Effect of Facial Cosmetic Acupuncture on Facial Elasticity: An Open-Label, Single-Arm Pilot Study

Abstract

Background. The use of acupuncture for cosmetic purposes has gained popularity worldwide. Facial cosmetic acupuncture (FCA) is applied to the head, face, and neck. However, little evidence supports the efficacy and safety of FCA. We hypothesized that FCA affects facial elasticity by restoring resting mimetic muscle tone through the insertion of needles into the muscles of the head, face, and neck. Methods. This open-label, single-arm pilot study was implemented at Kyung Hee University Hospital at Gangdong from August through September 2011. Participants were women aged 40 to 59 years with a Glogau photoaging scale III. Participants received five treatment sessions over three weeks. Participants were measured before and after FCA. The primary outcome was the Moire topography criteria. The secondary outcome was a patient-oriented self-assessment scale of facial elasticity.
Results. Among 50 women screened, 28 were eligible and 27 completed the five FCA treatment sessions. A significant improvement after FCA treatment was evident according to mean change in Moire topography criteria (from 1.70 ± 0.724 to 2.26 ± 1.059, P < 0.0001). The most common adverse event was mild bruising at the needle site. Conclusions. In this pilot study, FCA showed promising results as a therapy for facial elasticity. However, further large-scale trials with a controlled design and objective measurements are needed.

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Evidence-Based Complementary and Alternative Medicine
Volume , Article ID , pages
http://dx.doi.org/.//
Research Article
Effect of Facial Cosmetic Acupuncture on Facial Elasticity:
An Open-Label, Single-Arm Pilot Study
Younghee Yun,1Sehyun Kim,2Minhee Kim,1KyuSeok Kim,1
Jeong-Su Park,3,4 and Inhwa Choi1
1Department of Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University, No. 149 Sangil-dong,
Gangdong-gu, Seoul 134-727, Republic of Korea
2Graduate School of East-West Medical Science, Kyung Hee University, Yongin, Gyeonggi-Do 446-701, Republic of Korea
3Kyung Hee Center for Clinical Research and Drug Development, Kyung Hee University, 1 Hoegidong, Dongdaemungu,
Seoul 130-701, Republic of Korea
4Department of Preventive Medicine, Graduate School of Korean Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
Correspondence should be addressed to Inhwa Choi; inhwajun@khnmc.or.kr
Received  April ; Accepted  July 
Academic Editor: Bo-Hyoung Jang
Copyright ©  Younghee Yun et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. e use of acupuncture for cosmetic purposes has gained popularity worldwide. Facial cosmetic acupuncture (FCA)
is applied to the head, face, and neck. However, little evidence supports the ecacy and safety of FCA. We hypothesized that FCA
aects facial elasticity by restoring resting mimetic muscle tone through the insertion of needles into the muscles of the head, face,
and neck. Methods. is open-label, single-arm pilot study was implemented at Kyung Hee University Hospital at Gangdong from
August through September . Participants were women aged  to  years with a Glogau photoaging scale III. Participants
received ve treatment sessions over three weeks. Participants were measured before and aer FCA. e primary outcome was the
Moire topography criteria. e secondary outcome was a patient-oriented self-assessment scale of facial elasticity. Results.Among
 women screened,  were eligible and  completed the ve FCA treatment sessions. A signicant improvement aer FCA
treatment was evident according to mean change in Moire topography criteria (from . ±. to . ±., 𝑃 < 0.0001). e
most common adverse event was mild bruising at the needle site. Conclusions. In this pilot study, FCA showed promising results as
a therapy for facial elasticity. However, further large-scale trials with a controlled design and objective measurements are needed.
1. Introduction
With extended life expectancy, beauty and skin health are
important factors in perceived quality of life. Currently,
numerous interventions are oered for skin rejuvenation and
anti-skin aging including treatments for facial wrinkles, facial
muscle tone, and elasticity. Recently, cosmetic acupuncture
has been introduced as an intervention for skin rejuvenation
[].
Facial cosmetic acupuncture (FCA) is the use of acupunc-
ture on the head, face, and neck for cosmetic purposes. Sev-
eral dierent types of FCA are currently practiced, and many
possible mechanisms underlying these techniques have been
proposed, including increasing or balancing qi, balancing
internal Zang Fu organs, increasing blood ow by inserting
needles at certain acupoints [],andincreasingmuscletone
[].
However, little evidence addresses the ecacy and safety
of FCA. A recent case report describes the increased water
andoilcontentoffacialskinaerFCA[]; otherwise, there
is only an introductory [,]ornon-Englisharticle[].
To explore whether FCA has eects on facial elasticity, we
designed an open-label, single-arm pilot study using the most
frequentlypracticedFCAtechniqueinKorea.
2. Participants and Methods
2.1. Ethics Approval. is study was performed in accordance
with the International Committee on Harmonization Good

