Keeping it real smooth.
Beauty rituals are somewhat of a funny thing. Almost out of nowhere, an ancient technique or practice suddenly becomes mainstream, and the next thing you know, everyone is doing it. It's like everything old is new again in modern beauty. And that's kind of how gua sha — an age-old ancient Chinese remedy of skin massaging using a unique handheld tool — became a viral beauty sensation. Gua sha has grown so much in popularity and is so beloved that some proponents are swearing off Botox in favor of the facial massage technique, claiming it provides similar benefits.
“Gua sha has been part of traditional Chinese medicine for thousands of years and incorporates tools like horn, stone, and jade to scrape the skin,” says Dr. Elizabeth Trattner, A.P., DOM, Integrative and Chinese Medicine. “Gua sha also has solid clinical scientific evidence that other popular tools, such as facial rollers, cannot touch.”
One reason why gua sha fans love the practice so much is because routinely scraping the skin improves stagnant blood flow and can increase surface microcirculation by 400%, according to Dr. Trattner, which in turn clarifies the skin, defines and sculpts the jawline, and enhances facial symmetry.
The dramatic before-and-after images strewn across Instagram and TikTok are pretty impressive, too. Some call gua sha nature's Botox based on its ability to reduce the look of lines and wrinkles sans needles or injections.
But can skimming a piece of stone precisely across the skin do the same job as injectables and fillers? Intrigued and curious to know, we enlisted the help of three experts. Here's everything you need to know about potentially trading in your beloved beauty injectables for a gua sha tool and when it's best to pair it with in-office procedures.
How Gua Sha Works
A gua sha facial massage is a quick and easy step to incorporate into any skincare routine that involves "scraping" the skin with a palm-sized tool. Gently scraping the skin with firm, upward strokes wakes up the lymphatic system (it runs throughout the body) and increases blood circulation to carry away toxins and excess fluid, which reduces puffiness. Dr. Eunice Park, a board-certified facial plastic surgeon, explains that the manual pressure used with a gua sha tool also releases underlying muscle tension, similar to the relief we experience from a neck or shoulder massage. "This can be especially helpful for people who suffer from TMJ and jawline clenching or tightness."
Board-certified cosmetic dermatologist and Mohs surgeon Dr. Dendy Engelman says gua sha is "a nice opportunity to check in with ourselves and take a moment for self-care in the morning or evening." It also offers some pretty stellar beauty and anti-aging benefits. "Gua sha is popular now because of its dramatic effects on lifting and sculpting the face by improving blood circulation, decreasing inflammation, puffiness and fine lines, and creating a healthy glow. I have had patients transform their faces with gua sha," Dr. Trattner shares. Over time and with consistent use, it can also help reduce the appearance of fine lines and wrinkles.
Yet, despite gua sha's rising momentum, it's crucial to perform it correctly while staying in tune with the skin. Dr. Trattner shares that gua sha has significantly been commodified. "I see so many women doing this medial modality incorrectly because they watched an influencer or video and did not learn it correctly from a doctor of Traditional Chinese medicine." It's critical to always use a gua sha with a serum, oil or cream, which allows the instrument to glide effortlessly across the skin. Finally, she advises against using a broken or chipped gua sha, which can cut the skin.
Is gua sha as effective as Botox?
A before-and-after photo may be worth a thousand words. Still, regardless of what an image conveys about gua sha, it and Botox work differently. Even though both gua sha and Botox can improve the look of lines, wrinkles and an aging face, Dr. Park says gua sha and Botox should never be referred to as one and the same. "They have unique mechanisms of action. For example, gua sha can stimulate blood flow to the skin and help reduce puffiness and edema, but it will not magically erase wrinkles and expression lines." Gua sha reinvigorates stagnant tissues sans any needles, injections or chemical response.
Whereas gua sha relies on pressure, massage and anti-inflammatory scraping to work the muscle and tissue and get stagnant blood flowing again to revive the skin, Botox (and the like) employ neurotoxins that, when injected, block out signals from the nerve to the muscle that is needed to contract. Reducing or eliminating these contractions and facial expressions softens the lines and wrinkles that become ingrained in the skin.
Another differentiating factor between the two is their onset of action: neuromodulators kick in after a few days to one week; gua sha improves the look of the skin over the long run. However, you'll likely need to use a gua sha consistently for months before seeing a difference because it takes time to unblock stagnant blood and lymph flow. "Getting the lymph system and blood circulation moving helps lead to healthier and younger-looking skin, and with regular use, it can help reduce the appearance of wrinkles and fine lines," Dr. Engelman says.
Can gua sha replace routine injections?
While there may be some instances where gua sha can be a more natural alternative to Botox injections and filler, the results will never be identical to what an injectable can accomplish. "I think gua sha is a relaxing part of a skincare routine, but I don't think it should be considered a direct substitute for Botox and fillers," Dr. Park says. Instead, she prefers clinically effective treatments like chemical peels, laser facials, and microneedling treatments for those who are not yet ready for injections or want to avoid them altogether.
"We know that persistent and prolonged contraction of the facial muscles in between our eyebrows and on our forehead can lead to wrinkles. Gua sha can help relax these muscle contractions transiently and can play a role in preventing the formation of deeper skin creases over time," Dr. Park says. "But gua sha will not effectively smooth a visible wrinkle or sustain a smoothing effect over three months."
