The Expert Guide on How to Gua Sha

I recently discovered the heavily trafficked gua sha hashtag on Instagram, a feed featuring smooth, pore-less faces, not only unmarked but purportedly de-puffed and contoured. “How to Gua Sha” tutorials have since flooded my TikTok (and the rest of my socials), but rather than the soup spoons and hardened knuckles I associated with the face-massaging practice, I found an array of elegant devices, facial rollers and flat, grooved tools made of jade, rose quartz, and other  polished stones. They made the gua sha process seem like a soothing, meditative and even luxurious experience. Which was not how it felt when I was first introduced to it.

When I was a child, I spent many sweltering summers in my aunt’s Shanghai apartment, which had one air-conditioning unit that was only turned on for the hottest hour of the afternoon. Unused to the heat, I was often weak and nauseated. To assess my health, my aunt would palm my forehead and check my tongue for changes in color and shape. Then she’d clear the hair from the back of my neck and, with a spoon—or more often, her knuckles—press and pull at my skin until a reddish-purple mark appeared. I was suffering from heatstroke, she said, and this friction would draw out the toxins that were making me feel sick. The darker the resulting welts, according to her, the more bad energy had been released.

Did it work? All I really remember is being mortified that the bruise resembled a misplaced hickey. My biggest takeaway: that it hurt like hell—so much so that to this day, when I hear the term gua sha—often translated to “scraping” in English—my first instinct is to flinch. 

So how has this transformed into a form of self-care for the skincare obsessed? I turned to the experts to give me the breakdown of how to gua sha the right way and how to lean into its benefits. Consider this your gua sha 101 crash course. 

What is Gua Sha?

Was facial gua sha—which has been put through the woo-woo wellness spin cycle, really the chosen beauty routine of ancient Chinese princesses? So goes the internet lore. “Well, that is false. It’s marketing,” explains Ping Zhang, DOM, L.Ac, a New York–based traditional Chinese medicine (TCM) guru and a pioneering acupuncturist in the field of facial rejuvenation. “Gua sha was originally used for two conditions: the abrupt, immediate, sudden collapse of the body from heatstroke”—my aunt was onto something— “and seasonal diseases, like a cold virus.” Zhang goes on to describe how traditionally, gua sha could be performed with whatever tool was on hand—an animal bone or horn, a soup spoon, a coin—and was used as far back as the Yuan Dynasty to revive farmers who collapsed with exhaustion from working under the hot sun.

It then evolved into a traditional Chinese healing technique that many have turned to. According to Jerry Lin, DACM, Dipl.OM, L.Ac, traditional Chinese medicine practitioner (TCM) and staff member at the Holistic Healing Center at Nemacolin, gua sha involves scraping the skin with a smooth-edged instrument to release muscle tension, improve circulation, and promote the body’s natural healing process. “The term ‘Gua Sha’ (刮痧) translates to ‘scraping sha,’ where ‘sha’ refers to the reddish or purple-red petechiae (tiny, raised, red spots) that appear on the skin's surface as a result of the technique,” explains Lin. “Gua Sha has been used for centuries in traditional Chinese medicine and is also practiced in other Asian cultures with variations in the tools and techniques used.” 

The Benefits 

“The facial benefits of gua sha were discovered by mistake,” says Cecily Braden, a holistic esthetician and New York–based spa educator who has spent her career importing traditional Eastern beauty and wellness treatments and translating them for a Western audience. (We have Braden to thank for the early-aughts proliferation of Balinese massage at luxury resorts nationwide.) As acupuncturists used facial pressure points to treat ailments in other parts of the body, they stumbled upon face-rejuvenating effects as well. “They had this aha moment when they saw that wrinkles were going away,” says Braden. In her popular Gua Sha Facial Fusion protocol, outward, upward strokes of a flat S-shaped nephrite jade stone work to help manually drain sluggish lymph—stagnant fluid that can cause puffiness and inflammation—to, as she puts it, “kick our bodies’ natural cleansing system into gear.”

