can cause these adhesions where it can prevent the full expression on our face of different facial expressions, the full movement and.

Like if an individual perhaps had a stroke and things, or Bell’s palsy and things don’t move for a long time, then you have to physically get this area moving because of these muscle adhesions that can form. So here’s the bone. Here’s a piece of bone, and here’s the fascia, and here is a nerve, which as you could see, could get trapped in the fascia and it could prevent the signaling so the muscle won’t even.

The signal that it needs to move because the nerve is trapped or it can reduce. The ability of the muscle to move well, and it can also restrict blood flow. You can see there’s veins that could also get trapped. So here’s a picture of someone with Bell’s Palsy. They’re making a facial expression with the right side of their face, but the left side of their face isn’t moving.

At all, and part of this is due to nerve damage, but it can also be from entrapment

and wrinkles. When we think of wrinkles, we think of something that happens as we age, and in many cases it can be from sun damage, it can be from just the skin getting older, but also if you habitually make an expression and the skin is attached to the fascia. If that fascia is restricted at all, then you can end up with these deep wrinkles.

We see it a lot in people’s far heads and even sometimes around the eyes with crow’s feet or the lips. And also with jowling. , and I’m gonna talk about a couple of ways that we can help with this, but sometimes wrinkles and sagging are reversible just by doing things to the fascia layer. So here we have an example of forehead wrinkles.

Perhaps this person made the expression where they raised their eyebrows a lot. Also, this is when I said jowling. This is what is referred to as a jowl, and it can happen through the aging process. Things loosen and they become a fixed into a new position. Sometimes it’s from excess weight on the face, sometimes it’s from habitually frowning.

And When I was young, my mother used to say to me, Don’t make that face. It’s going to stay that way. And there was actually a lot of truth to that. A lot of our facial expressions get etched on our face over time.

So what are some of the treatment modalities that we can use in order to affect this fascia? On the face. One very effective treatment is facial cupping. Now, facial cupping is something it’s a skill that you would need to learn. It’s not like cupping on the back. You don’t want to try to use your glass cups and cup the face the way you would’ve back, or a neck or a shoulder or a.

Facial cupping uses small cups. and they look like this. And you would use these small cups and oil and you would glide these cups across the skin. You don’t park the cups and you do it in such a way that encourages lymphatic drainage. And works with the anatomy of the face. And this is a cupping set that is made by Oculus Skincare.

And so there’s a slightly larger cup and a smaller cup for different types of wrinkles and. Rubber part is very easy to squeeze so you can squeeze and move and release and squeeze and move and release, and really keep that chi and energy going. Facial Guha is also another technique that we can use.

And here are some facial guha tools. You can see that they are these are made out of Jade and they’re specially shaped to work around the gel. The cheeks to work along the temporalis and underneath the chin, across the clavicle. Lots of places where we can get these adhesions and by. This kind of physical movement of doing the cupping and then the guha afterwards.

You help to keep the lymphatic system of the face moving, the blood and the chi moving, and also to really get in there and break up those fas adhesions, especially with the guha tool on the forehead. You can spread the wrinkles and you can really get in there and break up a lot of that tension and that tight fascia.

So this is a picture of me just doing some gua along the jaw, jawline, sculpting the face, helping to lift everything up.

And the next technique that we can use, which is very beneficial for submuscular needle, for treating facial fascia is submuscular needling. and this is a technique where you would work on different areas of the face. And I teach a whole class just on submuscular needling, and it involves taking your needles and getting.

Underneath the muscle. So you’re really getting underneath these memetic muscles. I’ve lost my mouse. Where’d they go? You get underneath the memetic muscles. And you’re going to needle right through and down. And this can help get into the superficial fascia and then into some of the deeper fascia depending on which part of the face you’re working on.

And you would insert a few needles. Underneath the muscle, depending on what part of the face you’re working on. So I have a quick video that I’ll show in a moment, but you can use this to work. Underneath the mace here, you can use this to work along the attachment points for the pla. You can work into and underneath the anterior digastric.

You can work underneath the corrugator muscles. You can work underneath the frontals muscle. Pretty much any muscle were on the face where you have access to the margins of the muscle you can get underneath there. And this can really effectively break up some of those fossil adhesions, which is really quite wonderful.

And let’s see. I don’t know if you’ll be able to hear this, but you can see it and I can talk through it.

In needling, the frontalis muscle, the. Way that you isolate the muscle is you ask your patient to raise their eyebrows. Go ahead and raise your eyebrows. Okay? And then, so this is the frontals muscle and you can find the border of the frontals muscle. And the way that you needle is you’re going to go.

From the origin to the insertion, so you find the borders up here in the insertion is here. And typically what I do is I will put in usually three needles, and then you get right underneath the muscle lateral on either side and. I will put in two needles on the medial side, and when you’re needling, what’s important is that the angle of the tube is the angle that the needle’s gonna go in.

So if you go like this, it’s gonna go too deep. If you go like this, it’s going to be too shallow. I use. My thumb or a finger to help to guide the needle. So you wanna keep your fingers out of the way when you’re actually inserting. That way you can get to the correct depth right underneath the muscle.

That’s lateral side. Then you’re going to do the medial side, and usually two needles. Suffice. And I do the one side and then I do the other side and I’m using half inch noodles. You can use one inch noodles depending on how big your patient forehead is, so you just get all the way down underneath the muscle.

And isolate the muscle and needle right underneath it, and this, you would just leave the needles in for anywhere from 15 minutes to a half an hour. And this is especially helpful. Let’s say your patient has Bell’s Palsy or some sort of facial paralysis. You can do it on both sides. You can do it on one side, wherever the muscles are affected.

This is just a list of some of the classes that I teach facial and cosmetic acupuncture, facial cupping. A lot of what we talked about today is from my treating neuromuscular facial neuromuscular facial conditions class. I do some self care for acupuncturists safety ethics, microneedling. And a lot of the techniques that we use for cosmetic acupuncture can also be beneficial for treating neuromuscular facial conditions like osis.

Or if someone’s had a stroke, TMJ and vice versa. A lot of times when you’re working with a neuromuscular facial condition that your patient might have, it also helps to benefit the Movement of their face and therefore their skin will look healthier and more vibrant. So I think that’s everything.

I wanted to thank the American Acupuncture Council again, and next week we have Matt Callison and Brian Lao, and I hope to see you again next.

Facial Gua Sha for Enhancing Cosmetic Acupuncture Results

One of the benefits of implementing or adding Gua Sha to your acupuncture practice is it really takes your business to the next level. It boosts your treatment results. It attracts new customers. And promotes your vis your professional visibility.

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Hi, my name is Dr. Shelly Goldstein, and I am bringing this presentation to you from New York. I have been practicing cosmetic facial acupuncture for over 30 years, and I currently run the. Cosmetic Facial Acupuncture Program at the Pacific College of Health and Science. It’s a training program for those of you who are interested.

But before I begin today’s presentation, I’d like to thank the American Acupuncture Council for hosting me today. It’s always a pleasure to be here and let’s get started. This is one of my favorite topics. Always talking about beauty and health and different ways to enhance our acupuncture skills.

