Can Gua Sha Ruin Your Botox?


Ever since the ancient Chinese practice of gua sha, which involves gently pulling or ‘scraping’ a palm-sized surgical stainless steel, rose quartz, amethyst, or jade stone tool with contoured edges across the skin, became a modern-day beauty ritual, women and men have been incorporating the technique into their daily routines.

“Gua sha is great for lymphatic drainage, reducing facial puffiness, and evenly distributing skin-care products across the skin,” says registered nurse Cindy Mei, who works with New York facial plastic surgeon Dilip Madnani, MD. But despite all the benefits that gua sha offers, it’s best to avoid doing it immediately following neuromodulator injections. It turns out that using a gua sha tool too soon post-injection can affect how the neuromodulator settles and, ultimately, the results. Here’s everything you need to know about mixing gua sha with your favorite aesthetic treatment.

How Gua Sha Can Affect Neuromodulators

“Neuromodulator treatments are localized injections to specific areas of the face,” Mei explains. “It can take time for the injections to absorb into targeted areas, which is why I don’t recommend using gua sha tools during this period,” she says. Omaha, NE dermatologist Joel Schlessinger, MD, adds that pressing a gua sha too firmly against recently injected skin can force the neuromodulator to migrate and diffuse, leading to subpar results.

While it’s best to wait some time after a fresh ‘tox session before using a gua sha, there are other beauty practices to steer clear of. These include rubbing the skin, facial massages, lasers, and partaking in strenuous exercise. “Also, avoid alcohol, blood thinners, extreme heat, saunas, and direct sunlight. These instructions may vary depending on the treatment area and dose,” Mei adds.

Fixing Neuromodulators Gone Wrong

If you use a gua sha prematurely on your face, ‘bad Botox’ may (but not always) be the upshot. Santa Monica, CA dermatologist Ava Shamban, MD, says the pressure used during gua sha may conceivably spread the toxin. If this happens, there may be a temporary loss of function of a muscle. Or the treated area appears swollen or puffy, which subsides with time.

Where the adverse effects of a neuromodulator manifest dictate how to correct them best. If a neuromodulator migrates too close to the eyelid, it can cause “the brow or eyelid to drop, which can last a few months,” Dr. Shamban shares. If a droopy eye occurs, you can temporarily remedy it with Upneeq, prescription eyedrops for low-lying lids. “It is a new treatment for ptosis from neurotoxins, lasting 12 hours or more,” Dr. Schlessinger adds. Unlike hyaluronic acid fillers, there is no antidote for neuromodulators—it’s a matter of waiting out any poor results.

When to Use Your Gua Sha Again

Dermatologists have varying opinions on how long to wait after injections before using a gua sha. According to Spokane, WA dermatologist Wm. Philip Werschler, MD, approximately 90 minutes after neuromodulator injections, the neuromodulator binds to the terminal nerve plate in the injected skeletal muscle. “After this occurs, it is impossible to affect the toxin, even with gua sha,” he explains. But on the flip side, Dr. Shamban suggests avoiding massaging the face with a gua sha for about one week after administering a neuromodulator so that it doesn’t spread the toxin. If there’s any swelling or bruising, let it resolve entirely before using your tool on your face.

When it’s time to resume your gua sha routine, which you should always do with a thin layer of face oil, Dr. Schlessinger recommends using gentle pressure—too much pressure can damage the skin. Other than that, you should be good to go gua sha.