Mary Elizabeth Wakefield, LAc, Dipl. Ac., MS, MM
Facial acupuncture continues to command increased attention from the national media, print, Internet and television, commensurate with the desire of the general populace, driven by the highly motivated baby-boomer demographic, to reconfigure the "face" of aging. With this upswing in interest from a wide range of well-heeled, socially aware individuals, facial acupuncturists are now presented with the potential to accrue considerable financial largesse, as this immense group seeks non-invasive alternatives to the tried-and-true avenues of age "therapy."
It is our moment; we are surmounting the crest of an enormous wave of psychosocial change. These evolutionary energies are embedded in the fabric of our art and medicine, which, in accordance with its ancient philosophy, strives for transformation from within through re-establishing the essential harmonies of body, mind and spirit.
However, with this increased influence comes a heightened sense of responsibility to our patients, the modality and, ultimately, to our profession, which, not surprisingly, has become subject to greater scrutiny from the Western allopathic establishment.
For example, I recently contributed to an article in Cosmetic Surgery Times on the merits of facial acupuncture versus Botox. The cosmetic surgeons in the article seemed quite concerned about the encroachment of facial acupuncture on their exclusive terrain. They questioned the validity of facial acupuncture and its cost-effectiveness, calling for side-by-side, double-blind case studies and expressing concerns about practitioner ethics:
"What could be a useful treatment might be over promoted by less-than-ethical non-physician practitioners, thereby creating false expectations and possibly harming patients."1
Therefore, at this point in our development, it's necessary to establish the parameters under which we will continue to operate, to set appropriate boundaries and define scope of practice so as to avoid censure from our officially sanctioned counterparts in the Western medical world and possible legal repercussions, should we fail to measure up to those expectations of our more abundant, but generally uninformed, patients.
Facial Acupuncture and the AAC
Several years ago, while appearing as a presenter at the CSOMA Symposium in San Francisco, Marilyn Allen, editor of Acupuncture Today, requested that I perform a facial acupuncture treatment upon Michael Schroeder, attorney for the American Acupuncture Council. Attending was a group of approximately 40, ranging from the first licensed acupuncturists in California, to eager and interested students. I alerted them to the importance of the task ahead, and they respectfully became supportive midwives to the process.
Born from the fruits of this highly successful endeavor was the first consent form for facial acupuncture, allowing practitioners to legally receive insurance coverage from the AAC, and simultaneously advancing our cause in seeking greater legitimacy and recognition within the field of Oriental medicine. This birth, albeit a labor of love, was indeed somewhat protracted, encompassing a gestation period of several months (although far less than the customary nine!). The dialogue between the AAC and I served to define some crucial ground rules for the practice of facial acupuncture, in order to preserve the integrity of our modality and ensure its continued growth.
A Toddler Grasping at Everything in Sight
From a legal standpoint, facial acupuncture has perhaps progressed to the "toddler" stage - seeking greater independence and struggling to stand on its own two feet by latching onto whatever is available. However, as one of the practitioners in loco parentis, I see that our baby needs guidance, education, supervision and care in order to achieve successful integration within the larger frameworks of our profession and society, without necessarily surrendering its unique and creative identity.
Important Liability Issues
An excellent article2 in the October 2006 issue of Acupuncture Today outlined components of liability coverage as it relates to facial acupuncture: physical liability; and psychological liability based upon the expectations of the patient.
According to Michael Schroeder, our legal midwife, it's extremely important "to manage the expectations of people who think this treatment is going to provide them with a fundamental change in their lives." If we fail in our responsibility to educate our patients about the dynamics of facial acupuncture, they might equate the process to that of plastic surgery and anticipate, or even demand, the correspondingly dramatic changes in physical appearance that are the "prizes" awarded to the "contestants" on reality television programs such as Extreme Makeover and The Swan.
The "Facelift" Word Is Taboo
He also cautioned me about the use of terminology borrowed from cosmetic surgeons, in particular the term facelift. This extends itself even to the appellation acupuncture facelift, the proliferation of which is rapidly reaching epidemic proportions. This term likewise fosters unrealistic expectations and might serve to sow the seeds of potential dissatisfaction and legal complications, should less than satisfactory results be achieved. Michael Schroeder further stated that employment of this ambiguous language might serve to compromise the validity of the malpractice insurance offered to facial acupuncture practitioners, and that the AAC cannot legally insure anyone who advertises their services with the term acupuncture facelift.
