Chapter 7
MASSAGE TO THE
FACE
Facial massage is usually given with the
model in lying, and he or she should be given a
pillow under the knees, as well as pillows under
the head. The practitioner will be more com-
fortable, and have better access, sitting at the
head of the bed with the head pillows resting
on his or her knee (Fig. 7.1). This position
allows the practitioner’s forearms to be sup-
ported for some of the manipulations, but
check constantly as you work that as the
model relaxes, the head does not ‘sink’ into the
pillow causing the neck to extend and the face
Fig. 7.1 Starting position.
to tilt.
Preparation of the model
Ask the model to remove outer clothing The manipulations for the face
from the neck and shoulders and to remove Most of the manipulations are performed with
shoulder straps. Necklaces and ear-rings should the fingers or finger pads, and it is important to
be removed as should make-up, which can control the position of the rest of your hand,
become smudged. Obviously, spectacles must including the thumb, so that you do not rest on
be removed, but discuss the removal of contact the patient’s face.
lenses with the patient. If the hair is long or The manipulations which may be used are:
likely to obstruct, it can be restrained by a
headband. (1) Effleurage
Ask the model to lie down, and cover the (2) Finger tip kneading
body up to the subclavicular level if he or she (3) Wringing
so wishes. Ask the model to slide up the couch (4) Plucking
to rest his or her head on the pillows on your (5) Tapping
knee. (6) Reverse finger tip hacking
(7) Vibrations to the exit foramina of the
trigeminal nerve
Massage to the Face 97
Fig. 7.2 Effleurage — the finishing position for all
three strokes shown in Figs 7.3, 7.4 and 7.5.
(8) Finger kneading to the exit foramina of
the trigeminal nerve
(9) Vibrations over the sinuses
(10) Occipitofrontalis stretching to obtain
scalp movement
(11) Clapping to the area of platysma
(12) Stroke moulding to individual muscle(s)
Effleurage
Effleurage is directed from mid-line of the face
to just below the ear (sub-auricular glands), Fig. 7.4 Effleurage to the cheeks.
taking care that as you stroke you do not con-
stantly move the ear lobe. 7.4). On a small face, the second and third
As much of the palmar surface of the hand strokes are often combined.
as possible is used to start the strokes. The The fourth stroke starts in mid-line of the
finish is always with the finger pads, as the forehead and curves downwards — use your full
palms lift to clear the ear (Fig. 7.2). hand, and repeat for a fifth stroke if the fore-
The first stroke goes from under the chin — head is high (Fig. 7.5).
use your full hand (Fig. 7.3).
The second stroke starts with the fingers
Kneading
spread above and below the mouth — use your
full hand. The lines of work are similar to those for
The third stroke starts at the nose — use your effleurage, proceeding from mid-line to the
finger tips to start, then your full hand (Fig. sub-auricular area:
98 The Manipulations and Their Effects
Fig. 7.5 Effleurage to the forehead.
e The first line under the chin is done with the
flat of the fingers, which are also used on
the cheeks to finish the next three strokes
(Fig. 7.6)
® Then the chin to ear line is started with the
two distal phalanges
e Next the upper lip to ear line is started with
one finger pad
® The nose to ear line is done with one or two
finger pads
¢ On the forehead two or three lines are per-
formed with two or three finger pads (Fig.
77)
Fig. 7.7 Kneading to the forehead.
All the manipulations are performed with a
lifting pressure upwards and inwards so that
the delicate muscles are not dragged.
on one cheek (Fig. 7.8) and across the forehead
Wringing
in three lines to the opposite ear, in to the nose
This is a finger tip wringing performed between and you are back at the start (Fig. 7.9).
the finger pads of the index fingers and thumbs. Some people consider that this manipula-
It is a very small manipulation. Start at the tion should be avoided when treating facial
corner of the mouth and work out to the ear, palsy, in case the muscles are overstretched, but
then across the chin to the other ear. Now work if the depth is light and the speed is fast, there
back to the mouth, out to the ear from the nose is little reason to omit the manipulation.
Massage to the Face 99
Plucking
Plucking is a stimulating manipulation per-
formed by the tips of the thumb and index
finger, in which the tissues are literally
‘plucked’, i.e. grasped and let go very quickly
(Fig. 7.10). If the tissues were held longer you
would be pinching. Plucking may be performed
with one or both hands simultaneously, in
similar work lines to kneading.
Tapping
Tapping is performed with the fingertips (Fig.