 Evidence-Based Complementary and Alternative Medicine
F : Facial cosmetic acupuncture applied in this study.
Clinical Practice guidelines and the revised version of the
Declaration of Helsinki. e trial protocol was approved
by the Institutional Review Board of Kyung Hee University
Hospital at Gangdong (KHNMC-OH-IRB -). Written
informed consent was obtained from all participants prior to
enrollment, and participants were given ample time to decide
about participating before signing the consent form.
2.2. Participant Recruitment and Inclusion/Exclusion Criteria.
Participants were recruited by advertisements on bulletin
boards at Kyung Hee University Hospital at Gangdong.
Included were (a) women; (b) aged  to  years; (c) with
a Glogau photoaging scale III []. We excluded individuals
who (a) had dermabrasion, deep skin peels, laser resurfacing
(ablative or nonablative), botulinum toxin, ller injection, or
topical steroid treatment within the  months immediately
prior to study entry; (b) had obvious skin disease or a history
of chronic skin disease; (c) had a keloidal or hypertrophic scar
tendency; or (d) were pregnant or breastfeeding. No other
treatment for facial elasticity was permitted during the study
period.
2.3. Study Protocol. is study was an open-label, single-arm
pilot study at Kyung Hee University Hospital at Gangdong
from August through September . Five sessions of FCA
treatment were given over three weeks. All participants
received FCA twice a week for the rst two weeks, then once
a week for the last week, with three to four days between
sessions. Participants were assessed based on changes in the
Moire topography criteria [].
2.4. Acupuncture Procedure. Acupuncture was applied
(Figure ) according to the Standards for Reporting
Interventions in Clinical Trials of Acupuncture (STRICTA)
[].
() Acupuncture rationale
(a) A single practitioner inserted acupuncture nee-
dles into muscles of the face, head, and neck.
(b) All participants received the same FCA treat-
ment at every treatment session.
() Needling details
(a) e total number of insertions per treatment
ranged from approximately  to .
(b) e practitioner inserted acupuncture needles
at the insertion, origin, belly and/or margin of
(i) head muscles including the temporalis and
epicranial aponeurosis;
(ii) neck muscles including the sternocleido-
mastoid;
(iii) upper facial muscles including the fron-
talis, procerus, corrugator supercilii, and
orbicularis oculi;
(iv) midfacial muscles including the auricula-
ris, nasalis, levator labii superioris alaeque
nasi, levator labii superioris, zygomaticus
minor, and zygomaticus major;
(v) lower facial muscles including the orbic-
ularis oris, risorius, depressor labii inferi-
oris, depressor anguli oris, mentalis, and
platysma.
(c) e depth of needle insertion varied with skin
thickness and subcutaneous fatty tissue at the
insertion site.
(d) e practitioner did not use any specic nee-
dling technique. However, the practitioner tried
to insert needles into the contraction of muscles
bers over the muscle insertions, origins, bellies,
and/or margins of muscles.
(e) Needles were retained for ten minutes.
(f) e practitioner used an acupuncture treatment
aid, AcuPro (NEO Dr.), and stainless steel ne
needles (. × mm, . × mm) to reduce
pain and to shorten treatment time (Figure ).
() Treatment regimen
(a) All participants received ve sessions FCA over
the -week treatment period.
(b) All participants received FCA twice a week for
the rst two weeks, and then once a week for the
last week.
() Other components of treatment
(a) No other treatments were given and participants
were asked not to receive any other treatment for
facial elasticity during the study period.
(b) All participants received FCA with an interval
of three to four days between sessions.

