Position

The patient is lying or sitting with the head comfortably supported. Tell him to relax the muscles of the head and neck.

1. Stroking with the two thumbs over the forehead, starting near by the eyebrows gradually in succession working up to the hair-roots as in Fig. 20.

2. Friction with the tips of the fingers in small circles, the other hand being used to stretch the part worked upon; for this manipulation divide the forehead in two sections vertically. This is principally applied with the object of overcoming wrinkles of the forehead.

3. Repeated stroking as in No. 1, the operator being careful to tightly grasp the temples, so as to make the patient feel that the head is properly supported.

4. Stroking with the tips of the fingers over and below the eyes from the nose outward to the temples, both sides at a time.

5. Friction with the tips of the fingers over the same part with special attention to the outer corner of the eye and below it, where we generally find the so-called "crow feet." Stretch the part with the thumb and fingers of one hand, and perform the friction with the tips of the fingers of the other hand.

6. Repeated strokings as in No. 4.

7. Stroking with the two index fingers over the nose from the eyebrows downward and outward. Raise the hands up high and hold them so during the manipulation from start to finish. In other words the heel of the hand should be on a level with the tip of the finger.

8. Stroking with both hands one on each side of the face from the extreme lower part of the inferior maxillary region well up to the temple. We stroke upwards because the face frequently presents a drawn and pulled-down appearance; particularly so after a prolonged illness or a siege of nervous worry or tension.

9. Friction and kneading of the cheeks, picking up the muscles as much as possible, always remembering that the orbicularis oris is the insertion of most all the principal facial muscles.

10. Repeated strokings as in No. 8, only the patient is told to inflate his cheeks and to retain the air, breathing freely through his nose.

11. Stroking with the fingers around the lips and chin.

12. Frictions with the tips of the fingers over the same part or kneadings if our object is to remove superfluous fat. In the latter case never use any fatty ointment but instead some benzoin preparation that will help to contract the tissues.

13. Strokings repeated, as described in No. II.

In treating wrinkles the operator should remember that they are not, as a rule, caused by some trouble in the skin itself, but mostly always by a relaxed or weakened condition of the underlying muscular tissues; consequently our work must not be superficial but deep, care being taken, of course, not to bruise the patient. By stimulating the circulation to this particular part, we bring in increased nourishment to the relaxed and weakened tissues. It is really wonderful what can be done in the way of improving the facial expression by scientific massage, but like other parts of this valuable therapeutic, it has been horribly abused. Steaming the face is frequently practiced but it is not to be recommended inasmuch as it frequently causes the patient to contract a severe cold. Facial paralysis and "tic douloureux" have been traced to steaming of the face. A massage operator who cannot, by his manipulations, bring enough blood to the relaxed parts should not treat a face! Scars are treated by stretching the part and working with the tips of the fingers in circles across the scar-tissue, finishing with strokings. Never use an ointment for facial massage that contains vaselin or lanoline. They are both apt to produce hair growth, particularly the former. There are so many inferior preparations on the market that the author feels prompted to here give a recipe for the best facial skin food known, and, in the many years he has recommended it, he has never heard anything but the very best results from it.

It will be noticed that there are no mineral fats amongst the ingredients. Care should be taken to see that the genuine spermaceti and wax be used, as both these preparations are "made" from coal oil and we should not be willing to risk causing a hair growth on the face. If we wish to make the eyebrows thicker and wider we can do so with the aid of coal oil preparations, but it must be done by a trained person. Mr. C. Keeny, 1601 Arch street, Philadelphia, prepares the above-mentioned "Skin-Food" and it can be obtained from him at any time.

Fig. 21. - Massage of the Face.

In cases of facial paralysis it becomes necessary to work somewhat differently than previously described. Cover the antiseptically cleaned index finger with a rubber tip or a silk handkerchief, insert it in the mouth and with the thumb stroke the muscles in the superior and inferior maxillary regions. (See Fig. 21.) The index acts as a good and easily regulated support. Friction and kneading are given in a similar way. In applying vibrations to the facial nerves and muscles, the author has used with the greatest satisfaction the new mechanical vibrator made by the Vibratile Company, 117 East 23d street, New York City. It produces from 1,500 to 5,000 vibrations per minute by adjusting an easily regulated switch. The apparatus is very useful for the treatment of other parts of the body and every skillful operator should acquaint himself with its use and proper application. The vibrations are produced by an electric current from a storage battery consisting generally of four cells.