Ask an expert - general - cosmetic

7 questions

The first thing we would ask in cases like this is what investigations you may have had already. There are a number of medical conditions like blocked tear ducts and the related dry eye syndrome which may be the cause of the swelling, and this can impact on the success for which one might hope. We answered a question on both a couple of years ago, and the answer is worth repeating for the wider context in which it places treatment. 

Chinese medicine is based on an entirely different theoretical basis from conventional medicine, what is often called a different paradigm. The essence of Chinese medicine is a belief that the body, mind, emotions and spirit are all manifestations of an energy called 'qi' whose proper flow and balance means that everything functions the way it is supposed to. If this flow becomes blocked or disturbed in any way, then functional disturbances appear, often affecting all 'levels' of the system and for which needles are used by the practitioner to restore flow.

When someone reports blockages it makes one question immediately whether the energy of that area is flowing as well as it might, and a skilled and experienced practitioner could determine quite quickly whether, from the Chinese medicine perspective, there was something which might be done. Even if there were no immediately obvious signs in the area itself, the principles of Chinese medicine are founded on a notion of overall balance which means that symptoms are less critical, being indicators of a wider imbalance in the system rather than the necessary focus of attention. It would be worth your while to visit a BAcC practitioner local to you for an informal assessment of whether they believe that acupuncture treatment may be of benefit to you.

That said, we have to say that the research evidence for the treatment of both conditions with acupuncture is a little bit thin. There are a few studies, but one of the key factors in undertaking research from a conventional perspective is trying to reduce the variables, and this means being able to define clearly what the problem is. Blocked tear ducts  have several possible causes, and this means that comparing like with like becomes more difficult, and the results less reliable. What research we have identified is of relatively poor quality, and if we were making recommendations based solely on that we would have to say that it would not be worth pursuing. However, our clinical experience is that where there are clear energetic blockages treatment can sometimes have a very direct effect, and it would certainly be worth seeking advice from a BAcC member local to you.  There are, in fact, some quite useful studies of related problems like dry eye syndrome, and although it is rather technical this paper both realistic and encouraging.This expert has to admit that it has not been the most successful area of his practice. While few patients have come specifically for this as a problem several have had it as a secondary problem, and even where the main problems have responded well this hasn't. That said, in the minority of cases where there has been a positive change the result has been welcomed with great joy.

Acupuncture treatment is always worth a try. There is very little chance of an adverse effect, and there are enough reports of treatment working for this problem to suggest that it is worth a go. The only issue for cases where there is less evidence is to make sure that a patient doesn't get tied into a long and potentially expensive course of treatment without any tangible benefit. In another context, Dr Johnson once described something as 'the triumph of hope over experience', and we always ask our members not to succumb to joining patients in a desperate hope for good outcomes. If there is nothing happening after four or five sessions it may well mean that nothing will happen.
If, however, the bags under the eyes are a result of loss of muscle tone, then we enter the area of facial or cosmetic acupuncture which has been in vogue for the last few years. There is no doubt that there is some basis for this work, as studies like this one There may also be reasons to do with straightforward blockage where treatment may have an effect. Our belief, though, is that treatment of local blockages really needs to be done in the context of a wider diagnosis of a person's balance, and only by doing this can the results be maintained.The last decade has seen a proliferation in people training to do 'facial acupuncture' or 'cosmetic acupuncture', many of whom have no background in acupuncture at all. We are not being protectionist in saying that in the courses which people do, many of which are of one or two day's duration, we do not think that anyone can learn properly skills which form a part of a three year training programme. If you do decide to seek the help of someone offering facial or cosmetic acupuncture we would fully recommend that you make sure it is someone who is also properly trained as a professional acupuncture practitioner.

I  have seen few vidoes of acupuncture for nose correction. I have a bulbous short ungrown nose. Is it safe to have acupunture treatment and is it permanent and are there any side effects?

This is not something on which we can really comment.

 We have looked at the video accounts to which you are probably referring, and although they look pretty impressive they do not bear a great deal of relationship to what we do as acupuncture practitioners in trying to adjust the energies of the body. This is rightly called acupuncture because it involves putting needles in the body but as far as we can see, apart from the use of Hegu, a point on the hand for acupuncture anaesthesia, the rest of the technique looks rather like a physical reworking of the tissues using a larger needles than most of us would consider.

 There are a number of individuals whose clinics in India and in the United States promise results which are not replicated elsewhere. We have found, for example, a clinic in the US and one in India which offer treatment for an eye condition retinitis pigmentosa for which there is very little successful conventional treatment. Our view is that given our community if there were to be a successful treatment for these problems then the word would spread rapidly and we would all be offering the treatment. The fact that the results, as genuine as they appear to be, are only generated by a small number of charismatic individuals makes us wonder whether there is something going on here which has more to do with the unique nature of the individual than the practices which they use.

 We are sorry not to be able to say more than this, but we would be highly reluctant to create unrealistic expectations unless we felt that this was something that any of us could help with, and our feeling is that this is not an undertaking which we could give.

Q:  I understand you can have acupuncture on the face, to slow down/ help with the ageing process!! Is this correct please? 

A: There has been something of a boom in recent years in the use of acupuncture treatment to reduce the appearance of ageing. There is little or no research to validate claims for success, but this is really no surprise. It is difficult to imagine how one could design a meaningful trial with objective outcome measures. However, when something is popular and enduring, which this appears to be, then there is usually something in it. You can fool some of the people some of the time.......!