A Constitutional Treatment - Not Just a "Facial"
Your patients need to understand that facial acupuncture is based upon the precepts of Oriental medicine and that the appearance of the face reflects the overall balance and health of the entire body. Facial acupuncture derives its impact from the patient's immersion in an organic process of change, one that is gradual. Twelve to 20 treatments of 25-45 minutes each, depending upon the patient's needs and constitutional profile, should provide them with optimum results.
Do Not Guarantee Results; This Is Not a Quick Fix
Michael Schroeder also has advised against facial acupuncture practitioners guaranteeing results, as this, too, will establish unrealistic expectations on the part of the client. Likewise, this could provoke accusations of malpractice. Of course, not every facial acupuncturist is insured by the AAC. However, the failure to properly educate our patients about the realities of this modality cannot help but have wider implications for its continuing viability, and might negatively impact our profession as a whole. Facial acupuncture might indeed, due to the powerful societal forces coalescing around it, become the "face" of acupuncture itself for the overwhelming majority of individuals.
Thus, whether you call it an "acupuncture facelift," or advertise "five-minute" acupuncture facelifts (at lunch) or "acupuncture parties," the latter of which clearly takes the Botox party as its precedent, the potential downside to the acupuncture community from these marketing strategies far outweighs any short term individual financial benefit.
It was indeed an honor for me to have had the opportunity to collaborate with Michael Schroeder and the AAC on a consent form for facial acupuncture. (A sample consent form appears at the end of this article; it also is available on the Chi-Akra Center Web site at www.chiakra.com/AAC_release.pdf. As one of the pioneers of this emerging modality, I call upon all our practitioners to uphold the standards established thus far; maintain a high level of professional integrity; and emulate those educators and practitioners who have helped to bring facial acupuncture to greater prominence, both as an aspiring and increasingly authentic offshoot of Oriental medicine and within the consciousness of human beings worldwide.
References
- Jesitus J. "Acupuncture Versus Botox: Salesmanship or Science?" Cosmetic Surgery Times, September 2006, p.10 (full article available at www.chiakra.com).
- Lucas M, Ellinger D. "Cosmetic Acupuncture and Liability Insurance Coverage." Acupuncture Today, October 2006. www.acupuncturetoday.com.
Informed Consent for Constitutional Facial Acupuncture Renewal (Acupuncture Facial)
INSTRUCTIONS: This is an informed consent document that has been prepared to help your acupuncturist inform you concerning facial acupuncture treatments, the risks involved and possible alternatives. Please be advised that this is not a surgical procedure. It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page, and sign the consent for facial acupuncture treatments, as proposed by your acupuncturist.
INTRODUCTION: An acupuncture facial treatment involves the insertion of acupuncture needles into fine lines and wrinkles on the face and neck in order to reduce the visible signs of aging. In Oriental medicine, the meridians or pathways of qi (energy) flow throughout the entire body from the soles of the feet up to the face and head; consequently, a facial acupuncture treatment addresses the entire body constitutionally, and is not merely "cosmetic." An acupuncture facial involves the patient in an organic, gradual process that is customized for each individual. It is no way analogous to, or a substitute for, a surgical "face lift." A treatment session may confine itself solely to facial acupuncture, or it may be used in conjunction with other procedures.
BENEFITS: Facial acupuncture can increase facial tone, decrease puffiness around the eyes, as well as bring more firmness to sagging skin, enhance the radiance of the complexion and flesh out sunken areas. Customarily, fine wrinkles will disappear, and deeper ones be reduced. As this treatment is not merely confined to the face, but incorporates the entire body and constitutional issues of health.
ALTERNATIVE TREATMENT: Improvement of sagging skin, wrinkles and fatty deposits may be attempted by other treatments or surgery such as a surgical facelift, chemical face peels or liposuction. Risk and potential complications are associated with these alternative forms of treatment.
RISKS OF AN ACUPUNCTURE FACIAL: Every procedure involves a certain amount of risk and it is important that you understand the risks involved with an acupuncture facial. An individual's choice to undergo an acupuncture facial is based upon the comparison of the risk to potential benefit. Although the majority of patients do not experience the following complications, you should discuss each of them with your acupuncturist to make sure you understand the risks, potential complications and consequences of an acupuncture facial.
BLEEDING: It is possible, though very unusual, that you may have problems with bleeding during an acupuncture facial. Should post-acupuncture bleeding occur, it will usually only consist of a few drops. Accumulations of blood under the skin may cause a bruise or hematoma, which will resolve itself.
INFECTION: Infection is very unusual after an acupuncture facial. Should an infection occur, additional treatment, including antibiotics, may be necessary.