When we think about facial acupuncture, it’s not modern it’s dates back to the time thousands of years ago, and it was referred to as my. MYR means beautiful appearance. And it was a holistic regime practiced throughout Asia for centuries. And it was a combination of acupuncture herbs that are either topical or ingested and then various MYR treatments of which Gua Sha is one of ’em.

And that’s what we’ll be talking about today. With all of these, this, the intention was to promote systemic health and wellbeing and to delay the visible signs of aging. And initially it was used for the emperors to keep their concubines looking beautiful and healthy and for the EMS to maintain a youthful and radiant appearance.

But honestly, I’m pretty sure that there were variations of my wrong regimes utilized in most house. One of the benefits of implementing or adding Gua Sha to your acupuncture practice is it really takes your business to the next level. It boosts your treatment results. It attracts new customers. And promotes your vis your professional visibility.

And what does that mean? It adds monetary value to your service menu and at the bottom at the end of the line, it increases your business revenue, both in terms of your services that you provide. And then also these are wonderful tools to retail, and so you can make money selling them to your patients as well.

And the patients actually really love it. They enjoy the treatments. They like the results of the treatments and they really appreciate the home care engagement, which means when they take the tools home. They then begin to use them for themselves and it empowers them. It makes them feel like they’re participating in their treatment and they love the results and it feels good to it.

I don’t know how many of you actually use Quasha in your practice or on yourself. It really, it’s such a wonderful treatment and it really feels good on your skin. Not only that, but it gives you great results as well. So let’s look at Gua Sha, let’s look at the application of it and then how to use it.

And when we talk about Gua Sha, we’re specifically talking about it for the face today because we’re improving facial appearance. When you look at the different layers of the face, we look at it from bone, muscle, fat and skin, and to, and with Gua Sha, we’re primarily affecting those upper layers of tissue, which is the skin.

And for us, the skin is made up of multiple layers. The at the bottom is the muscle on top of the muscle is the subcutaneous or level of the hypodermis. And then the dermis and the epidermis is what you see when you look in yourself in the mirror, or you look at someone else it’s a top layer of skin.

And directly, it’s very thin as you can see in this diagram and then the dermis or the dermal layer as we refer to it is this much thicker area that sits directly below the epidermis below the dermis is the subcutaneous or the fat layer. And then below that lies muscle and surrounding all of those tissues either to attach them one layer to the.

or to separate the layers from the next or the individual components within those tissue layers is connective tissue. And here’s a diagram of connect tissue looks like this kind of sticky web of of tissue and it, so it’s sits in between the different layers of tissue. And it also is within the different layers that we just referred.

When you think about connective tissue, and this is gonna be very important for this conversation. We wanna look primarily at the primary components of connective tissue. So you see this red line running up and down, that’s called collagen and collagen is what provides the support for the tissue.

It’s like the mattress that you lie on and you get. and it pops back up and you lie on it and it pops back up and you lie on it pops back up and over time it starts to sink our breakdown. And so the collage and the structure of the collagen starts to break down over time. And then you have a last in fibers.

They’re the more angled little lines in this image. And there, the snap ability, what we call the ability for the tissue to. Back to its original shape after you stretch it. And you can see, I try on your hand, if you grab a piece of your skin and you lift it up, the ability for that skin to snap back into place, that’s due to this skin’s elasticity dedicated by the elastic fiber, and then you have another primary component.

Are these little blue. Circles that’s called. Those are called fibroblast cells and they make collagen. So something happens. It stimulates fibroblast cells to produce more collagen in the tissue. And all of these elements are bathed in hyaluronic acid. Hyaluronic acid is what’s responsible for that binding or the water that is within those tissues that provide primarily moisture within the tissues.

Now what’s important here is this. So if you look at this image, you can see what collagen depletion looks like with the loss of skin integrity. So on the face, and it first begins right at the angle of the corner of the mouth. And you can start to see a little pitting in the tissue as in, right in here.

So this is plumper tissue and then where it starts to pit or think of the. The collagen in that mattress that starts to break down well, that’s what happens in your skin. And so the tissue actually starts to break down the collagen structure starts to break down and it causes the tissue on the surface of the skin to have this collapsed appearance.

For us. What we need to know is remember the collagen that snap back collagen is actually the primary component in connective tissue. And what’s unique to collagen is collagen fibers have this mechanical or electric property, and that’s the basis of the ability to interact with other tissues.

So how is it that when we put an acupuncture needle, The skin, it radiates the Dutchy, it radiates through the tissue. From a Western perspective, it’s the collagen fibers that crab this mechanical and Al electrical property that actually caused that radiation throughout the tissue. And when there, when that collagen is activated or when this, we call it Paso electricity, it can be activated by a number of items or influences.

And when they are these external influences activate the collagen. What happens is it sends that electrical or that Paso effect through the tissue in this specific area, but into other neighboring structures as well. And when we talk about those external influences, we’re talking about pressure.

Vibration and friction. And what’s interesting about Gua Sha is it contains all of those. You can use your Gua Sha tool to apply pressure to the skin. And when I say pressure, what you’re doing is you’re taking the tool and you’re rubbing it across the surface outta either. Light with light pressure, medium pressure are maybe more firm pressure.

And when we do that, what you’re doing is you’re stretching the tissue to cause that small electrical current to slide across the skin. And we call that effective for a, what we call a mild FA release. And then there’s vibration is when we take the tool and we can jiggle it across the area.

And what happens when we create what we’re doing is we’re also increasing that neural signaling and we use it to relieve muscle tension, to stimulate lymphatic drainage and to. Circulation. And then there’s friction. We actually use across the gradient. So if the muscle fibers are running in a horizontal fashion, you may use the tool more perpendicular to actually run across.

The direction of the tissue to create a little bit tension. And when that happens, what we’re doing is we’re actually challenging, stimulating that fiberblast activity to create more collagen to help, to decrease pain, realign, collagen fibers. We can use it to break up adhesions in the skin tissue, which is great for diminishing scars.

And so we’re gonna talk about that a little bit. Now what’s important to note is when with classic Gua Sha treatment and for those of you who done it, what do you do? You take the tool you scrape across the skin, along the skin with the intention of creating T TKI are the little red dots that you see.

And then the redness, or it almost looks like bruising on the surface of the skin. What you’re doing is you’re almost breaking the capillaries and creating that blood, the red blood cells to excavate into the subcutaneous layers of skin. And then in, with the intention of, from a Chinese medicine perspective, moving blood and Chi harmonizing the tissue, and then we use it for multiple fascial and muscular imbalances, like muscle pain, tension tissue stagnation.

And from Chinese medicine perspective to relieve pain, wind cold and heat, and typically the discoloration resolves itself or begins to resolve itself within 20 to four to 48 hours. This is not the intention of facial acupuncture. Our patients generally do not like big bruises on their face. So when we apply facial Gua Sha on the face, we’re not promoting Pete.