There are literally thousands of practitioners operating in this field, not all of them professional acupuncturists with a full degree level training. We have said for many years that local interventions like this will only have enduring effect if they are underpinned by constitutional treatment. The face does reflect very well the overall balance of the person, and it would be unrealistic to expect to improve one part of the system when the rest of it is showing signs of overall imbalance and disruption. The best that one might hope for is a short term fix requiring further treatment a few weeks down the line. While this falls within the normal pattern of beauty treatment, we rather hope that our members that use facial/cosmetic acupuncture are aiming for something a little better.

There are a number of things you should check. First, is the practitioner properly trained? There are a number of

reasonably reputable courses around, and these are a minimum requirement, in our view. Some of the needle techniques are not within mainstream treatment, and the face is not a place for amateurish treatment. Second, is the person properly insured and registered for what they do? Many beauty practitioners take short courses without any information about safety, waste disposal, registration for skin piercing and proper insurance. This could have serious implications if something goes wrong.

Because we have yet to agree standards for this specific practice we have no way of telling which BAcC members offer this type of treatment. However, if you use our home page postcode search facility and retrieve a list of names, it should be fairly easy to search on google to see who offers this. Those who do tend to use it in their PR. If not, most practitioners know which of their colleagues to refer people to for speciality treatment, and it should take you very little time to find someone who can offer facial treatment alongside traditional treatment aimed at restoring balance overall.

Q: There is absolutely no doubt that this has become a very popular and recent extension to traditional acupuncture practice; many BAcC members undertake postgraduate training in the techniques, some of which are not a part of mainstream acupuncture training, and openly advertise this as an extension of their work. 'Rejuvenation' is not an acceptable term any longer; you would need much more rigorous evidence to meet the current ASA standards for advertisers. Most people describe their work as 'cosmetic acupuncture' or simply 'facial acupuncture.'

A:  Popularity brings challenges, and this field has also become something of a lucrative sideline within the beauty business. This has meant the entry into the business of people who have trained only in this aspect of the work, and we have two major reservations about this. First is that no-one can be properly and effectively trained in the safe and hygienic practice of acupuncture in the course of a weekend training programme. From our perspective it matters not whether the practitioner uses ten needles a year or ten thousand needles a year, the standards remain the same. Our concern, as always, is that an amateur in what is a professional field does something wrong, and we can guarantee that the headline will say 'acupuncturist does.....'. No point in us quibbling about levels of training, the damage will have been done. When you think that this technique may be used by people in the public eye, the possibilities for a PR disaster are considerable.

More importantly, though, there is no separate field of 'facial acupuncture'. There are simply the techniques of traditional acupuncture applied to a specific area, and these techniques will only be effective to the extent that the practitioner takes into account the systemic problems against which the facial problems occur. The most irritating thing from our perspective is that acupuncture used without an understanding of the wider system will most often not work very well, and we believe that a porr experience, where acupuncture treatment seems not to work, will turn someone away from a system which properly applied could do a great deal not just for the face but for the rest of the person too.

Our advice is that if you are looking for someone to provide this form of treatment, be sure to go to someone who also uses traditional acupuncture as a main profession. That is your best chance, in our view, of optimising your investment in time and money. We would also advise you to shop around. In the view of this expert, this has become something of a 'cash cow' for some practitioners who price themselves according to the beauty market in which the treatment is offered. Whilst we would recognise the value of postgraduate training and experience, it is after only only traditional acupuncture applied in a specific area, and the gap between someone's ordinary charges and this form of treatment should not be too great.

There has been an upsurge over the last few years in what has been described as 'cosmetic acupuncture' or 'facial revitalisation acupuncture'. With it has come a rather hot debate inside the profession, not least because some of the clinics where this technique is used charge fees that are considerably higher than the average fee charged by a BAcC member, and also because some of the people offering this treatment are not fully qualified practitioners but simply beauticians who have undertaken short course training.

Our general position is that there is not a specific separate discipline of cosmetic acupuncture but rather the application of traditional techniques on the face adapted for a specific purpose, but, and most importantly, taking into account the system as a whole as traditional acupuncture does. We have taken great care to get the message across that a properly trained traditional acupuncturist treats the person as a whole, not simply a named condition or a single part of the body, and that unless treatment is undertaken in this way, there can be no guarantees that short term local results can be be sustained.

We are also keen to get across the message that however limited the area of interest, acupuncture remains acupuncture wherever it is performed on the body, and our members undergo three years of degree-equivalent training to ensure that they are safe and competent and fully aware of factors affecting the safety of the patient. We do not believe that someone undertaking a short training over two weekends can realistically hope to match this level of safety training as well as learning the techniques. This is especially the case with some of the techniques commonly used in cosmetic acupuncture which are not a part of the standard protocols for body acupuncture.

We do not keep a separate register of our members who offer this type of treatment. The best bet would be to use google to identify someone in your area providing this style of treatment and then cross-refer with the BAcC Register to ensure that it is someone who is properly trained and insured.

As a general comment, though, we would want to have a look at what in your life was contributing to your wrinkles. If you are under constant stress and worry, there may be systemic treatments to help you to cope better with either in such a way as to reduce your wrinkles. We always ask whether wrinkles go when people are on holiday. You'd be surprised how many people say that they do. If so, local treatment will not be a proper solution to the problem unless it is supported by treatment of the system as a whole.

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