At the Paris-based atelier of acupuncturist Elaine Huntzinger, gua sha facials were one of the most sought-after appointments during the spring collections. “My whole face feels different, like, all of the tension is gone in my jaw,” Eva Chen, the director of fashion partnerships at Instagram and a vocal Huntzinger supporter, posted pre-Balenciaga. Canada-born with family roots in Hong Kong, Huntzinger was raised on TCM. After her mother’s death, she found herself drawn back to the home remedies she grew up with, driven partially by a desire to find a solution for her eczema, which had not responded to cortisone or antibiotics. Her skin finally cleared up when she started to address her diet and lifestyle, but also her grief. “In Chinese medicine, you learn the root of what’s causing your imbalance with emotional issues,” she says. She brings these lessons to her treatments, which begin with a 20-minute consultation to determine physical, emotional, and spiritual health. Like my aunt, Huntzinger also looks at people’s tongues as a portal to other system imbalances; like her own mother, she leaves them with food recommendations to rebalance qi—energy flow—all of which contributes to a toned, radiant complexion.

Other benefits, says Han, include reduced anxiety and the ability to depuff certain areas and sculpt the jawline and cheekbones. Lin adds pain relief, improved blood flow, and relaxation to that list—when done correctly. 

The Downsides

Michelle Han, DAOM, L.Ac, traditional Chinese medicine (TCM) practitioner and co-founder of Potion Lab, says that when done incorrectly, there is a chance of bruising, discoloration, or severe muscle soreness. She would not recommend gua sha for those taking blood thinners or anyone with thin skin. Those who may be pregnant or anyone who might have a rash, sunburn, inflamed skin, open wounds, psoriasis, or eczema should consult with a gua sha professional before doing gua sha on their own. If you’ve had any facial injections, such as Botox and filler, she recommends waiting at least four weeks post-jab. 

“It should be approached with caution,” Lin adds. “Individuals should be skeptical of claims that go beyond its established therapeutic effects. Consulting with a healthcare professional and seeking a trained practitioner can help ensure a safe and effective gua sha experience.” 

Gua Sha Treatments

Gua sha’s holistic philosophy is only beginning to gain traction in the beauty industry. But the benefits of such an approach seem obvious, if you think about it, notes Katie Woods, a Bay Area–based esthetician and the owner of Ritual SF, a San Francisco face-massage studio offering bespoke facials that incorporate gua sha tools and techniques. “The skin is a map for what’s going on in the body,” she explains when I come in for an appointment.  Before even entering Woods’ treatment room, I have to fill out two pages of paperwork covering everything from my menstrual cycle to my bowel movements, a line of questioning that is more comprehensive than many conversations I’ve had with my primary-care physician. The customized facial begins with an edible honey-and-berry mask that Woods prepares on the spot—“your skin loved that,” she says as she wipes it off—and includes a deeply relaxing gua sha interlude administered with cooling spoons and stone tools of all shapes and sizes.

When I catch a glimpse of myself post-treatment, my face is bright and clean, its natural lines defined as if the angle of my jaw and the plane of my cheek have been sculpted anew. And I feel oddly drained—in a good way. “You can do it once a week,” says Portland, Oregon–based licensed acupuncturist Beth Griffing Russell, speaking to a big part of #guasha’s 21st-century viral appeal: Unlike with Botox, these results can be replicated at home. Griffing Russell emphasizes that home gua sha enthusiasts should not neglect the neck. “Flick up,” she instructs, moving her gua sha tool from one ear to another and around the base of the skull to stimulate the muscle that connects the back of your head “to the wrinkles in your forehead.”

A few days later I try the no-frills version of gua sha to alleviate some persistent tension and fatigue at Oakland Foot Health Center, a walk-in storefront not dissimilar to the medical-massage clinics in China serving working-class men on their lunch breaks, aunties, grandmas, and, once upon a time, me. “Gua sha has saved many peasants’ lives,” my masseuse tells me in Mandarin as she scrapes my back during an hour of body acupressure with gua sha, which goes for a modest $60. When I ask what her tool is made of, she chuckles. “It’s supposed to be ox horn, but it looks like plastic to me.” I leave with the same drained lightness coursing throughout my body that I felt after my experience at Ritual SF.