That is not the intention of our treatment. What we’re trying to do is increase. We’re still increasing circulation and moving blend and chew. We’re still harmonizing the tissue fashion, the muscular imbalances, and we’re still relieving pain. Cold in heat, but we’re not doing it to the degree that we’re actually stimulating that the Ticia and there’s controversy about whether this is really a Gua Sha or not Ma naming that the intention or the purpose of Gua Sha is to excavate that blood, but it, but we do know that it works on the face and.

Because we’re not breaking those capillaries because we’re not promoting that TKI release or what we’re using it for more is to, from a cosmetic perspective, to soften wrinkles, to sculpt and contour the face to improve collagen, to create thicker skin, we can use it to break up scar tissue. And then very important is to resolve local blood coagulation or, and to break up lymph stagnation in the myofascial tissue.

One of the primary benefits of Gua Sha for facial acupuncture is in fact, this removal of stagnation of limp in the tissue.

To talk about the stones just for a moment. We’re using gemstones. So gemstones versus crystals versus jewels are basically the organic mineral that is caught and polished to create a specific shape. And we know that each of these different. Types of materials or minerals have different purposes and different properties.

But we’re also concerned right now about the shape and the shape for most of our treatments are gonna determine the function that we’re using the tool for. So you have an, these names are not. The technical names, but they’re common names. So you have the fin or that teardrop shape. You have the dolphin heart, you have waves, you have rectangular shapes, the spoon, the fish, the.

And ones so on each of these, the curved edge say the long edge and also the shorter edge of the fin and the tear drop in the hard shape. The longer edges of the wave, these are the, and the wand. These are used for that long sweeping movement that you’ll do. For sculpting different areas and moving li where is the combed edge?

Say this right in here. You can use it for wrinkles for the forehead area. So it’s really good for the top of the head. We have the pointed edges. Remember we’re talking about pressure specific pressure. So these little more pointed edges say the bottom of the wind or the bottom of the fish. Those are really good for acupressure for getting into the wrinkle areas and redo and minimizing lines.

And then you have the rounded paddle say this spoon. Or the top of the fish, or even the bottom of the second wave or the last wand. And those are really good for specific areas. Say under the eye for gentle lymph drainage dark circles and just general lymph drainage as well. So the really the type of tool that you use is gonna determine the.

Treatment that you’re gonna provide, which is always nice to have a multiple different or different types of tools in your toolbox. Also what’s very popular. These days are the Combs, the edges or the Chrome. And this is for cross fiber friction. Remember we talked about going against the direction of the tissue.

So the bottom right here these are what we call Combs or for, or edges for cross fiber fiction. And there are a number of those tools available in the market as well. I’ll give you a link at the end. And then also to be aware of the thickness of the tools. So the thicker tools are more for long strokes, treating long areas where the thinner ones might be used for more targeted areas or shorter strokes.

Yeah. Now don’t confuse Gua Sha tools with a roller, the Gua Sha tools we’re really using for specific treatment. Whereas the roller is more of a massage tool. You might use it after your treatment. As a nice little massage. Some people use it to improve blood circulation. I think the gosh eye tool works a little bit better for that.

As well as decreasing puffy Ma, but people generally use it. They’ll finish their treatment. They’ll apply a little bit of oil or cream or something to the surface of the skin. And then they do use the roller at the end just to either improve circulation, calm, calm the skin again, depending upon the gemstone that you’re.

Jade might be used for cooling. Whereas the rose quartz is more beneficial for improvement, circulation, that type of thing. We talked about lymphatic drainage. And again, I want to emphasize that one of the primary benefits of applying Gua Sha treatment to your treatment. And I personally use it in the beginning of the treatment at primarily to move the lymph.

It’s the Pillsbury tube. It’s nice and squishy and puffy. It’s hard to actually activate the points and to get your treatment results in. But if you get rid of some of that lymph, you reduce some of that swelling that’s in the tissue, then it’s a lot easier to be effective in your treatment. So when you look, when I say lymph, what we’re looking at, for those of you who aren’t familiar, we have lymphatic vessels that are located near the vessels of the circulatory.

They run through the body and through the face at certain points in the lymphatic system, there are lymph nodes. So the swelling or the fluid goes through the lymph vessels, they get cleaned or purified. Pied in the lymph nodes and then they keep moving down and on the face, they dump at the sub super clavicular node right here, it’s around kidney 27 with the intention of going back and taking that fluid back into the circulatory system to repeat the cycle.

What’s interesting is that these lymphatic vessels and nodes follow the trajectory of the meridians or familiar meridians and pathways of acupuncture points. So let’s look at this when we are applying. Facial gloss off or lymphatic drainage. What we wanna do is we want to follow the meridians and the specific pathways in the face around the ears, behind the ears, down the SCM, into the clavicular head, right at the kidney 27.

So it looks like this. You have your patient, you clean their face, you apply a little oil because you’re, you are moving the tool across and it can scratch or irritate their skin. If you’re not, if you don’t have a certain amount of slip or ability to slide, but don’t use too much because then you can’t, you don’t have as much control.

Then oftentimes for Gua Sha, for lymphatic drainage, what we’re gonna do is we’re gonna empty the portal, starting from the neck. So we’re gonna clean the we’re gonna slide the Gua Sha tool down the SCM. Across the clavicular area into kidney seven, and then we’re going. So we’ll do that several times. You can come up the back of the neck.

It feels wonderful. And then again, just empty this area, clear it out. And then we’ll move up to the face. So you will start across the jaw area. You’ll go along the cheek area. Again, the intention is just to move that li out back into the kidney 27 area. You will go either down the face, across the cheeks, around the eyes, but again, in the mid face and lower face, you really wanna move it into these little black areas where the nodes.

Down the SCM and across the clavicle on the forehead, you’re gonna sweep across the forehead again with our behind the ear, with the intention of sliding of moving all of that fluid through the nodes to be cleaned. Down the SCM and again, into the kidney 27 area. So that’s your intention and you can pull out maps either the one, the previous picture from here, right?

This image and find the nose and then just keep sweeping along the meridians into the nose, back into the kidney 27 area. Once you open up that the lymphatic system, get that nice and drained. Then you’re gonna focus on the areas of concern. So what are your areas of concern puffiness under the eyes?

Are you gonna do use wrinkles, treat it to treat wrinkles. Do you want to go on the spot side, sun spots? Do you. Skull this along the zygomatic bone. That’s your cheekbone. Do you wanna clean the Mandal the jaw area? Do you wanna massage the scalp, the neck, if there’s neck tension in the neck and the upper back and the shoulders.

So depending upon the intention of your treatment, those are the different tools that you’re gonna use, and you’re gonna apply different strokes to, to create the changes that you’re looking for. In general, we say that one to two sessions a week will give you longer lasting results, especially if you use have six to 12 sessions, but remember what our life pattern also determines the problems that we’re causing.

So if they’re constantly lifting their shoulders or your patient is constantly tightening their neck or furrowing their brows or frown. It’s gonna come or drinking or eating foods that create lymph inflammation within the tissues that will come back. And this is where it’s helpful to sell the tools to your patient and have them teach them how to do it themselves.

