Can Gua Sha Replace Your Botox and Fillers?

Beauty rituals are somewhat of a funny thing. Almost out of nowhere, an ancient technique or practice suddenly becomes mainstream, and the next thing you know, everyone is doing it. That's kind of how gua sha — an ancient Chinese remedy of skin massaging using a unique handheld tool — became a viral beauty sensation.

“Gua sha has been part of traditional Chinese medicine for thousands of years and incorporates tools like horn, stone, and jade to scrape the skin,” says acupuncturist Elizabeth Trattner. Gua sha is so beloved that some proponents are swearing off Botox in favor of the facial massage, claiming it provides similar benefits. But can sliding a piece of stone across the skin really do the same job as injectables and fillers? To find out, we enlisted the help of Trattner, plastic surgeon Eunice Park, and dermatologist Dendy Engleman.

Keep reading to see whether gua sha can get rid of forehead wrinkles, according to experts.

What Is Gua Sha?

A gua sha facial massage involves gently scraping the skin with firm, upward strokes. This wakes up the lymphatic system, increases blood circulation, and diminishes toxins and excess fluid to reduce puffiness. Dr. Park explains that the manual pressure used with a gua sha tool also releases underlying muscle tension, similar to the relief we experience from a neck or shoulder massage. "This can be especially helpful for people who suffer from temporomandibular joints and jawline clenching or tightness."

According to Dr. Engelman, gua sha is "a nice opportunity to check in with ourselves and take a moment for self-care in the morning or evening." It also offers some pretty stellar beauty and anti-aging benefits. "Gua sha ... has dramatic effects on lifting and sculpting the face ... and creating a healthy glow," Trattner adds. Over time and with consistent use, it can also help reduce the appearance of fine lines and wrinkles.

Gua Sha vs. Botox

Even though both gua sha and Botox can improve the look of lines, wrinkles, and an aging face, Dr. Park says gua sha and Botox should never be referred to as the same. "They have unique mechanisms of action. For example, gua sha can stimulate blood flow to the skin and help reduce puffiness and edema, but it will not magically erase wrinkles and expression lines." Gua sha reinvigorates stagnant tissues sans any needles, injections, or chemical response.

Gua sha relies on pressure, massage, and anti-inflammatory scraping to work the muscle and tissue and get stagnant blood flowing again to revive the skin. Botox (and the like) employ neurotoxins that, when injected, block out signals from the nerve to the muscle that are needed to contract. Reducing or eliminating these contractions and facial expressions softens the lines and wrinkles that become ingrained in the skin.

Another difference: Neuromodulators kick in after a few days to one week, while gua sha improves the look of the skin over the long run. However, you'll likely need to use a gua sha consistently for months before seeing a difference because it takes time to unblock stagnant blood and lymph flow. "Getting the lymphatic system and blood circulation moving helps lead to healthier and younger-looking skin, and with regular use, it can help reduce the appearance of wrinkles and fine lines," Dr. Engelman says.

Gua Sha as a Botox Alternative

While there may be some instances where gua sha can be a more natural alternative to filler, the results will never be identical to what an injectable can accomplish. "I think gua sha is a relaxing part of a skincare routine, but I don't think it should be considered a direct substitute for Botox and fillers," Dr. Park says. Instead, she prefers clinically effective treatments — like chemical peels, laser facials, and microneedling treatments for those who are not yet ready for injections or want to avoid them altogether.

Even if you follow a steadfast gua sha routine, it won't erase fine lines and wrinkles with the same efficacy as Botox and other injectables. "Neurotoxins, like Botox, are clinically proven to relax the underlying facial muscles that cause dynamic wrinkles, lasting about three months," Dr. Park shares.

Also, there may be long-term benefits with consistent gua sha use, but, according to Dr. Park, these effects are difficult to quantify. “Gua sha will always yield a much milder result,” Dr. Engelman adds. But if you're okay with that, then gua sha may be the right choice.

When to Use Gua Sha After Injectables

How long should you wait after a trip to your dermatologist before resuming your regular gua sha routine? It comes down to what you had done, where, and how much product was injected. Dr. Engelman recommends waiting about one week before using a gua sha, ensuring that any swelling or bruising has subsided.

"By this point, the neuromodulator has had enough time to settle and take effect." If you want to take a more cautious approach, you can wait another week — two weeks is recommended for fillers — or up to one month. Always use caution in delicate areas such as the under eyes, lips and nose to avoid displacing the filler. "Consult your injector about best practices immediately post-filler placement since filler injection is highly customized to the individual," Dr. Park says.

Botox and Neuromodulators

Using a gua sha (or any other facial tool or massaging device, for that matter) too soon after injections, especially Botox and neuromodulators, can potentially hinder the results, shorten their duration, or even affect the appearance. "You could end up with asymmetry in your face and areas of unwanted swelling or [drooping], which takes time to fade," says Dr. Engelman. In other cases, you might move the neuromodulator to your eyelid or eye area — which can cause more serious complications that take weeks or months to heal or require treatment, she shares.

The pressure put on the face during gua sha massage is another reason to steer clear of it post-injections. Trattner recommends always using delicate pressure, especially on the neck, since excessive force can dislodge a clot. As if that's not enough, it's normal for an injection site to be tender to the touch, bruised, and even swollen, and facial massage may create discomfort in the area. Dr. Engelman says that using gua sha (and other at-home tools) incorrectly or too frequently can harm the skin. "Using too much force or pulling on or tugging the skin roughly can irritate the skin and cause bruising and broken blood vessels."

Sculptra

Certain injectables, like Sculptura, come with even more specific gua sha cautions. "I say to hold off for a good month or two so that the product can work to make more collagen," Trattner shares. The same goes for filler injected along the sides of the face and in the jawline, which tends to experience minor swelling. As tempting as it may be to gua sha these areas to release unwanted puffiness, don't. "Instead, what can help is gua sha on the neck and décolletage to facilitate lymphatic drainage and to open and move the meridians of the neck and face," Trattner suggests. "This will help the face drain naturally and expedite healing."

Kybella

Kybella is one injectable where gua sha can make a significant difference post-treatment. "It can be beneficial several weeks after receiving Kybella injections because gua sha helps the fascia move back together and facilitates the drainage of the neck and lower jaw. However, it is imperative to have this done by a cosmetic acupuncturist only. Otherwise, you can make matters worse," Trattner explains. "I have seen substantially improved healing after Kybella but do not advise gua sha at home for this purpose."

The Bottom Line

There's still nothing like the OG wrinkle reducer, Botox, but a solid and consistent gua sha routine can come in as a close second. While the results from gua sha won't be identical to those of Botox and other neuromodulators, it definitely won't hurt to use one, and it can even improve the skin and facial contours. Just know what each treatment is capable of doing and not doing, whether you choose to go the route of the needle or a scraping tool.