I’m back with the next chapter in my series on Informed Consent Body Regions, this Massage Monday, we’re talking about Facial Massage!
The face is considered a region that requires informed consent because some clients have an aversion to having their face touched, they may struggle with dermatological issues, they might prefer an aesthetician or cosmetologist to work on their face, or they may not realize that facial massage is within the massage therapists scope of practice.
However, the face has extensive motor and sensory sensitivities, in fact, all five major senses are housed in or around the face. Sight with the eyes. Smell with the nose. Taste with the mouth. Sound with the ears. And most of all, touch with the skin.
Massage of the face can stimulate the Central Nervous System. It can stimulate the muscles that create and reflect our expressions and mood. And facial massage can subtly interact with the client’s emotions.
Facial massage can be provided dry (meaning without the use of massage lubrication or products) Or you can use oils or moisturizers. You can also provide compressive massage on the face with a warm damp towel.
General guidelines for working on the face are to focus your massage strokes upward and outward. This keeps the skin from drooping by fighting gravity and enhances the circulation of lymph fluid toward the ears and neck (which are the next largest lymph nodes in the body). One should approach the face with confidence and moderate pressure. Avoid the eyes, nostrils, and mouth to reduce the risk of spreading pathogens.
Basic “Facial” protocols can be performed by massage therapists, but intense services like microdermabrasion, needling, extractions, etc. are outside the scope of practice for massage therapists and should not be offered. The best way to think of facial massage treatments can be like a basic facial. Massage therapists must adhere to our scope of practice and the laws and ethics of our profession. Again, this means that more intense esthetic techniques like extractions, microderm, waxing, etc. will not be applied for massage therapy clients. It is important to remember that massage therapists ARE NOT aestheticians – we cannot remove any tissue from the body (including hair & skin) nor can we diagnose skin conditions.
Most facial massage employs a lofty use of effleurage strokes. Notice how I am very briefly applying some Cranio Sacral holds for the clients frontal & temporal bones, as well as a posttrial-lateral traction of the sphenoid bone by applying traction on the client’s ears.
In terms of anatomy, the face has approximately 43 muscles and 14 facial bones. Again, this becomes tricky in determining which bones and muscles belong strictly to the face and which ones belong strictly to the scalp. Tell me what you think, where does the scalp end and the face begin?
When working with product, I stick to a six-step facial massage protocol. Which features cleansing, exfoliating, massaging, masking, toning, and moisturizing.
When applying cleanser product, that process mainly features effleurage strokes to work the product all over the skin in upward & outward strokes. Once a good lather of cleanser has been achieved, a towel should be applied to remove the product.
With the exfoliation step, it is best to stop the exfoliator product at the chin and jaw lines. Light effleurage and gentle vibration strokes can be used in this step. Another towel should be used to remove as much as the exfoliator as possible.
For the massage step, one would typically apply a facial cream or oil in light even layers. This process can run under the chin, into the neck and along the pectoral/decolletage regions. This is one step in the protocol where one could pull out all their massage strokes; effleurage, petrissage, tapotement, vibration, and friction. The massage product should be absorbed into the skin and the next step can be applied right on top of the massage product without removing it with a towel.
The mask process is best stopped at the chin and jaw lines (just like the exfoliator). Make an even coat of mask product on the clients face. A good rule of thumb is to wait until the mask visibly hardens or at least five minutes after applying before removal with a towel. Special care should be made to ensure that all mask product has been removed from the client’s face.
The toner step can be applied with two cotton rounds working bilaterally to gently rub the product across the surface of the client’s pectoral/decolletage, neck, and face.
Finally, layer your moisturizer on top of the toner without removing it with a towel. Again, use all five variations of the massage strokes (effleurage, petrissage, tapotement, vibration, and friction) working the product in to the skin well.
The skin is the body’s largest organ and acts as a barrier to the outside world and is therefore the first line of defense against pathogens. Our skin also communicates our state of health. Massage therapy IS skincare! The skin is the first layer of soft tissue we contact and manipulate- massage therapists should be given a much deeper and richer understanding of healthy skin. Because healthy skin is also beautiful skin. In the same way it is not vain to want to take care of ourselves, it is also not vain to want to take care of our skin.
Facial massage is done to assist the skin’s natural functions. The skin naturally “sheds” and regenerates new skin cells approximately every 28 days. As we age, that regeneration rate (or skin rollover) and healing slows to approximately every 72 to 90 days! (That’s going from a regeneration rate every month to once every three months! Only 4 times a year in older age!) By age 70, it is estimated that up to 80% of sensory receptors in the skin MAY be lost due to lack of use- facial massage can help by stimulating those receptors, the skin, muscles, and nerves.
The following protocol is my basic procedure for providing facial massage. None of these basic steps or products is outside the scope of practice for massage therapists as defined in Arkansas Laws & Rules:
Cleanser is any process or product that removes dead skin cells, oil, dirt, and other pollutants from the skin.
Exfoliators are any process or product that removes dead skin cells- often some degree of abrasive scrub.
Massage is the treatment of soft tissue (including skin, muscles, and fascia) to maintain good physical condition, comfort, and relief of pain.
Masks/Masques are products that have highly concentrated ingredients, often creates an occlusive barrier that locks in the treatment so the skin can directly absorb the product.
Toners/Toniques are products that cleans, protects, and refreshes the skin. Toners will often tone the skin and reduce the size of pores.
Moisturizers are products that are used to restore moisture and hydrate the skin.
I encourage massage therapists to get more of a grasp on the processes and benefits of facial massage! Get out there and find a great esthetician to learn from and network with! Or find a great dual licensed mentor like I was fortunate to know and learn from each other.
Massage IS Skincare! Get out there and approach face massage with confidence!
Peace and Healing,
Kirby Clark Ellis, MMT, BCTMB