Even if you follow a steadfast gua sha routine, it won't erase fine lines and wrinkles with the same efficacy as Botox and other injectables. "Neurotoxins, like Botox, are clinically proven to relax the underlying facial muscles that cause dynamic wrinkles, lasting about three months," Dr. Park shares. "Botox is one of the most highly studied aesthetic products with data that supports its efficacy."
There may be long-term benefits with consistent gua sha use, but, according to Dr. Park, these effects are difficult to quantify. “Gua sha will always yield a much milder result,” Dr. Engelman adds. But if you're okay with that, then gua sha may be the right choice.
Several areas of the face are prime real estate for gua sha. Dr. Park says the improvement in blood circulation and lymphatic drainage, one of the most significant benefits, helps with puffiness around the under-eye region. The positive effects of gua sha can also be seen between the eyebrows. "These wrinkles result from prolonged and persistent muscle contraction. Some people engage these muscles more than others, so there can be varying degrees of facial animation and expressivity," Dr. Park notes. “Gua sha can play a role in relaxing these muscles through massage and pressure. However, as a stand-alone treatment, Botox is clinically effective, and the added benefit of gua sha in enhancing the results is still debatable," she adds. Another area where regular gua sha is highly beneficial is the jawline. "Using a gua sha on the jawline and masseter muscle can decrease muscle tension," Dr. Park says.
When Botox and gua sha mix — and when they don’t
Like so many other aesthetic and beauty treatments, there’s a time and place to combine injectables with gua sha and a time to choose one over the other.
Using a gua sha (or any other facial tool or massaging device, for that matter) too soon after injections, especially Botox and neuromodulators, can potentially hinder the results and shorten their duration. Dr. Engelman explains that gua sha can cause the neuromodulator to move beneath the skin, changing the location of where it settles and thereby affecting the appearance of the results. "You could end up with asymmetry in your face and areas of unwanted swelling or muscle relaxation (drooping), which takes time to fade. In some cases, you can move the neuromodulator to an unsafe location, for example, the eyelid or eye area, which can cause more serious complications that take weeks or months to heal or require treatment," she shares.
The pressure put on the face during gua sha massage is another reason to steer clear of it post-injections. Dr. Trattner recommends always using delicate pressure, especially on the neck, since excessive force can dislodge a clot. As if that's not enough, it's normal for an injection site to be tender to the touch, bruised and even swollen, and facial massage may create discomfort in the area. Dr. Engelman believes using gua sha (and other at-home tools) incorrectly or too frequently can harm the skin. "Using too much force or pulling on or tugging the skin roughly can irritate the skin and cause bruising and broken blood vessels."
Going forward with your regular gua sha routine ahead of schedule may also abbreviate the wrinkle-reducing effects of Botox due to increased blood flow. And you’ll want to be equally as cautious post-filler, too, since gua sha can move it out of place.
Certain injectables, like Sculptura, come with even more specific gua sha cautions. "I say to hold off for a good month or two so that the product can work to make more collagen," Dr. Trattner shares. The same goes for filler injected along the sides of the face and in the jawline, which tends to experience minor swelling. As tempting as it may be to gua sha these areas to release unwanted puffiness, don't. "Instead, what can help is gua sha on the neck and decolletage to facilitate lymphatic drainage and to open and move the meridians of the neck and face," Dr. Trattner suggests. "This will help the face drain naturally and expedite healing."
Kybella is one injectable where gua sha can make a significant difference post-treatment. "It can be beneficial several weeks after receiving Kybella injections because the act of gua sha helps the fascia move back together and facilitate the drainage of the neck and lower jaw. However, it is imperative to have this done by a cosmetic acupuncturist only. Otherwise, you can make matters worse," Dr. Trattner explains. "I have seen substantially improved healing after Kybella but do not advise gua sha at home for this purpose."
So how long should you wait after a trip to your dermatologist before resuming your regular gua sha routine? It comes down to what you had done, where, and how much product was injected. Dr. Engelman recommends waiting about one week before using a gua sha, ensuring that any swelling or bruising has subsided. "By this point, the neuromodulator has had enough time to settle and take effect," she adds. If you want to take a more cautious approach, you can wait another week — two weeks is recommended for fillers — or up to one month. Always use caution in delicate areas such as the under eyes, lips and nose to avoid displacing the filler. "Consult your injector about best practices immediately post-filler placement since filler injection is highly customized to the individual," Dr. Park says.
If you "mess up" your injectables, what should you do? When it's the case of disturbed Botox, you have to wait it out. When filler migrates or turns lumpy, your dermatologist can reverse those effects with a few shots of hyaluronidase, an enzyme that breaks up hyaluronic acid gel.
The Bottom Line
There's still nothing like the OG wrinkle reducer, Botox, but a solid and consistent gua sha routine can come in as a close second. While the results from gua sha won't be identical to those of Botox and other neuromodulators, it definitely won't hurt to use one, and it can even improve the skin and facial contours. Just know what each one is capable of doing and not doing, whether you choose to go the route of the needle or a scraping tool.
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