Evidence-Based Complementary and Alternative Medicine 
(a) (b)
F : AcuPro and stainless steel ne needles used in this study.
(a) (b)
F : Criteria for evaluating Moire topography.
2.5. Outcome Measurements. Outcomes were measured
before and aer the ve sessions of FCA.
2.6. Primary Outcome. e primary outcome was a change
in the Moire topography criteria aer treatment compared
with baseline. We generated contour lines on the face using
a Moire topography system and took pictures with a digital
camera Ixus (Canon, Tokyo, Japan). A single independent
evaluator read the contour lines near the cheek and the
perioral region in the printed digital image and graded the
images based on the Moire topography criteria (Figure )[].
2.7. Secondary Outcomes. A patient-oriented self-assessment
scale of facial elasticity was performed with the same fre-
quency as the primary measurements. Participants assessed
their degrees of the facial elasticity using a  cm vertical line
visual analog scale (VAS). e scale was marked at the top
with “most severe condition,” with the bottom labeled “ne
condition.”
2.8. Safety. e Institutional Review Board of Kyung Hee
University Hospital at Gangdong reviewed the protocol,
monitored patient safety, and investigated any adverse events
independently of the investigators.
2.9. Statistical Analysis. All primary analyses were based on
an intention-to-treat (ITT) population. End-of-study analy-
ses were performed using the last observation carriedforward
for participants who did not complete the study. Patient
characteristics were summarized using descriptive statistics.
e nonparametric Wilcoxon signed-rank test was used for
assessingclinicalimprovement.SPSS.forWindows(SPSS
Inc.,Chicago,IL,USA)wasusedfordatamanagementand
statistical analysis. A 𝑃value less than . was considered
statistically signicant.
2.10. Quality Control. Beforestartingthetrial,theacupunc-
ture practitioner was trained and had been administering
FCA at a clinic of Kyung Hee University Hospital at Gang-
dong for over a year. e investigator who assessed the
outcomes received thorough training in assessing Moire
topography.
3. Results
3.1. Participants. Of  participants screened,  were eli-
gible for the study,  completed the ve sessions of FCA
treatment,andonedroppedoutbecauseofpainaerthe
rst FCA treatment. e mean age was . ±. (range:
–) years, and all participants were Asian females with a
Glogau photoaging scale III (Figure ).
3.2. Primary Outcome. e primary outcome was mean
change in Moire topography criteria from baseline to the end
ofthestudyintheITTpopulation.eMoiretopography
changed signicantly (𝑃 = 0.0001) aer FCA treatment
(Table ). Of the  participants who underwent all ve
sessions,exhibitednochange,whileshowedapositive,
single-level improvement (Table  ).

