Botox Above, Balance Below: How Constitutional Facial Acupuncture Complements Integrative Aesthetics

Can a patient continue treating their forehead and frown lines with Botox while receiving Constitutional Facial Acupuncture for the rest of the face?

Absolutely.

In fact, this is one of my favourite conversations to have with Naturopathic Doctors who already incorporate cosmetic injections into their practices.

This does not need to become a debate about Botox versus facial acupuncture. They are different tools, they accomplish different things, and when used thoughtfully, they can work beautifully together.

A patient may love the way Botox softens the lines between their eyebrows or reduces repetitive movement through the forehead.

This is where the conversation becomes much more interesting to me.

Once we look below the forehead, we are no longer thinking about one wrinkle or one muscle. We are looking at the relationship between the jaw, cheeks, mouth, neck, posture, nervous system, constitutional health and the emotional landscape being expressed through the face.

That is where Constitutional Facial Acupuncture Renewal™ can add an entirely different dimension to an integrative aesthetic practice.

Watch: How Botox and Constitutional Facial Acupuncture Can Work Together

In this short demonstration, I explain how a patient can continue treating their forehead and frown lines with Botox while we work constitutionally and address the jaw, neck, cheeks, smile and lower face through acupuncture.

We Can Continue Treating the Rest of the Face

When a patient has Botox in the forehead or frown lines, it does not mean that we have to stop treating constitutionally or avoid the rest of the face.

We can still work with jaw tension and TMJ-related muscular patterns.

We can address the neck and the relationship between the platysma, jawline and lower face.

We can work with the digastric region beneath the chin, tension around the mouth, and the muscles involved in the natural movement of the cheeks and smile.

Depending on the patient’s presentation, this may include:

• The masseter and temporalis
• The platysma
• The digastric muscle
• The risorius
• The zygomaticus major and minor
• Muscles surrounding the mouth
• The depressor and levator muscles
• Other facial and neck motor points

Facial aging is complex. Changes in the lower face are influenced by the skin, connective tissues, fat compartments, underlying bone, muscular patterns and the effects of gravity over time.

Constitutional Facial Acupuncture does not pretend that one needle can reverse every structural aspect of aging.

What it gives us is another way to work with the living, moving face in front of us.

What Does Jaw Tension Have to Do With the Lower Face?

Quite a lot.

Many people live with jaw tension without realizing how much they are holding.

They clench while they work. They grind their teeth while they sleep. They brace their jaw while concentrating. They tighten their neck and lift their shoulders when stressed.

Some have headaches, facial pain or restricted jaw movement. Others do not recognize the tension until we begin palpating the muscles.

Over time, the masseter, temporalis and surrounding structures may become overworked and tender. The lower face can begin to look heavier or more compressed. One side may appear different from the other. The corners of the mouth may look less animated, and tension through the jaw and neck can affect the way the entire lower face is carried.

This does not mean that TMJ dysfunction is the sole cause of jowls or sagging.

It does mean that clenching, grinding, muscular tension and jaw dysfunction deserve to be part of the conversation when we assess the lower face.

When I treat someone with jaw tension, I am not only asking how the jaw looks. I am asking:

• Does it hurt?
• Do they wake with headaches?
• Are they clenching at night?
• Does the jaw open evenly?
• Is their neck tight?
• Are they sleeping?
• What is happening with their digestion?
• What has their stress level been like?
• What do their tongue, pulse, posture, voice and overall presentation tell me?

That is the difference between treating an isolated aesthetic concern and treating the person who is experiencing it.

The Platysma Is Part of the Picture

The platysma is an important muscle when we are talking about the jawline, mouth and neck.

It extends from the upper chest and shoulder region into the lower face. Its activity can influence the appearance and movement of the neck, lower jawline and corners of the mouth.

As we age, platysmal bands may become more noticeable, and the muscle can contribute to changes in the contour of the neck and lower face.

An injectable treatment may be used to temporarily reduce activity in a carefully selected area of the platysma.

With acupuncture, I may be looking at how the platysma is functioning within a much larger pattern involving the neck, jaw, digastric region, mouth, cheeks, posture and nervous system.

Sometimes we need to release excess tension.

Sometimes we want to encourage better neuromuscular balance.

Sometimes we need to look at why the patient is gripping through the jaw, mouth and neck in the first place.

And sometimes the most important part of the facial treatment is not happening in the face at all.

The Treatment Begins With the Body

This is one of the principles I feel most strongly about.

In Constitutional Facial Acupuncture Renewal™, we do not begin by simply placing needles into every line or area of sagging.

We build the treatment through the body first.

We consider the patient’s constitution, current symptoms, emotional presentation and the patterns that may be contributing to what we see in the face.

That may involve working with the Eight Extraordinary Meridians.

It may mean addressing sleep, digestion, hormonal changes, headaches, pain, stress or emotional holding.

It may mean supporting a patient who has spent years living in a state of tension and is now beginning to see that tension reflected in the jaw, mouth, neck and eyes.

Only then do we bring the treatment into the face.

Working With the Cheeks and Smile

When someone feels that their cheeks are becoming flatter or their smile is beginning to look less lifted, it can be tempting to focus only on the area they see in the mirror.

But again, I want to look at the relationships.

• How is the patient using the muscles of facial expression?
• Is the risorius pulling the mouth laterally without enough upward movement?
• Are the zygomaticus muscles engaging well?
• Is there tension through the masseter that is changing the balance of the lower face?
• Is the platysma pulling downward?
• Is the neck restricted?
• Are there scars, dental procedures or injuries affecting local movement?
• Is the person smiling freely, or has the face become guarded?

