Though Botox and fillers have become popular anti-ageing methods in Australia, there are signs that our faith in injectables is beginning to wane. Concerns around injecting foreign substances into the face, as well as concerns whether certain people are becoming resistant to Botox over time, have contributed to the #notox movement, which sees users share alternative anti-ageing treatments they deem safer and more natural.

One such alternative is cosmetic acupuncture, a traditional Chinese medicine facial rejuvenation treatment that involves inserting a number of extremely fine needles into specific points of the face.

Elizabeth Cullen, the principal traditional Chinese medicine practitioner at The Dao Health in Sydney, says the needles create “micro-traumas” in the skin, which stimulate blood flow and the production of collagen and elastin. This in turn is said to aid skin hydration, even skin tone and pigmentation, and reduce fine lines, sagging, wrinkles and scarring.

“There has been a cultural shift in how we as a society perceive ageing. Rather than anti-ageing, there’s now a movement towards embracing the process and ageing well,” Cullen says.

However, cosmetic acupuncture is probably not an effective alternative to Botox. Dr Alice Rudd, a general and cosmetic dermatologist affiliated with The Alfred Hospital in Melbourne, says the two treatments work in very different ways and therefore deliver different results.

“[Botox] limits the muscle movement, as opposed to cosmetic acupuncture, which relaxes the muscle. It’s therefore unlikely to give the same clinical end point,” Rudd says. “There are no robust clinical trials comparing the efficacy of Botox to cosmetic acupuncture.”

Dr Belinda Welsh, principal dermatologist at Complete Skin Specialists agrees. “There’s no evidence that cosmetic acupuncture does anything. It has no physiologic benefit or ability to change the tissue structure or function in any way.”

So, if the two practices are incomparable, what exactly does cosmetic acupuncture do?

According to Rudd, it could theoretically help reduce fine wrinkles. “By inducing low level, controlled trauma to the skin, we stimulate the body’s natural wound-healing response to promote collagen and other growth factors ... [This] can, in turn, improve fine lines and scarring.

“Regarding pigmentation and evening skin tone, usually surface-based treatments are more effective than ones that penetrate the muscle,” Rudd says. “The theory of cosmetic acupuncture should work for anti-ageing, but it’s uncontrolled, leaving room for more potential side effects and less powerful results.”

Rudd also notes the lack of robust clinical studies around its efficacy. For example, a 2015 study in the peer-reviewed Acupuncture in Medicine journal tested the effectiveness of “manual acupuncture” in reducing melasma, a facial skin condition that presents as brown or grey patches. It found that acupuncture “appeared to be beneficial and safe for women with melasma”. However, not enough data was gathered for it to be considered conclusive evidence.

Though it didn’t test cosmetic acupuncture specifically, a 2003 study published in the European Journal of Applied Physiology found that acupuncture could result in an increase in both skin and muscle blood flow in healthy women, with more intense needling (i.e. more manipulation of the needle) eliciting the greatest results.

In addition to improving blood flow and skin tone, cosmetic acupuncturists claim it can reduce headaches, stress, tension around the jaw and facial neuropathy through natural means.

Thao Ngo from Suci Acupuncture says the treatment can have these longer-lasting effects because it strengthens facial muscles and activates meridians (points on the face that connect to your organs and help rejuvenate cells and slow ageing), thereby treating certain internally rooted problems.

However, Welsh takes issue with the way it’s “seductively marketed”, particularly on social media, as a natural, one-stop-shop for certain physical ailments and facial conditions, including acne, dryness, eczema and rosacea.

“Each individual skin condition requires its own approach and diagnosis... If it sounds too good to be true, that’s because it is,” Welsh says, adding that the promotion of cosmetic acupuncture as a more “natural” alternative to Botox is also flawed, given Botox contains a product of a bacteria (Botulinum toxin), which is technically natural.

Cosmetic acupuncture is also occasionally promoted as a cheaper alternative to Botox. According to financial comparison site Canstar, Botox can cost anywhere between about $300 and $700, with its effects lasting for approximately three to four months. Therefore, the minimum cost for someone seeking repeat treatment would be about $900 a year.

In comparison, owner of Melbourne Cosmetic Acupuncture Dr Vivian Tam says one session costs between $130 and $150 (this differs between clinics). She recommends a patient begin with weekly sessions for about four to eight weeks before moving into “maintenance sessions”, which would include around one session every one to two months. Therefore, the minimum annual cost for the recommended treatment would be around $1170 – though those with private health insurance extras cover may be eligible for a rebate.

Welsh says the safest and likely cheapest option for address skin care concerns is to book an appointment with a certified dermatologist, who will be able to diagnose and treat conditions using regulated medications in just a few sessions.

Despite the lack of sturdy evidence for much of its physiological effects, cosmetic acupuncture has been gaining traction on social media in the past few years, particularly in western countries, like Australia and the US.

Practicing acupuncturists are pleased to see more people trying the treatment, but some are concerned the market for ancient Chinese medicine treatments is becoming saturated, with influencers spruiking gua sha (jade tools which are applied to the face) and cosmetic acupuncture without sharing its context and cultural significance.

“There definitely isn’t enough background or knowledge shared. You have to find the right people who know their stuff and are doing it for the right reasons,” says Lily Beeley, director of Brisbane’s Nurture and Nourish Skin, who notes that a professional cosmetic acupuncturist must study Chinese medicine acupuncture for four years, followed by additional training and courses in cosmetic acupuncture.