So why, I wonder, would I pay $285 to visit Crystal Cave LA, a “healing hut” in Santa Monica where Julie Civiello Polier performs her much-blogged about “shamanic” gua sha facials three days a week? Described as “a meditative journey and intuitive reading,” the whole concept makes me laugh before I even arrive. “I love how gua sha gives us a tool that is charged by the person using it and the person receiving it,” Civiello Polier—a petite blonde former actor—tells me of her popular treatment’s purported energy exchange. At least I’ll get a nice nap out of this, I think to myself as I close my eyes.

But when Civiello Polier places crystals on my various chakras—including an amethyst at my feet that she claims “wants to go home” with me—I do feel something, a deep radiating warmth that allows my overthinking mind to let go. As she performs the facial gua sha, at one point even sticking her fingers inside my mouth for a deep, tension-relieving buccal massage, she takes long audible breaths that lull me into an ASMR-like trance. Afterward, my skin does not look totally transformed. “There’s a limitation to the results you can get with gua sha,” confirms Julia Tzu, M.D., a clinical assistant professor at NYU’s Ronald O. Perelman Department of Dermatology, who recommends fillers, such as Restylane Lyft, for longer-lasting tightening. But a superficial result seems besides the point; I feel like I’ve been lifted from the inside out.

I step out of Civiello Polier’s studio into the bright Southern California sun, conflicted by the commodification of Chinese folk medicine and home remedies. But the craving for a more holistic conception of beauty feels real. I remember something Huntzinger told me when describing her work. “These days, society is so yang, so active. With the advent of social media, the yang has been overstimulated to such a degree, and the yin has not been nourished,” she explains. Maybe, in a paradoxical twist, #guasha has risen precisely from our innate desire to restore focus on the yin—the darker, interior, reflective parts of ourselves.

“People are not just getting a skin-deep treatment,” Zhang confirms of what she sees as the technique’s actual rejuvenating benefits. She slips into Chinese for a moment for emphasis, and I notice that in place of “anti-aging” she uses the words yang sheng—a phrase I’ve heard often from my aunts and grandmothers when telling me to take care. Remembering how the Chinese women in my life have always emphasized that to be healthy is to be beautiful, Zhang’s message suddenly makes sense. After all, I’d never thought of yang sheng as having a purely utilitarian meaning: The phrase translates more directly to “nourishing life.”

How to Gua Sha at Home 

The main differences between at-home gua sha and a treatment you find at a spa, says Lin, are the environment, expertise, and tools used. “At-home gua sha is a do-it-yourself approach that offers convenience and affordability, but it may not be as effective or safe as a spa treatment,” he explains. “Spa Gua Sha, on the other hand, provides a professional, relaxing, and personalized experience with the expertise of a trained practitioner and the use of high-quality tools. The choice between the two depends on your specific preferences, needs, and budget.” 

So if you’re looking for a more accessible approach to add the gua sha practice into your skincare routine, Han shares her personal method for facial self-care that’s easy for anyone to follow. She starts by putting on a light facial oil to moisten the skin (her personal pick is a ginseng face oil.) Then with her gua sha stone (an amethyst stone is her preferred choice, though you can use jade, an obsidian stone, or whatever you desire), she applies light pressure on the skin and gently strokes upward from her neck then back down into the slope of her shoulder and along the collarbone. She’ll then take the tool from the base of her neck and move it upwards towards her jawline and back down. Moving onto the face, she follows the natural curve of her chin and works upwards to the ear and back down, then the cheekbones from the nose outwards towards the ear, and finally moving the tool from the top of the brow bone towards the hairline.

Light to medium pressure is key throughout to make sure you avoid bruising, discoloration, or even severe body or facial muscle soreness. “The strokes should be smooth and controlled, not rough or aggressive,” says Lin. “You should aim for a slight reddening of the skin, which is normal and indicates improved blood circulation.” 

He goes on to say that you can choose an area of the face or body that you want to treat but recommends looking for a place that you can comfortably reach. Depending on which part of the face or body you’re applying your tool on, he says you’ll typically scrape in the direction or muscle fibers or along meridian lines, which are seen as the energy pathways in traditional Chinese medicine.

But for best results, Han encourages consulting with a TCM practitioner or gua sha specialist to get a customized treatment plan for your and your skin needs. “Gua sha should not be taken lightly or be done at home without prior experience or knowledge,” she says. “When done properly, gua sha is so much more than just skin deep.”