7.11). Either one, two or three finger tips are
used according to the size of the area of the face
being treated. If two or more fingers are used,
they may tap simultaneously, or in rapid suc-
cession as in striking two or three adjacent
piano keys. The tap should be firm enough to
cause slight indentation of the skin at each tap.
Note that the simultaneous use of two or more
fingers is likely to be heavier than sequence
tapping. The lines of work are those used in the
effleurage. The work may be performed on both
Fig. 7.9 The lines of work for wringing.
Fig. 7.10 Plucking to the cheeks.
100 The Manipulations and Their Effects
mandibular divisions of the trigeminal nerve.
They emerge respectively from the supraorbital
notch and the infraorbital and mental foram-
ina. The fingertip should rest lightly over the
exit and constant vibrations of a small dimen-
sion are performed until discomfort diminishes.
This technique is used in the treatment of both
trigeminal neuralgia and tension headaches
(Fig. 7.12).
Finger kneading to the exit foramina of the
trigeminal nerve
The index or middle fingertips are used to
Fig. 7.11 Tapping to the cheeks. perform stationary finger kneadings over the
points of exit of the ophthalmic, maxillary
and mandibular divisions of the trigeminal
nerve, at their respective exits through the
sides of the face simultaneously, or one side of supraorbital notch and the infraorbital and
the face at a time, in which case use your other mental foramina. The finger kneadings are
hand to stabilise the face. deeper manipulations than the vibrations
described above, and are used successively with
them for the same clinical circumstances (Fig.
Reverse fingertip hacking
7.12).
Reverse fingertip hacking is performed with the
palmar aspect of the medial three fingertips.
Vibrations over the sinuses
The hand starts pronated and the fingers are
held in slight flexion. The tissues are flicked If the tips of your fingers and thumbs are
gently with the fingertips by rapid supination of held bunched together, and your hand is raised
the forearm. The lines of work are those used so that the ends of the tips rest on the skin,
in effleurage. The work may be performed on vibrations can be performed over a circular area
one side of the face or both sides simultane- (Fig. 7.13). The fingertips can be placed over
ously. Reverse fingertip hacking is lighter than the area of the frontal sinus and of the maxil-
tapping and may be used earlier when the lary sinus, and static vibrations performed to
patient is recovering from facial paralysis. encourage a mechanical effect on the sinuses
when they are congested and perhaps blocked.
The patient can be taught to perform this
Vibrations to the exit foramina of the
manipulation, and may find that the frontal
trigeminal nerve
sinuses are cleared best when he or she is
Fingertip vibrations may be performed using upright and the maxillary sinuses in the side
cither the index or middle fingertip over the lying position. The right sinus is drained in left
points of exit of the ophthalmic, maxillary and side lying and vice versa.
Massage to the Face 101
(b)
(b)
Fig. 7.13 Vibrations with all the finger tips: (a) over
the maxillary sinus; (b) over the frontal sinus.
Occipitofrontalis muscle stretching
Place the palmar surface of one hand on the
forehead and the palmar surface of the other
hand under the occiput. Move them simultane-
ously so that the hand on the forehead takes the
front of the scalp downwards towards the eye-
brows, and the hand on the occiput takes the
back of the scalp upwards (Fig. 7.14). The
(©) movement should be smooth and slow and
Fig. 7.12 Positions for kneadings or vibrations with reversed equally smoothly. The scalp will be
one finger over the: (a) mentalis foramen; (b)
felt to move forwards and backwards. This
infraorbital foramen; (c) supraorbital notch.
102 The Manipulations and Their Effects
Fig. 7.14 One hand over anterior and one over the
posterior belly of occipitofrontalis to rock the
muscle and scalp.
Fig. 7.15 Clapping to platysma.
stretching movement is of great use in severe the muscle actions. At the same time ask the
headache when the two bellies of the occip- patient to attempt the muscle actions of:
itofrontalis often remain in painful spasm.
* Pursing the lips
¢ Opening the mouth
Clapping to the area of platysma
* Producing a mirthless grin
The area below the chin can be clapped using e Smiling
the cupped fingers (Fig. 7.15). Your hands must ¢ Sniffing
circle round one another in such a manner that * Wrinkling the nose
the ‘strike’ is in a forward and upward direc- e Scowling
tion. Be careful not to touch the front of the ¢ Raising the eyebrows
throat, and work at a brisk speed. The patient * Closing the eyes
may learn to do this himself or herself, using ¢ Blowing or whistling
the backs of the fingers. s Expressing disgust
Muscle moulding
Place your fingertips on each of the groups of
muscles of facial expression in turn and mould