They’ll really appreciate it. and then here’s just a list for you of different points. Remember, we talked about using the pointed end of the tissue of the tool to actually go into the the acupressure points. And so you remove lymph. You direct your treatment towards your area of concern, and then you can complete your treatment by taking the pointed end and applying it into specific pressure points that are, or acupuncture points again, relative to the treatment results that you wanna obtain.

So are you treating the neck? are you treating the lower face? Are you treating the cheek area? Are you treating the forehead in the eye? So again, you’re tailor constantly tailoring your treatment to the to the specifics of what your patient needs. Of course, there are always a few precautions or contraindications for eye use.

So if someone has facial cancer cells on their face, you wanna be careful if they have extreme edema, you may wanna look into that. Why is that happening before you start draining? If they’re bleeding or clotting disorders, if by any chance you are a little too heavy handed with your glass eye toll, you could cause clotting, you could cause bleeding.

You could cause that TKI on the face. And again, we never use squa eye directly over open wounds or sore. And we’re careful about acne and eczema, particularly if the acneic lesions are open and oozing. And then when you see Ray moles tags or lesions, you probably wanna refer them to your dermatologist or their dermatologists prior to treating them.

And then precautions. If they’re pregnant or lactating, we may or may not use Gua Sha again, if they’re very weak or I, you may wanna do some treatments first that are more building and then immunocompromised, you would certainly want to make sure that they have permission with, from their physicians in order to move forward.

It’s just safety for. Once you have performed your wash hour treatments, you will notice right away. That you can improve facial contour, you can improve wrinkles, reduce them. You can improve skin tone and color. You can remove tissue, puffiness and swelling that lymph drainage that we’re talking about.

It’s really good for under eye circles or puffiness. You can also in moving the lymph and doing some sculpting, you can actually plump and tighten flacid skin. It’s great for easing muscle tightness, tension and pain. You can smooth, fine lines and wrinkles. You can sculpt the cheekbone and the jaw lines tighten the neck area.

Even skin color by working on the points that where the there’s hyper mentation or sun spots, and it really gives your skin this really rosy glow doing look and appearance. So it’s a wonderful tool to have it. Doesn’t take a long time to use. And it’s great as a retail and for in improving your bottom line, your finances and your business and That’s about it.

So I know this is short. I know it’s a kind of the cliff note version of Gua Sha. If you have more information that you’d like, or if you have any questions, you can always contact me through my website. If you’re interested in more facial courses for facial cosmetic acupuncture and lectures. And then I highly recommend if you’re interested in purchasing Gua Sha shop products, this is a great website.

She has beautiful tools in their reasonably priced. So again, I just want to thank everybody and thank for being here. Thank the American Acupuncture Council and stay tuned next week, where Poney Chiang is coming. He’s wonderful speaker and I, and he is always a delight to listen.

So again, thank you. Thank you for being here. Thank you. For listening to this, I hope you’ve enjoyed today’s. Today’s good.

Cosmetic Acupuncture a Source of Profit

Today I will be speaking about cosmetic acupuncture as a major source of profit for your practice.

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Hi, my name’s Michelle Gellis. I am an acupuncture physician, and I would like to thank you for coming today to my presentation. And also thank you to the American Acupuncture Council for hosting today’s talk. Today I will be speaking about cosmetic acupuncture as a major source of profit for your practice.

I teach facial and cosmetic acupuncture classes internationally, and some of the questions that I get have nothing to do. The actual act of performing the the techniques, the protocols, the theory of cosmetic or facial acupuncture frequently. A lot of the questions that I get, have to do with setting up your practice marketing.

Timing of treatments and other services in addition to facial and cosmetic acupuncture. So I would like to cover those topics today so I can bring to light some of the lesser talked about topics when it comes to facial and cosmetic acupuncture. So first, I would like to talk about how to set up your cosmetic acupuncture practice.

First and foremost, before you begin practicing cosmetic acupuncture, it is imperative that you get trained now. Many of us feel that because we went to acupuncture school and maybe we had one class on cosmetic acupuncture or we feel comfortable and familiar with treating points on the face. I know I did because I am.

Classically trained five element acupuncturists. We use a lot of face points, but the American acupuncture council and some of the other insurance companies do require specialized training in. Cosmetic acupuncture. And the reason is because of the nature of the structure of the face, the nature of treating the face is heavily vascularized.

And you want to make certain to really understand if you’re going to be doing cosmetic acupuncture, how to be doing it, not just effectively, but safe. many of the things that we see on, especially on social media. Now people have hundreds of needles in the face and not only can that be painful, but it can cause bleeding, bruising, neuropathy.

So it, and it doesn’t have to be that way. You can. Get a wonderful effect from facial and cosmetic acupuncture by using very few needles, if you’re properly trained. So one of the most important things for an effective cosmetic acupuncture practice is to. Trained. And this goes for facial acupuncture as well.

So what’s the difference between facial acupuncture and cosmetic acupuncture? The way I use the terms, when I am talking about facial acupuncture, I am speaking about acupuncture for neuro or neuromuscular or muscular. Facial conditions, things like bells, palsy, TMJ, trigeminal, neuralgia, OSIS. There are a lot of diseases that can affect the face.

And there are treatment protocols which are highly specialized, which involve. Specialized techniques for treating the face. So that is what I consider to be facial acupuncture and cosmetic acupuncture is primarily designed to work with the muscles and the fascia and the skin and the blood supply. and even with cupping in Guha with the fat on the face to help, to reduce sagging wrinkles, skin dyschromia and other things which are more cosmetic, not always due to aging, some of them can be acne or rosacea.

Primarily when we talk about cosmetic acupuncture, what comes to mind is wrinkles, sagging, things of that nature. So getting properly trained is the first thing, if you are setting up your cosmetic acupuncture practice, a good training will include. Paperwork, such as intake forms your specialized contracts.

You will need specialized contracts before you start doing cosmetic acupuncture because you have to set up realistic expectations. You want to outline all the contraindications and precautions upfront. So there’s no surprises on the back end. So good training should involve a set of paperwork. If you’re lucky, you’ll get some marketing tools.

We’ll talk about those in a minute and also an overview of what tools you’ll need and how to use them. And maybe even where to get them. Some classes will. Provide tools for you to use some will sell tools there. Some will include the cost of the tools in your training. When I teach classes, I give my students everything they need to practice.

And then I tell them where they can get any of the tools that they will need moving forward. So what are some of these tools? You will need a good set of tweezers to insert intradermal needles because intradermal needles are an important part of helping to stimulate collagen. ANCA gel can be very beneficial for bruising, bleeding inflammation and knowing how and where and when to apply.

It is very. Q-tips are great for applying pressure. If there is some bleeding, I like it better than a cotton ball. You can apply direct pressure onto the point. And if there is some sort of a swelling occurring than, or little hematoma you can apply direct pressure. And then of course intradermals what type of intradermals to use?

How many, what size, what brand, these are all things that will be important pieces of information. When you set up your cosmetic acupuncture practice, I like using a floor lamp in my treatment room. It will provide adequate lighting so that you can see what you’re doing. The floor lamps that I like are these goose neck lamps, where it’s on the floor, but you can move it this way with a fluorescent bulb.

