A Physician’s Opinion

by Richard H. Tew, M.D., Harvard graduate, General Practitioner, Integrated Medicine

 After reading your article…FWIW, my model of the anatomy of the skin of the face (and to a lesser extent elsewhere) is that the links between the skin’s underside and the underlying tissues are complex. Relevant to your interests, these tissue links are something like the cords of a parachute in that there are many fibers connecting from muscles to the underlying skin, and conversely, there are many fibrils extending from the skin down into the tissues, all in various planes and bundles. I suspect this tissue organization is shaped by some combination of genetics (defining development of the face) and use (like everywhere else in the body, use alters anatomy — think: calluses), as well as by trauma (direct physical injury, of course, but also chemical injury; oxidant injury is probably the most relevant). These processes result in folds and drooping and other effects we usually attribute to aging. It’s interesting (and not often recognized) that folding doesn’t just make wrinkles; it also makes ridges! All these generally involve a loss of flexibility of the underlying tissues. One word that’s used medically is “sclerosing”; the skin “scleroses” when it ages. But that’s not all. The skin also grows as we age, at least wherever there’s a constant distending force put upon it. The operative word here is “constant”.

You may recall that Iraqi boy who was so horribly burned (intentionally — the madness of wars and sectarian violence cannot be overstated). His face was scarred so much he had almost no lips, and there was mostly scar (after the burns healed) where face originally existed. Now this is an extreme problem of facial distortion that’s obviously light-years beyond facial exercise. However, what the doctors did to help this little guy (who is quite endearing according to every account, and very intelligent too — all in all, testimony to the resilience of the child) was to insert balloons under those areas of his face and neck that were spared burn injury and stretch them by slowly over many weeks inflating those balloons. Then the stretched skin (this is easier in a child who is growing, of course) was used to reconstruct portions of his face. There are images on the Internet showing this process, which has not yet reached completion, but has accomplished a great deal already.

Now what’s evident from this process is that in someone young and growing, this sort of process doesn’t lead to drooping. Rather if done well surgically it can be transformative. The plastic surgeons who do “face lifts” on adults use this same premise when they “lift eyes” and other treatments. But to the extent these maneuvers pull out wrinkles, they also decrease flexibility. And a loss of flexibility means a loss of expressiveness. While the techniques that destroy flexibility (lifts and Botox®) are getting more discriminating with their techniques, it remains true these techniques impede movement. And a loss of movement generally means a loss of vitality (expressed and actually on a tissue level). At an extreme, the mask of death is the perfect face lift.

Your techniques do something quite different. Your points about “de-tacking” do seem correct, in that you are restoring flexibility. Some might worry de-tacking is traumatic, and of course it could be. Hence having good gentle but sufficiently powerful and effective techniques are essential.

What an exercise program does is “enliven” the facial tissues. I am reminded of an orthopedic problem, the frozen shoulder. While most of the time this problem only get serious evaluation after it has advanced to the point it requires arthroscopic surgery to restore joint function, milder cases can be helped, even fully cured, with physical therapy, a process in many ways analogous to what you’re doing with facial exercise. In fact there is probably a therapy program that a person can do in their home for frozen shoulder, but this rarely is offered or taught, although some therapists do show their patients exercises to do at home between their sessions at a physical therapy center.

My point? That your work with the face can be seen as a special application of this well-developed and fairly well understood healing process.

Another point worth mentioning (maybe) is that your program does far more than simply exhaust the facial muscles to make them less tense. The relaxation of the musculature often (very often) is accomplished when unrecognized “tensions” that are frozen into the face get released, not just temporarily through exhaustion but entirely because the mind-body has no reason to tense the body area any longer.

It is well recognized by body-workers (massage therapists, rolfers, acupressure therapists, etc) that the body tends to “hold” trauma, stress, and other forms of “history”. We all bear in our posture and expression various forms of “splinting” (yes, just like what’s done when we break a bone or overstretch a ligament, “splinting” by our own muscles immobilizes a part of the body where movement is linked to pain). We do this to deal with an experience or a memory that is linked to tension and stress. Body workers report their work fairly frequently uncovers long-past event memories that are “held” in the body’s muscles. While these workers often notice facial smoothing and other changes in the face as their clients proceed with body work, these same workers less frequently work directly on the face, in part because they know the face is fragile. It seems fair to suggest your program, and to some extent other facial programs that work the face, are going to encounter depots of stress in the face that often are not realized by the person themselves. It seems an advanced aspect of your program could advise clients about this and perhaps even attend to that factor affecting facial change usually attributed to aging.

I think also you might look into the effects of exercise on elastin, the stretchy component of connective tissue. I will not be surprised to hear that working an area enhances the elastin in that same area. This is certainly true of ligaments and muscle sheaths. While some might think this effect could tighten the skin excessively, it is almost certainly otherwise. A chief outcome of any training program in athletics is to reduce the risk of injury because the body becomes more elastic and of course also simply stronger. It seems unreasonable not to expect that the same sort of improved fitness is achieved with facial exercises. The only difference: instead of being able to run farther or do more chin-ups, the face has better “tone” and thus looks more vital. Where’s the problem with that?

Lastly I have to say your article is simply elegant! I cannot but imagine it will find great resonance in the community.

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