TikTok is full of videos demonstrating gua sha techniques, jade roller tips and facial massages that claim to promote “lymphatic drainage” — a process that reduces swelling from the lymph nodes that, according to some posts on social media, can cause facial puffiness.
For the uninitiated, gua sha is a traditional Chinese medicine technique that uses a smooth tool to scrape the skin in different parts of the body. Gua sha has been a mainstay of traditional Chinese medicine for centuries, and the idea of manually draining the lymph nodes entered Western culture in the 19th century.
But does the average person really need a DIY facial massage to “drain” their lymph nodes? Are there any risks to performing gua sha at your bathroom counter? And when should you see a doctor for a puffy face?
We asked doctors to weigh in on the facial massage trends that promise aesthetic and health benefits — plus we learned when you should seek help from a professional. Here’s what the experts had to say.
Lymphatic drainage 101
The way people talk about lymphatic drainage on social media can be compelling: Simply massage certain spots around your face or neck, et voila: You can reveal a slimmer, less puffy-looking face.
But what exactly is lymphatic drainage?
“The lymphatic system drains from the lymph nodes in the neck, which go down into the chest,” says Dr. Babak Azizzadeh, a board-certified plastic surgeon specializing in facial plastic surgery at the Facial Paralysis Institute in Beverly Hills, California. “Then that fluid goes back into the circulatory system. “It’s a very critical component of the healing process, especially when there’s trauma, swelling, surgery, etc.”
So, does the average person need to think about lymphatic drainage if they’re not recovering from a major trauma or procedure?
Azizzadeh says no: “I don’t think it has any role from a cosmetic perspective.”
Do gua sha and other facial massage techniques work?
If your goal is to slim down your face or in any way alter your appearance: no.
Manual lymphatic massage can be helpful for people with certain medical conditions, however, and when puffiness is the result of a major procedure.
“It can decrease edema caused by surgery or illness,” says Dr. Fadi Nukta, a board-certified plastic surgeon and the founder and director of NOVA Plastic Surgery and Dermatology in Ashburn, Virginia. “However, it can’t make a face slimmer by changing the anatomy of muscles, bones or fat.”
That said, your evening jade roller routine probably isn’t hurting anything. If it helps you wind down and de-stress, it’s generally safe to carry on.
“If the feeling of it is good, their neck feels better afterwards and they like doing it, that’s fine,” Azizzadeh says. “But as an anti-aging treatment, I don’t think it really does anything.”
Risks of DIY facial massage
Although the risks of a gentle facial massage are minimal, it is possible to overdo it.
“You could potentially irritate the skin and the deeper tissues, so you don’t want to do that,” Azizzadeh says. Signs of irritation include minor abrasions and hyperpigmentation in people with darker skin.
Dr. Jennifer Baron, a board-certified dermatologist and dermatologic surgeon in San Jose, California, says she doesn’t recommend DIY facial massage to her own patients or friends. This is due to the risk of spreading infection and the potential to make facial swelling worse, particularly if the swelling is caused by an allergy, medication or disease. Gua sha and jade rollers can also cause burst capillaries and bruising.
“Gently rolling a stone over your face is not specifically harmful if the device is clean,” she says. “However, microbes can be introduced and spread to sensitive areas in one pass.” The lips, for example, can tolerate certain bacteria and yeast that would cause irritation if spread to the eyes.
Do dermatologists offer lymphatic drainage?
For the most part, no.
“We refer our patients to a licensed lymphatic drainage massage therapist or a professional wound care center,” Baron says.
Most therapists who specialize in lymphatic drainage are used to working with patients who have had some kind of surgery.
“Dermatologists typically do not [specialize in lymphatic drainage],” Azizzadeh says. “It’s mainly physical therapists who specialize in certain areas, like post–breast surgery, or in the neck, when lymph nodes are removed for cancer.”
When to see a pro for puffiness
If you notice your face is suddenly looking swollen, call your dermatologist or primary care doctor right away.
“Facial puffiness as a presenting symptom can be a marker for several medical concerns,” Baron says. Possible causes of puffiness include medications, hormone or electrolyte imbalances, diseases and some tumors. A dermatologist can help determine the cause of puffiness and refer you to the right specialist, if needed.
If your concerns are aesthetic, a dermatologist or cosmetic surgeon can help you find the right approach for your goals.
“Sometimes all you need is really good skincare and maybe laser resurfacing,” Azizzadeh says. “Sometimes you can solve your concern with fillers. And then sometimes you’ve got to go to [cosmetic] surgery.”
Ultimately, it comes down to what you’re trying to accomplish. Get an expert opinion (or multiple) before booking a major cosmetic procedure. “You don’t want to jump into surgery before you need to,” Azizzadeh says.
The final word on DIY facial massage
If you can’t imagine parting ways with your beloved jade roller or gua sha stone, you don’t have to — just keep your expectations in check. DIY massage can offer a relaxing routine to help relieve stress, but it won’t deliver a dramatic before-and-after for your face.
“Lymphatic drainage at home is a low-risk, low-reward procedure,” Nukta says. “Unless someone is completely misusing the tools, I see no significant harm to patients. The reward, likewise, is probably modest at best and short-lived.”