They are available usually at craft stores and possibly on the internet as well. I like having a. Like a foam, like a Tempur-Pedic type foam cushion on the table because sometimes our tables, although they are comfortable for the short term, our cosmetic patients tend to be on the table for quite a while.

So having that extra layer is really nice, gives it that spa feel without a huge investment. And depending on where you live a table warmer is really nice too, because you will have arm and leg points exposed. In some instances, your patient’s neck and chest might be exposed because they have needles in them.

And of course their head and face will be exposed. And this will. Warm up the body and help the blood flow up to the face. Depending on what style and brand needles you have having an extra garbage PA in your treatment room comes in handy because you’ll be working at their feet at their arms doing your body points.

And then you’ll be sitting at the head of the table working on their face. Having a couple of small trash panels, I found to be very beneficial. A hand mirror so that your patient can look at themselves. They can point out things to you that are areas of concern, or they could look at themselves after the treatment and then a small magnet.

They make these They’re it looks like a pen, but it’s an extendable magnet. If one of the intradermal needles were to fall someplace, instead of using your fingers to pick it up, you could use these small magnets to pick them up.

What about marketing tools? What are some of the things that can really get you noticed? I have had a cosmetic acupuncture practice for almost 20 years. And. I still to this day, have paper brochures explaining cosmetic acupuncture. When I teach classes, I have a marketing kit available and I have pre-made brochures that my students can download.

So they don’t have to design them. They can customize them, however they would like, but having brochures in your waiting area. so that when your, maybe your non-cosmetic patients are waiting for a treatment, they can pick them up. Maybe they won’t read them right in the moment. They’ll take them home.

They’ll look at them and they know what questions to ask. I also have a book in my waiting room and I. Testimonials from my cosmetic acupuncture patients plus before and after photos. And if you’re just starting out, you might say I don’t have any before and after photos again. When you get trained, ask the person who’s training you.

If they have photos to share, this is something I also provide in my classes, so that students. Before they even have foreign afters, at least they have something verifiable that they can show to patients. And also on your website, you should have a separate section just for cosmetic acupuncture and have your S E O your search engine optimization.

Pointing towards this as far as log posts your social media can PO can point to this page directly on your website. The more activity the page has, the more is going to be shown when someone is in your area and they Google. Cosmetic acupuncture or facial acupuncture and whatever city you are in, but the testimonials having them both on your website and in your waiting room can be very powerful.

As far as your social media, you have to know your audience. There are certain. Types of social media that lend themselves more to the videos, certain lend themselves more to stories and sharing, but definitely if you want to focus on facial and cosmetic acupuncture, getting your perform afters, having your videos, having your hashtags, everything set up.

To drive traffic to your TikTok or your Instagram or your Facebook pages is very important. And I know a lot of my younger students left Facebook or were never on Facebook. They say it’s for old people. Many of your clients will be old. So keep that in mind. If you’re not on Facebook, if you’ve never been on Facebook, if you got off of Facebook, you might wanna reconsider having a Facebook page, maybe just for your cosmetic acupuncture piece of your practice and for nothing.

I do have a Facebook group that I run, which has over 8,000 people in it. It’s called facial acupuncture and being connected with other people that are doing what you’re doing helps to it, it raises you up because you learn from each other and it keeps it front and center in your mind. I, when I was first starting out, I used to have spa nights where I would invite my patients who might be interested in cosmetic acupuncture.

I would have some products out. I would talk to them. I would maybe do a little demo or just do a couple of intradermal needles so they could see what it felt like. during that time, you could do giveaways. You could even do an instructional class, let’s say on self care, cupping and Guha. So if you sell cupping and Guha kits your patients can, this is something they can do at home.

In between treatments. You could teach a little class on the Accu lift facial cupping set. It comes with a video for you to learn the self care piece, plus it has directions on the box and this can be a wonderful activity. A lot of my students have either done this for free or charge their patients.

So they might get a free class if they buy a cupping. or they just charge a couple of dollars and they buy a cupping set and they take a class that way packages providing if it’s legal in the state where you practice providing a package. Of let’s say you buy 12 facial acupuncture treatments, and maybe they get a free Derma roller or a free cupping session.

I would not do buy 12, get one free because that is really giving away a lot of your time. But something minimal doesn’t cost you a lot of money, but they feel like they’re getting something you wanna check with your local acupuncture board and make certain you’re allowed to do that. But those are great ideas for cosmetic acupuncture, because the important thing to think about is cosmetic acupuncture is a cash based business.

Insurance will not pay for cosmetic acupuncture. So your patients are paying you cash. You’re not having to go through the time and the trouble of filing for insurance. You get paid right away, right there. And there’s no having to deal with all of that paperwork and paying someone else to file it or.

You could also do patient classes on Derma rolling. Same thing with the facial cupping in Guha, you get some Derma rollers and the OCUL lift Derma rollers are the only Derma rollers. Which are approved by the American acupuncture council for use in the treatment room. You might wanna check those out as well, also converting your current customers.

So you have your clients, they’re coming to see you maybe. Complaining about getting older and they feel like they look tired all the time. Here is a whole audience that you already have people that are already coming to see you, and you can share stories about other. Patients who have the same concern and you help them.

And sometimes I’ll just throw in a couple of extra points to lift a brow or thread or wrinkle so they can get an idea of what it’s like. And typically they love it. Another question I get asked a lot is about the timing of the treatments. People are worried, I’m gonna be spending all this time in my treatment room.

Isn’t it more cost effective for me to just have three or four rooms going at once. And how am I ever gonna make any money doing this? The answer is you have to Once you get your flow going, you can have two rooms going at once 15 minutes to get the needles in. While that patient’s lying on the table for a half an hour, you can go, you can treat another patient.

Then you come back in, you take the needles out, do your cupping in Guha, and then you. Back to the other patient. So you can easily get two rooms going at once and whatever you typically charge for an hour treatment, I would charge that. And then half that again. So one and a half times what you would normally charge for a one hour acupuncture treatment.

You’re going to charge one and a half times. Because your patient will be in the room for about an hour and a half, maybe a little less. So it is entirely possible to have two rooms going at once. Maybe not. When you first start out, when you first start out, it might take you a little longer to get the needles in, but once you’ve done it a few times, couple a dozen times, you should be able to get the needles in, in about 15 minutes.

And be on to the next room. What about ancillary services and by ancillary services? Cupping in Washa Derma rolling microneedling. How do you work this in? As I just mentioned I never do. Cosmetic acupuncture without doing facial cupping and GU jaw. So it’s how I end my treatments. It helps with bruising, it relaxes the patient.

It’s something that I look forward to and it helps to bring the blood and the cheat out to the skin level. And it’s a really nice way and a treat. You can be trained specifically in facial cupping in Guha, or you can take a comprehensive course in facial acupuncture, cupping and Guha, which is what I would recommend.

Also, you will have patients who don’t want needles. And with them I can do in a half an hour. I do just facial cupping in Washa and I would charge accordingly for an abbreviated, half an hour cupping in Washa treatment. Derma rolling is something that you can offer as an add-on and. What I like to do would be more like Derma rolling and facial cupping in Guha, or I might do derro on a neck and chest and just do the facial acupuncture on the face.

