First there were surgical facelifts, and women who had bravely gone under the knife found themselves with tighter skin, better facial contours and, at times, a rapidly receding hairline. Then there was Botox, marketed as the more wallet-friendly, less invasive way to look years younger, although some unfortunate users have found themselves with an occasional drooping eyelid or with a drooling problem. Now, there is cosmetic acupuncture - with virtually no pain, no recovery time and no significant wallet trauma. The choice is obvious, no? Well, not exactly. Those with substantial excess skin might benefit more from surgical measures. There is a limit to what 0.1mm-wide needles can do, and surgery provides more dramatic changes in a shorter time. If, however, you're looking for a gradual but significant improvement in skin tone, quality and texture, acupuncture is the way to go. Although many people think of acupuncture and Chinese medicine as vague, almost mystical treatments, Steve Paine, a doctor of Oriental medicine and a listed Chinese medicine practitioner, says that acupuncture is as 'real' as Western bio-medicine and works through physiological processes that can be explained by science. Acupuncture needles stimulate reactions within the body which increase blood flow, delivering more oxygen and nutrients to the skin cells and underlying muscles, resulting in more supple, elastic skin and enhanced muscle size and tone. Acupuncture is also able to regulate the automatic nervous system, relaxing the muscles and smoothing the skin. Tissue repair is one of the benefits of acupuncture. 'By causing a micro-trauma to the structure of typeIII collagen, the fibrous protein which supports the skin, the body's tissue repair mechanisms are kicked into a higher gear,' says Dr Paine. This in turn causes the body to synthesise more typeIII collagen, which accounts for the softness of a child's skin. The chosen points of needle insertion on the face, are acupoints that direct localised tissue reactions which bring about increased blood supply. Of the dozens of acupoints, only four to 10 are actually used in each session, and cosmetic acupuncturists will vary needle placement and the number of needles used from session to session for maximum benefits. 'We focus on the entire face when doing cosmetic acupuncture, but with particular attention to lines and furrows,' Dr Paine says. '[We also focus on] areas that are cold or pale, indicating poor blood flow, and areas which are hollow, or sag.' The needles are between 0.1mm and 0.2mm wide and normally 1.27cm long, but may reach up to 5cm if used for threading purposes. They must be placed on the acupoint in order to be effective and, depending on each acupoint, the margin of error is only 1mm to 3mm. The needles must also be inserted so that they are pointing to the top of the head in order to counteract the sagging effects of gravity. Depending on the patient's age and the severity of their problem, the number of acupuncture sessions needed varies. Patients in their 20s and 30s often need less than 10 sessions, and some might even start seeing results after two or three sessions. Women who have entered or passed menopause, however, have thinner and drier skin, and often continue beyond 10 sessions. As for side effects, Dr Paine says that bruising can occur at times, although it is rare. He stresses the importance of going to a licensed, experienced Chinese medicine practitioner and acupuncturist for the procedure. He also suggests patients see facial rejuvenation as part of a holistic lifestyle upgrade, and says that some choose to undergo treatment in conjunction with herbal supplements, dietary modifications, stress management training, exercise consultation and sleep management. 'The face is a reflection of one's physical health and state of mind,' he says. 'With acupuncture, that reflection is a radiant glow.'