 Evidence-Based Complementary and Alternative Medicine
Assessed for eligibility (n=50)
Excluded (n=22)
∙Not meeting inclusion criteria (n=21)
∙Declined to participate (n=1)
Enrolled (n=28)
∙Completed the ve sessions of FCA (n=27)
∙Discontinued FCA aer rst FCA (because of pain) (n=1)
Analysed (n=28)
ITT analysis
Received FCA (n=28)
F : Progression of participants through the study.
T : Me an ch a n g e i n M o i re topogr aphy.
Before FCA
(𝑛=28)
Aer FCA
(𝑛=28)𝑃value
Moire topography criteria 1.70 ± 0.724 2.26 ± 1.059 .∗
Data are mean ±standard deviation of percent change (% condence
interval).
∗Statistically signicant dierence, 𝑃 < 0.05.
T : Changes in Moire topography for participants who com-
pleted the study.
Negative change aer FCA (𝑛)
No change aer FCA (𝑛)
Single level improvement aer FCA (𝑛)
Total (𝑛)
T:Meanchangeinpatientself-assessmentofskinelasticity.
Before FCA
(𝑛=28)
Aer FCA
(𝑛=28)𝑃value
Patient self-assessment
Elasticity scale 6.15 ± 1.562 4.81 ± 1.942 .
Data are mean ±standard deviation of percent change (% condence
interval).
3.3. Secondary Outcomes. Mean changes in a patient self-
assessment of skin elasticity showed no signicant dierences
(Table ).
3.4. Safety Evaluation. e most commonly reported adverse
eventthatwasclearlyattributabletoFCAtreatmentwasmild
bruising (/ treatment sessions;.%) at the needle site.
Onlyoneparticipantdroppedoutbecauseofpain.Noadverse
events of scarring, nerve damage, or lengthy recovery periods
were observed.
4. Discussion
is clinical open-label, single-arm pilot study investigated
the ecacy and safety of FCA on facial elasticity. FCA has
been increasing in use and popularity but few introductory
articles [,]wereavailableuntilDonoyamaetal.reportedin
 on increased water and oil content for facial skin aer
cosmetic acupuncture [].
Several dierent types of FCA are practiced. Recently, in
Korea, clinicians have used FCA to enhance facial elasticity
by restoring resting mimetic muscle tone by inserting needles
into head, face, and neck muscles. Louarn et al. []conducted
an MRI study on changes in the contour of facial mimetic
muscles in patients of dierent ages. ey found that facial
mimetic muscles gradually straighten and shorten with age
asaresultofincreasedrestingmuscletone.Basedonthese
ndings, we hypothesized that FCA could be used to improve
facial elasticity with needles inserted into the muscles of the
head, face, and neck, resulting in restored muscle tone.
Dierent methods for measuring facial elasticity range
from manual examination to direct visualization. Moire
topography is an optical measurement that does not require
direct contact and allows high-precision visualization of
facial shape in three dimensions, similar to a contour map [].
Moire topography is used in studies of facial palsy, zygomatic
fractures [], facial morphology, and facial plastic surgery
[]. e Moire topography criteria were developed by Ahn
et al. [] for measuring facial elasticity. Moire topography

Evidence-Based Complementary and Alternative Medicine 
criteria show a very high correlation with age and the
Cutometer, which evaluates skin elasticity.
In this study, we found that participants who underwent
ve FCA treatment sessions showed an improvement of about
. by Moire topography. FCA also improved scores on a
patient self-assessment of elasticity, but the changes were not
signicant. ese results suggested that FCA improved facial
elasticityinwomenagedandyearswithaGlogau
photoaging scale III.
is study had several limitations. It is an open-label,
single-arm pilot design. e sample size was small with no
control group, and the trial duration was short compared
to the actual clinical environment. For example, in the
Cosmetic/Derma Clinic of Kyung Hee University Hospital
at Gangdong, an FCA treatment course is generally eight
treatment sessions over  weeks. e Moire topography
criteriaareanordinalscalewithwideintervals.escale
might not detect small changes and is highly dependent on
the evaluator’s judgment.
However, in spite of these limitations, this study could be
helpful in providing clinicians with procedural details about
FCA and could be the basis of future investigations aimed
at elucidating the possible mechanisms of FCA including
restoration of resting mimetic muscle tone. A larger study
with a controlled design using dierent objective outcomes
measure could be warranted.
Conflict of Interests
e authors state no conict of interests. No nancial support
or benets were received by the authors. e authors have no
commercial associations or nancial relationships to disclose.
Acknowledgments
e authors would like to thank Inho Jung for introducing
the FCA procedure and Seungphil Cho for the helpful
discussions. is study was supported by a grant from
the Traditional Korean Medicine R&D Project, Ministry of
Health & Welfare, Republic of Korea (B).
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