I don’t like to end a facial acupuncture treatment with Derma rolling, because it can be a. For the skin. You can sell your patients of Derma welder and teach them how to use it, and then they can use it at home in between treatments, or you can offer it as a separate service. And then depending on how much time you wanna spend with the Derma, rolling will determine.

What you would charge and charge accordingly. Now dermas are single person use, you don’t wanna be sharing them between patients. There’s no way to Barb aside or autoclave these safely, because little pieces of hair and skin fragments, microscopic can. Stuck in between the needles and you could cross-contaminate.

So if you were going to offer it as a service, you either keep the Dermer roller for your patients for when they come and you would clean it and use it just on them, or you reduce it on them and send them home with it. And then if they wanted you to do a treatment on them, when they come back, they would have to bring it.

As far as microneedling, I do microneedling as a standalone service. So I will do facial acupuncture, and then microneedling. And the only caveat to this is. If someone only wants or needs microneedling, let’s say on their neck, on their chest, on their hands, I can do cosmetic acupuncture.

So I would put in the body points and the face points, and then I could put numbing cream on them. And then once I take the needles out of their face, I could do the microneedling, or even when the needles are in, I could potentially do the microneedling once the numbing cream comes off. And this way the person is getting the best of both worlds, especially if they have problem areas around the lips, on the chin.

But you don’t wanna be doing cosmetic acupuncture and microneedling on the same area in the same treatment. And microneedling is extremely profitable. It’s very easy to add into your practice. And people are charging anywhere from 350 to $700 for a half an hour. Microneedling treat. Yes. So you have your initial investment of your microneedling tool, like the ACU lift MicroPen or and then the only thing you have to replace are your serums, which are not a tremendous investment up front.

And then you can add this on as a treatment. I think that is all I have for you today. You can find me on social media at facialacupuncture,classes.com or on Facebook or Instagram or TikTok Michelle Galles. And again, thank you to the American Acupuncture Council for hosting this. And I look forward to seeing your next.

My Favorite Points for Cosmetic Acupuncture

thank you to the American Acupuncture Council for giving me this opportunity to talk about my favorite acupuncture points for the face.

Click here to download the transcript.

Hi, my name is Michelle Gellis and I want to thank all of you for coming today to my facebook live presentation and thank you to the American Acupuncture Council for giving me this opportunity to talk about my favorite acupuncture points for the face.

I have been teaching cosmetic acupuncture for almost 20 years now. And during that time, I frequently get asked what are my all time favorite points for either lifting the face or enabling more movement, more fluidity and the facial expressions and. So I have put together my top seven and I’m going to start out with points that I use in my protocol that are mandatory for my students.

And they are what I call steps. 3.5 or stomach three and a half. It’s almost like stomach three and three quarters because it’s pretty low down. So normally when we find stomach three, we get in line with the center of the pupil and we come down. Over the cheek and that is stomach three, but for stomach 3.5, you want to come down until you’re all the way over the cheek area.

And you are going to needle straight up into either the fatty part of the cheek, or if you’re a. Patient is very thin. You can even get underneath the cheek bone and right into the foramen in the orbital rim. And so that stomach three and a half, and the next point is small and test an 18, which is found on the outer canthus of the eye you come down and the same thing, you’re going to needle straight up.

And in some individuals you’ll be into the fatty part of the cheek, maybe into the Fatia or to what we call the mass layer, which is the superficial muscular aponeurotic system, which is what enables the muscles to control the movements on the. And for some individuals, you’ll actually be able to get underneath that cheekbone.

But when you needle both of these in an upward direction, it can really provide a lifting effect to the face. And I have a picture of that in a second. The next is Sanjay 17 for the gels and the lower face. Stomach nine for the neck and balancing the hormones. You yeah, for the, I’m sorry, you yell for the brow area and yin Tom for the frown lines and stomach for the mouth.

So let me go through each one of these individually. So here is a photo of. Of someone where I have needled stomach three and a half, and you can see it’s almost down into that stomach four area and then small intestine 18, which is way over the cheekbone and you needle straight up. And you can see how this could have a lifting effect on the cheeks, on the mid cheek area.

The next is San Joe 17, which is behind the ear. It’s in that space that really deep divot behind your ear. And. When I needle this point, I needle it towards the nose. You want to be careful. There’s a lot of glands back there and, but this point is wonderful. Is great for the lymphatic system.

It affects the whole lower part of the face that we call the gels. I always joke when I’m teaching and I say there’s two types of people that have gels and people that are going to get them because as we age all of the. Fat and muscles and ligaments that used to be up here, the ligaments loosen and the fat kind of slides down.

And we ended up with a less defined jawline. So by noodling this point, And then whenever I do facial cupping, I always cut this point and I do wash Shaw back there. It really has a very lifting effect on the lower part of the face. And also on the neck area.

Stomach nine is. Definitely one of my all time favorite points. This is a picture of yours truly, and thought it was a great example of a neck. So I went ahead and marked stomach nine on it. And so stomach nine can be found. It is inline with the prominence of the laryngeal prominence and the way you find it is you ask your patient to swallow.

And when they swallow, you will feel the prominence, the laryngeal prominence, you put your finger on it and you slide right over into the empty space between the larynx and the S. And if you’re having trouble finding the SCM, you can ask your patient to just press against your hand and the SCM will pop out and.

Once you found the SCM and the larynx, then you put your finger in between the two and you feel for a pulse and wherever you feel a pulse don’t needle there you can push against where you’re feeling the pulse with your finger and then needle straight in. I use a half an inch needle. You don’t have to needle very deeply, but this point is.

Wonderful for a lot of reasons, it helps with hormones, right? It’s right by the thyroid. It also helps to open the energy up to the face is a local treatment for the neck and. I’m a classically trained five element acupuncturist. This point is called people. Welcome. It can really people who have shut down, maybe they’re a little shy or they’re.

Pushing people out of their life. Maybe they have things they want to say, but they weren’t saying them this point can help to open people back up. It’s especially important. Since the pandemic where people were in and not getting out. So this stomach nine is definitely one of my favorite points.

Next is you. Yeah. Now when I needle this, I don’t needle it in the traditional way, which the traditional definition is at the center of the brow you needle straight. And the way that I needle it is I take a half an inch needle, a two, I put the two underneath the eyebrow. I go to the center of the pupil and the center of the pupil lines with the levator muscle.

So you want to get above the orbital rim. You don’t want to be noodling on the eyelid inside the. You get above the orbital rim. Sometimes you have to lift your patient’s brow up a little bit and you take that tube and you get it right underneath the brow. And then you, once the tube is right underneath the brow, you can just push the needle right up.

And so you can see in this picture that I have. Where I’ve needled underneath the brow. And then I have followed this up with bladder two and Sanchez 23, all three lifted a needle in a kind of lifted direction in order to really pull that brow. So you, yeah. Now is a real heavy hitter when it comes to lifting the brow and it can even help, not just with the brow, but with the lid.

next are those frown lines. And some people we have just the one line in the center. And if that is the case, I will thread in Tom right through the wrinkle. I needle it in an upward direction, right through the wrinkle. And again, I’ll use a half inch. Needle. And this serves two, three purposes. One is it relaxes this whole area and relaxes your patient.

