Facial tension is a primary cause of premature facial aging. Exacerbated conditions often end up being seen in a chiropractor's or dentist's office. Let's first outline the various types of facial tension and how to alleviate them. The process should be a team approach in which the client is proactive in her treatment, along with the other professionals on her team, including massage therapists, estheticians and/or movement therapists.

Under optimum conditions, a trained coach is available to help the client (or yourself) adjust and correct the movements described in this program. However, if this program is tried individually, use "listening eyes" to follow the directions. Consistent practice will clarify the directions, and the naturalness of the movement will evolve, along with self-correction. Finally, there are TMJ orthodontists, chiropractors, structural bodyworkers, and other medical professionals who can help you chase away the dragon of premature aging.

Accumulated tensions are largely due to repeated stresses that brew long and hard before we encounter them as pain or as symptoms of aging. Let's group them all together as facial, head, neck, jaw and shoulder stresses. It takes a long time to accumulate tension in the face before one feels it. The masseter, or jaw muscle, is the third strongest muscle in the body after the gluteus and the trapezius, and performs like a shock absorber. It can store a lot of tension before you hear the joint creak or feel discomfort. Underlying these warning signals are muscle spasms which prevent the muscle from lengthening. Thus, part of aging and tension comes from muscle shortening.

During my own personal search for a way to recover from whiplash and TMJ symptoms after a car accident, I became a patient of Dr. Edmund Wong in Hawaii, a TMJ orthodontist who developed a more holistic view of how to reduce jaw and neck tension, aside from the usual methods of grinding down teeth and applying orthodontics. He helped see me through my own personal recovery, as well as invited me to observe the treatment for many of his patients. His concern for healthy tendons of the temporalis, masseter and stylomandibular ligaments, along with his understanding of TMJ and its components, greatly influenced the development of my hands-on therapeutic Exerssage.

Sometimes it may be something as clear-cut as a car accident such as mine that creates the tension problem, but more often than not, the causes are the subtle and invisible aspects of our lifestyles. Many of us find ourselves sitting in front of the computer for long periods of time without moving. We hold the telephone receiver by lifting one shoulder and clasping it to our ear. The shoes we wear may not support us properly. We sit cramped on airplanes, read books and watch television while slouching. We lean forward over a massage table while performing bodywork. We sit on stools or chairs for long hours during the work week without breaking to stretch and lengthen our contracted muscles.

Sedentary postures slow down our circulation, and oxygen-starved muscles will spasm and spread to one or more areas of the body. For example, if while sitting for long hours, you cut off or slow down circulation to the tip of the trapezius that inserts into the lower back of the spine, that same muscle spans to affect the top of the trapezius neck muscle, which also connects to the frontalis (forehead) muscle. Many factors, including an overabundance of tension, may eventually create a frown to stop the tension from traveling further into the face or from developing into a headache. Of course there are other reasons for a frowning habit, but this is a good example of how body tension can express itself in facial tension. Remember, the head is connected to the body.

Also, remember there is a vital connection between muscles and nerves. When muscles shorten, nerve conductivity becomes unbalanced. You may experience this nerve imbalance as tenderness. The nerve points become too hyperconductive or too hypoconductive and the facial muscles will lose their tone. (Hyperconductivity occurs when facial nerves become overexcited. Hypoconductivity occurs when facial nerves become under-excited and cold.)

The majority of clients I consult exhibit an initial stage of jaw tension of which they are unaware. The irony is it is only when you relax that you become aware of how much tension you've been holding. The facial muscles are the most neglected muscles of the body and they need to be touched and massaged in order to neutralize the signs of aging. Obviously, wash your hands before touching your face as sensible personal hygiene. Note that the combination of working with traction/sculpting and breathing will prevent you from improperly stretching the skin.

Alternate Lesson One (as detailed in Massage & Bodywork, Feb/March 1999) to strengthen and tone and Lesson Two (outlined here) to prevent and release negative tension every other day.

Jaw Tension-Related Problems
Normal, healthy chewing, kissing and eating are good, natural exercises for your temporalis and masseter muscles (the muscles of mastication). However, too many of us brux or clench our teeth in our sleep or as a daily habit. When you do this to any great extent, your muscles tighten and the nerve points spin out. The masseter, pterygoids and temporalis muscles, along with the neck muscles, will often go into spasm. When you brux or clench, your jaw muscles may also feel tired the next morning.

My own orthodontist helped me become aware of early clicks and late clicks. The sooner you notice a click in the jaw, the easier it will be to remedy. (To determine if you have this type of problem, take the TMJ jaw click test described in Exerssage 2 below. ) Not all clicks have pain. A click can progress to such a point that it has bony spurs. If you feel bone rubbing against bone or hear a clicking, popping or grating sound, it means either that the joint is displaced or there is too much compression and tension around your jaw hinge and consequently in your jaw muscle. The feeling of clicking and popping can be ever so soft and will self-correct quite often just by applying StarFace techniques. If the jaw joint is injured or has slipped out of normal position, massaging the muscles which have pulled the bone out of joint will more than likely assist the joint to reposition itself.