DAMAGE TO DEEPER STRUCTURES: Deeper structures such as blood vessels and muscles are rarely damaged during the course of a facial acupuncture treatment. If this does occur, the injury may be temporary or permanent.
ASYMMETRY: The human face is normally asymmetrical. Thus, there can be a variation from one side to the other in the results attained from a facial acupuncture treatment.
BRUISING AND PUFFINESS: There is a possibility of bruising (hematomas), puffiness, blood, tingling, itching, warmth, pain or other symptoms at the site of the needle.
NERVE INJURY: Injuries to the motor or sensory nerves rarely result from facial acupuncture treatments. Nerve injuries may cause temporary or permanent loss of facial movements and feeling. Such injuries may improve over time. Injury to sensory nerves of the face, neck and ear regions may cause temporary or, more rarely, permanent numbness. Painful nerve scarring is very rare.
NEEDLE SHOCK: Needle shock is a rare complication after an acupuncture facial.
UNSATISFACTORY RESULT: There is the possibility of a poor result from an acupuncture facial. You may be disappointed with the results.
ALLERGIC REACTIONS: In rare cases, local allergies to topical preparations have been reported. Systemic reactions which are more serious may occur to herbs used during an acupuncture facial. Allergic reactions may require additional treatment.
DELAYED HEALING: Delayed wound healing or wound disruptions are rare complications experienced by patients in the aftermath of an acupuncture facial. There is a greater risk for smokers, who frequently have dry, sagging skin, which does not heal as readily as that of non-smokers.
LONG-TERM EFFECTS: Subsequent alterations in facial appearance may occur as the result of the normal process of aging, weight loss or gain, sun exposure, or other circumstances not related to an acupuncture facial. An acupuncture facial does not arrest the aging process or produce permanent tightening of the face and neck. Future facial acupuncture maintenance treatments, or other treatments, may be necessary to maintain the results of an acupuncture facial.
HEALTH INSURANCE: Most health insurance companies exclude coverage for an acupuncture facial and/or any complications that might occur from an acupuncture facial. Please carefully review your health insurance subscriber information pamphlet.
ADDITIONAL CARE NECESSARY: There are many variable conditions in addition to risk and potential complications that may influence the long term result from acupuncture facial treatments. Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with an acupuncture facial treatment. Other complications and risks can occur but are even more uncommon. Should complications occur, other treatments may be necessary. The practice of acupuncture is not an exact science. Although good results are expected, there is no guarantee or warranty, either expressed or implied, on the results that may be obtained.
FINANCIAL RESPONSIBILITIES: The cost of an acupuncture facial involves several charges for the services provided. The total includes fees charged by your acupuncturist, the cost of acupuncture supplies and topical preparations. Depending on whether the cost of your acupuncture facial is covered by an insurance plan, you will be responsible for necessary co-payments, deductibles and charges not covered.
DISCLAIMER: Informed-consent documents are used to communicate information about the proposed procedure along with disclosure of risks and alternative forms of treatment(s). The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances. However, informed consent documents should not be considered all-inclusive in defining other methods of care and risks encountered. Your acupuncturist may provide you with additional or different information which is based upon all the facts in your particular case and the present state of knowledge within the field of acupuncture. Informed consent documents are not intended to define or serve as the standard of acupuncture. Standards of acupuncture are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.
It is important that you read the above information carefully and have all of your questions answered before signing the consent below.
Consent for Facial Acupuncture Procedure or Treatment
- I hereby authorize __________________ and such assistants as may be selected to perform the following: an acupuncture facial. I have received the following acupuncture facial sheet: Informed Consent for Acupuncture Facial.
- I recognize that during the course of the acupuncture facial, unforeseen conditions may necessitate different procedures than those above. I therefore authorize the above acupuncturist and assistants or designees to perform such other procedures that are in the exercise of his or her professional judgment necessary and desirable. The authority granted under this paragraph shall include all conditions that require treatment and are not known to my acupuncturist at the time the procedure is begun.
- I acknowledge that no guarantee has been given by anyone as to the results that may be obtained.
- I authorize the release of my Social Security number to appropriate agencies for legal reporting and medical device registration, if applicable.
- It has been explained to me in a way that I understand:
a. The above treatment or exposure to be undertaken.
b. There may be alternative procedures or methods of treatment.
c. There are risks to the procedure or treatment Proposed.
I CONSENT TO THE TREATMENT OR PROCEDURE AND THE ABOVE-LISTED ITEMS (1-5). I AM SATISFIED WITH THE EXPLANATION.
Patient or Person Authorized to Sign for Patient ___________________
Practitioner ___________________
Date ___________________