We can work with facial and neck motor points to encourage healthier muscular balance and more natural movement.

The intention is not to create a frozen or artificial expression.

It is to help the patient look more like themselves when they are rested, relaxed and feeling well.

The Emotional Landscape of the Face

When I talk about the emotional landscape of the face, I do not mean looking at one wrinkle and deciding that we know everything a patient has lived through.

Human beings are far too complex for that.

I am talking about the patterns we begin to notice when we genuinely pay attention.

The jaw that never quite lets go. The forehead that remains tense even when the person is resting. The mouth that is held tightly. The shallow breathing. The guarded expression. The exhaustion around the eyes.

The patient who tells you they are “fine” while their entire body looks as though it has been preparing for an emergency for the past five years.

Our emotions influence how we breathe, sleep, digest, move and hold our muscles. The face is part of that physiology.

Chinese medicine gives us a beautiful framework for exploring these relationships. We can consider the Shen, the organ systems, the channels, constitutional tendencies and the ways that long-standing patterns may be expressed throughout the body.

When patients begin to release some of that internal holding, their face often appears softer and more alive.

They do not simply look more relaxed.

They actually are more relaxed.

That is a very different kind of beauty treatment.

This Is Not Botox Versus Acupuncture

Botox may be wonderful at doing the particular job for which it was chosen.

Constitutional Facial Acupuncture addresses another layer.

A patient can continue treating their forehead and frown lines while we work with:

• TMJ dysfunction and jaw tension
• The masseter and temporalis
• Platysma and neck tension
• The digastric and submental region
• Muscles surrounding the mouth
• The cheeks and smile muscles
• Facial asymmetry
• Headaches and cervical tension
• Stress and nervous-system regulation
• Sleep, digestion and constitutional health
• Deeper emotional patterns being carried in the face and body

Treatments must, of course, be timed appropriately. Practitioners need a strong understanding of facial anatomy, must remain within their professional scope, and should communicate with the patient’s injector when necessary.

But the patient does not have to choose between a softened forehead and a treatment that supports the rest of their face and body.

They can have both.

Could Treatment Be Covered by Extended Health Benefits?

Potentially. This is another important distinction between constitutional treatment and a service that is purely cosmetic.

When a regulated Naturopathic Doctor or acupuncturist is treating appropriate clinical concerns—such as TMJ pain, jaw tension, headaches, neck pain, sleep disturbances or stress—the appointment may be eligible for reimbursement through the patient’s naturopathic or acupuncture benefits.

The beauty of this approach is that it truly is deeper clinical care.

A patient may first arrive because they are concerned about their jawline or cheeks, but they may also receive meaningful treatment for the headaches caused by clenching, the neck tension they carry throughout the day, the sleep disruption worsening their pain, or the stress pattern keeping the face and body contracted.

For some patients, this allows treatment to become part of their ongoing healthcare rather than something they view only as an occasional aesthetic service.

Why I Want More Naturopathic Doctors to Learn This Work

Naturopathic Doctors are already trained to look beyond the surface. You are accustomed to asking why.

• Why is this person clenching?
• Why are they not sleeping?
• What is changing hormonally?
• What is driving their pain or inflammation?
• How is their digestion affecting their overall wellbeing?
• What has been happening emotionally?

That way of thinking fits beautifully with Constitutional Facial Acupuncture Renewal™.

If you already offer cosmetic injections, this training does not ask you to abandon them. It gives you another clinical language and another set of tools.

It allows you to offer the patient who loves their forehead injections something more for the jaw, neck, cheeks, smile, stress and constitutional patterns that injections alone were never designed to address.

It may also change the way you observe and assess patients throughout the rest of your practice.

That is part of the long-term value of this training.

Join the Five-Day Vancouver Course Bundle

Foundations

September 11–12, 2026 | 16 CEUs

Foundations establishes the constitutional framework, body-to-face treatment sequencing, observation skills, facial needling techniques and practical use of the Eight Extraordinary Meridians.

Advanced

September 13–15, 2026 | 24 CEUs

We then move directly into the Advanced training, where we explore facial and neck motor points in much greater depth.

The Advanced course also includes:

• TMJ and other facial syndromes
• Neuromuscular considerations
• Facial asymmetry
• Scar therapy
• Intradermal needles
• Threading techniques
• More complex constitutional treatment strategies

Constitutional Facial Acupuncture Renewal™ was developed by internationally respected educator, clinician and author Mary Elizabeth Wakefield, founder of the Chi-Akra Center for Ageless Aging™.

Since 2015, I have been honoured to serve as the designated Canadian educator for this work.

I bring more than 20 years of clinical experience into the classroom, along with real patient stories, demonstrations, supervised practice and the practical adaptations that come from using these techniques in a busy clinical setting.

My goal is not for you to leave with a binder that sits on a shelf.

I want you to leave feeling confident enough to begin using what you have learned.

A More Complete Way to Think About Beauty

I do not want practitioners to stop using the tools that already work well for their patients.

I want to expand the conversation.

Botox can soften the frown.

Acupuncture can help us explore why the patient is still clenching.

An injection can reduce movement in a carefully selected muscle.

Constitutional treatment allows us to work with the jaw, neck, cheeks, smile, nervous system and the deeper patterns being carried throughout the body.