And it also works right on the procerus muscle, which is this little triangular muscle here, which pulls this whole area together. And You can also needle with little intradermal needles, if someone, so you can have just the one wrinkle or you can have the two wrinkles, which they call the Eleven’s and this woman has those.

And then some people, they get the, what they call the a hundred and Eleven’s where they’ll have a wrinkle. Medial to each eyebrow, plus they’ll also have a wrinkle right in the center here. So you can use yin tongue needled and you can also use some intradermal needles and get into those other little wrinkles right there.

And this will. Both relax, your patient lacks the procerus muscle. And locally, any time you take an acupuncture needle and you thread it through a wrinkle, you’re stimulating collagen locally in the scan, fibroblasts are created and it helps to Create a collagen in the area. So the wrinkle itself can fill in because even if you just relax the muscle, there can still be a resultant, a wrinkle in the area.

And the last point. Which is another favorite of mine, and this is a real powerhouse for the whole mouth area. And the mouth area can be difficult to treat because there are a lot of different issues or concerns that individuals have with their mouth, not just cosmetic, but also with issues with movement.

And I’m going to back up real quick, a step. This can be the same with, I was talking about using you yell for the brow. If someone has had Bell’s palsy, you can use the point noodle, the way that I said, and this can help get movement back into the brow area, lift their lid. If they still have drooping, or if they’ve had a stroke.

Stomach four is right in this area called the Modi OLIS and it is just lateral to the corner of the map. And the reason why this is such a powerhouse and why it’s one of my favorite points is the muscle around. It’s not shown in this picture, but there’s a muscle that goes all the way around the outside of the mouth.

So this is the or us and people get wrinkles all around their lips. So by treating pretty much any of the acupuncture points, like run 24 or stomach for any of the acupuncture points that light around them. You are going to treat the whole obicularis Oris, which really plays into these wrinkles around the lips.

So that’s one reason. And the other reason is people can get these frown lines that go they’re called marionette lines, but it looks like the person is frowning, even when they’re not. And the wrinkles go from the corner of the mouth, down to the jaw line. And by treating stomach four, you can see all the different muscles that stomach four is attached to.

So the Buka Nadir, which is very deep here, the resorts, which pulls the mouth this way. And you have your zygomaticus major and that helps to pull the sides of the mouth up. You have your , which runs, it hooks onto your jaw and then goes all the way down over your clap. You have your levator angulate Orus your depressor anguli Oris.

And your what we call the D a O is the depressor anguli Oris, which is this muscle right here. And this muscle right here attaches right onto your platoon. So you can see all these different muscles. 1, 2, 3, 4, 5, 6. I think there’s a muscles that are attached to this modal list, which is our stomach four.

So by treating stomach four, you’re treating all of these muscles. You’re helping the wrinkles. You’re helping the drooping that can go on. And also laxity since the Dao is attached to the . When you treat the Dao, you help to reduce any pulling on the platoon FISMA, which can cause those SMA bands that can happen.

I love stomach four and I highly recommend it. You can needle it straight in. And it’s one, it’s actually a motor point for treating the whole mouth area. And so those are my favorite points for treating the face. There are many more, there are many muscles on the face, but those are my top.

And if you want to learn more about. Cosmetic acupuncture or acupuncture for treating neuromuscular facial conditions. You can go to my website, facial acupuncture, classes.com, and learn more about I’ve got a lot of free videos. I have a lot of free information handouts and plus my class informing.

So thank you for showing up today. And I look forward to seeing you again, next time.

Ethical Concerns in Facial and Cosmetic Acupuncture

So as acupuncturists, we are all required to do some ethics training. Things will come up when you’re dealing with taking care of your facial and your cosmetic acupuncture patients that are a little different than your traditional patients.

Click here to download the transcript.

Hi, my name’s Michelle Gellis and I would like to thank the American Acupuncture Council for giving me this opportunity to present on Ethics in Facial Acupuncture. I’m ready for the first slide.

So as acupuncturists, we are all required to do some ethics training. And over the years I have a full acupuncture practice and cosmetic and facial acupuncture practice. And what I have come to know to be true is that frequently. Things will come up when you’re dealing with taking care of your facial and your cosmetic acupuncture patients that are a little different than your traditional patients.

And so I put this I put a course together it’s a two hour CEU course to cover. Facial acupuncture, ethics. And this is an overview of that little bit about me. For those of you who don’t know me. I was on faculty with the Maryland university of integrative health from 2003 to 2021. And I teach facial acupuncture classes internationally.

Here are some of my publications. You can look them up. On my website, which is facial acupuncture, classes.com and there is the NCC a O M code of ethics. Now each state will have its own code of ethics, but since this is a nationally broadcast show, I put up the NCCC Aon, a O M code of ethics just as a guideline.

And in a nutshell, the code of ethics state that you will work within your scope. You will practice integrity and respect, and you will also. Participate in events like this that helped to contribute your learning. And so the topics I want to talk about in the time we have together is an overview of communication.

So the ethics of communication, how do you see. With your patients in an ethical fashion, the ethics of contract. So having integrity between what you say and what’s in writing, how to document with your facial patients and then the ethics of touch when you are when the face is concerned. Under the big umbrella of ethics of communication, our listening skills, which I’m going to talk about in a minute.

And then really that goes to understanding your patients. And this can be unique when it comes to. Facial acupuncture because we have in, or we may have in our heads, some ideas of how we think about aging, but how do your patients feel about aging? What does it mean to them? Where did they get those ideas and letting them communicate to you?

What they are unhappy with as far as their appearance and what they’re happy with and not projecting our thoughts and our ideas on aging and appearance onto our patients. So this all comes back to listening skills. So the Chinese. Character for listening effectively is the ear and the king. So the ear above the king the number 10 or maximum the eye and the number one or single, and then the heart.

And essentially what it means is. When you’re still, you listen with the heart and the ear is worth 10 eyes. Tic not Han had said an hour of mindful listening can change the life of an individual. So what does it mean to be a good listener? When I was teaching at M U H a. Used to give a one hour lecture just on listening skills.

So here are some of the highlights a an Indian philosopher had said that to observe. Without evaluating is the highest form of intelligence. So to be able to be in the presence of our patients without putting our values and judgements on whatever’s going on over there, and then being able to listen to them is.

The most, one of the most important things when we are doing cosmetic acupuncture, it is very human to have our preferences and our opinions, but letting go of the sheds, the expectations, the beliefs, the judgments can be very freeing, both for your patient and for yourself, not interrupting. So putting yourself on.

Just let them talk because every time you interrupt them, you give the message that what you have to say is more important than what they have to say, and it can cause your patients to shut down. Being a little more quiet, providing where you assurance paraphrasing what they said, these will encourage talking, denying.

If your patient says something is a concern to them making light of it or saying, oh, don’t be ridiculous. That’s not a big deal that will cause them to shut down, interrogating them. And this doesn’t mean question asking, it means really bombarding them with questions. To the point where they’re not comfortable.

Advice-giving people come to us for a certain amount of our professional opinions, but too much advice giving patients will shut down and then psychoanalyzing your patients. If you are a therapist that. They should be coming to see you for that. And many states, I don’t know about the laws in every states, but in many states even if you a licensed therapist, you’re not supposed to be doing psychoanalysis in your treatment room, they’re two separate things.

So listen for their feelings, ask them, don’t tell them And what you think or what you feel really get into how they feel about different things. And this will give you information about where and how you should be approaching treatment as far as their eyelids their jowls, their lips really listen to what it is they’re saying.

I’ve had patients come to me with concerns that really weren’t that obvious. And through questioning and listening, I come to find out they had something else going on in their life. And so this drooping, eyelid or thin what they felt were very thin lips a wrinkle or something. Really was not that apparent became a big deal to them because that’s what they were focusing on.

Let them tell their story. Even if you have the same story, keep your story sharing to a minimum, your stories that you share should be teaching stories. This is not a conversation that you’re having with one of your friends. This. About really drawing a picture in your mind of where your patient’s coming from and being able to listen to what it really is they want.

So paraphrase and check in with your patients. Each of the 800 words that we use on a regular basis. Has an average of 17 definition. So if you’re all unclear, check in with your patients, listen between the words. People really want you to hear what they’re not saying. And this can come through with their tone, their body language, let their face be the guide to your understanding of.

What they’re saying, listen to those incomes for in consistencies. Are they telling you how happy they are about something, but they’re all slumped in their seat. Make observations about these types of things. Really getting a picture of what your patients want. Why they are coming to see you.

This all falls under the umbrella of respecting their dignity and in order to set realistic goals and outcomes,

you want to be able to like over pro over. Under promise and over deliver. So when you’re telling them how you’re going to help them with any concerns that they have. Have integrity in what you say, let them know what are realistic expectations and stay within your scope of practice. If someone is asking you to do something, that’s not really in your wheelhouse, just refer out.

American acupuncture council does require that you get training. In cosmetic acupuncture by someone who they have deemed appropriate to teach you cosmetic acupuncture is not just something you can learn. By yourself by watching YouTube videos or just making stuff up. There are certain country for indications and precautions and guidelines for cosmetic acupuncture.

So respect the dignity of the patients who come to see you. They need to understand that this is a safe space, that if you were going to use any before and after photos, it would only be done with permission that you are going to check in with them every step, along the way. Everything that happens in the treatment room is confidential and really keeping appropriate boundaries.

Also things like gender and race diversity. People’s sexuality. So much of this is tied into our appearance and have that in mind when you’re talking to people when they’re discussing a body part, certain races of people have we all have different face shapes and. Certain individuals might want their face to look more Caucasian or less Caucasian or their eyes to be more round or less round.

These are all things we can actually work with, but again, use the listening skills, understand what’s going on for this person. And it will guide you. With your boundaries and how you are communicating, setting realistic expectations is really important. There’ve gotta be verbal expectations on the phone written expectations.

When you’re talking to the patient, you write down what it is that they’re expecting, and then you have to communicate to them. How many treatments might this? What might the results look like and be clear and honest about this. There are a lot of things that go into setting these expectations. And when I teach my cosmetic acupuncture classes, we go through quite a bit of there’s quite a bit of learning around.

How can you determine what the outcome might be? And some of those things are your patient’s diet, their lifestyle, their genetics, their actual chronological age, their constitution type from a five element TCM perspective, their TCM diagnosis, and then their history. Have they spent a good part of their lifeline out in the sun.

So this is all part of the big picture because not everyone is going to get the same results. General rule of thumb is people are going to come once or twice a week. And then you reevaluate after six to eight treatments. And. For most individuals, they are going to be looking at 12 to 20 weeks of treatment and then maintenance people are going to continue to age for someone who’s younger or has less signs of aging.

They may need fewer treatments and it goes the other way as well. So how do you talk to your patients? Cottage medic acupuncture. What can you do? How does it work? This is a pretty extensive list, but it’s certainly not comprehensive. And that is, it works with your body. I always do body points.

When I do cosmetic acupuncture, it works with the face. It brings blood and cheat to the area. It increases circulation. It helps your digestion. And if a person has had a facelift and they are fully healed, like a year out, it can help their face lift last longer. And improved digestion immunity, circulation, and is going to carry nutrients out to the skin, helps to create collagen and elastin in the areas where needles have been inserted.

But it does take a minimum of 28 days to produce collagen. So it’s not a one and done and. There are things that contribute like facial expressions. And as I mentioned, lifestyle, that can cause a lot of these conditions or signs of aging. And if the person continues to do it, it can take a lot longer.

So when you’re talking to them, you set the realistic expectation. You find out from them what they would like to accomplish. You go through your TCM diagnosis and if they’ve had any outside treatments done, they must speak to that person to find out when it’s okay for them to have acupuncture and everything should be documented.

Everything that they say. If they’ve had Botox, any sort of surgery on their face. Injections lasers, peels, all of that stuff should be documented. And then what it is they would like help with and what your treatment plan is, and then go over it with them.

As far as contra-indications major ones should be screened for on the phone. Things like high blood pressure migraines debilitating or severe health conditions seizure disorders, epilepsy, hepatitis coronary disease, some of the. Or red flags. You wouldn’t even begin with the patient. Others. You can still have them come in, but you would have to discuss a treatment plan with them.

And it may be that you have to treat them for the condition for a while before you start the cosmic. Acupuncture, cosmetic acupuncture can make Botox wear off. You cannot do cosmetic, or you should not do cosmetic acupuncture on individuals who were pregnant. And just because of the way cosmetic acupuncture brings energy up to the head, it can bring on.

Migrants as far as documentation, of course, I’ve mentioned notes, how and when to take photos is important. We don’t have time for that here, but it’s an important conversation. You can visit my webinar for the expanded version, but I do recommend strongly that you take before photos. And then privacy.

Any previous procedures, how to know if they’ve had certain things done and then how to talk to your patients about it regarding touch when you’re working on the face Lillian bridges have. Said that treating the face is trauma work. And whenever you’re working on someone’s space, there is because all of our emotions are stored in our face.

There is the possibility that things will get released at sometimes resolved, but there’s the emotional aspects of the face. And then any sort of. Deformity scars, acne scars. If they’ve had skin cancer, car accidents, these types of things are shown that we don’t cover our faces up. So when you’re touching someone’s face, when you’re working with their face, be mindful of all of these things.

And I always do a follow-up after the first time I meet with a patient. I contact them within the next day or so. Although bruises are in my experience, fairly uncommon they can happen. So you want to find out how they’re feeling, how the experience was. Did they get any bruises? And I always talk to them about that ahead of time.

So there’s no surprises. So you have to prepare your patients upfront for any Contra indications. And always screen them for the precautions. And here is a list of all of the courses that I offer. They are all offered as recorded webinars. And I also have live hands on training throughout the us, Canada, the UK and Austria.

So I hope that was beneficial. And let’s see. I can see who we have next time. Ah, next time is Sam Collins and thank you so much. And thank you to the AAC for this opportunity to present.