If you are having bite challenges, you want to select a facial therapist, or preferably a holistic dentist, who specializes in the facial and upper torso muscles. I learned from my orthodontist that many of these structural misalignments are interrelated to joint, nerve and muscle tension triad syndromes. An altered occlusion can become a source for bruxism and clenching. The level of the lower jaw may be forced upwards, backwards, sideways or forward. This too can alter the bite.

If the sound or the feel of clicking is loud (like when you crunch on a carrot), this could be a more complicated problem, such as the temporomandibular joint not functioning normally. Proceed with caution and consult with a TMJ specialist if the problem persists.

The jaw muscle is tough and the effects of associated joint malfunction can be surprising. By working to normalize the tension surrounding the jaw, you will re-educate the muscles to work together rather than to resist each other. As the muscles become fluid and balanced, your complexion will start to glow and the cheeks will relax and tone.

Sunny's Case History
A specific case history can help to illustrate the kind of progress a client can make over a remarkably brief period of time. Such is the history of Sunny, a 51-year-old professional who had beautiful skin and clear signs of TMJ. She attended an Exerssage education series and scheduled a private session after the first group class. Sunny had considered an early facelift and had consulted two surgeons. One suggested inserting implants containing fat from her body along the nasal labial fold line, as well as eye surgery. The other denied her a facelift saying she was not a good candidate, but suggested she work on retraining her facial expressions.

During our initial consultation, Sunny realized she needed private coaching because, in her words, "I couldn't move my upper lip independently and hold the Moon pose taught in Lesson One." Client's who realize they don't have strong facial muscles are good candidates for Exerssage consultations.

The initial consultation revealed Sunny's pattern of long-standing jaw tension, including lip chewing, teeth clenching and pain in the temporal mandibular area she thought was chronic sinus congestion.

Starface Insights
The range of motion of Sunny's jaw joint was constricted on both sides and tighter on the right side. She needed to correct an upper right droopy eyelid and a right side nasal labial sag. Her tension was chronic and it hurt to lay her head and neck on a pillow. The jaw area throbbed, and she had zygomatic pain. She pursed her lips and had pouches at the sides of her mouth.

During our private sessions, I coached Sunny through a set of Exerssages and microcurrent massage. Sunny practiced the Exerssage techniques 20 minutes each day at home to a follow-up series of StarFace audio tapes. Sunny's comments after we worked through six sessions help demonstrate several principles of facial restructuring.

StarFace Principle 1
Clients will discover how they overuse or under-use their facial muscles when they begin these facial exercises.

Sunny's First Session
"I use my face too much. I push my energy in a contracting way and create more tension. My most chronic issue is sinus congestion. I take a decongestant. I see I am scrunching down with physical force, contributing to my sinus pain and creating a lot of jaw tension. Sometimes, my teeth hurt. How do I stop that?"

StarFace Principle 2
Clients need to have a vacation from the tension to realize how much they live with it every day.

Sunny's Third Session
"My right side feels lifted and stronger. My right side is still sore, but it feels much lighter. I can feel lymph fluid draining and the TMJ joint is not resisting when I do the exercises. My cheeks feel lifted. Now the left side feels tight!"

StarFace Principle 3
Consistent practice will strengthen, tone and lift your facial muscles.

Sunny's fourth Session
"I am now aware that I clench my teeth all the time. When I clench, I simultaneously purse my lips and block off my breathing. This was my posture for concentration. I'm still doing both of these things, but less frequently because my awareness is higher and I have an alternative. The Active Resting Pose (see box) has become a comfortable, stress-free posture to assume and it's becoming familiar after all the practice. Now, when my head and neck rest on my pillow, they feel light. There's more oxygen in my face now. I did not know how tight my neck and shoulders were. My eyes are more alive. Everything feels better. Three people today asked me what I was doing to look so well, so rested. It's from all of the practice."

StarFace Principle 4
With consistent practice, the symptoms of facial tension will diminish.

Sunny's fifth Session
"I'm clenching less. I start with pressure toward the front of my teeth, and then it moves to the back. The soreness is still in my neck and shoulders almost as if it's pre-migraine. This work is very deep. I've had this tension for a very long time. The upper lip feels like it's almost tacked onto the gums."

StarFace Principle 5
There are layers of tension in the face which may require patience and commitment to the process.

Sunny's sixth Session
"There is a visible softening. The bags under my eyes are gone. My eyes are more alive and open. I am not feeling tight. I can concentrate and my back molars do not clench. My upper lip pucker lines are almost gone. My cheek bones don't hurt, and I can yawn without hearing clicking and feeling like my jaw is dislocated. I never knew I lacked strength in the upper lip. I have so much more confidence. I know how to reduce jaw tension."

StarFace Principle 6
The cumulative effects of the program "soften" the face, producing the same result as toning and lifting. Practicing StarFace provides an opportunity to discover the communication network which lies beneath the skin. Sunny's story and her progress are not unusual. The following series of exercises can give you an idea of your current tension levels. Over time you will see these tension levels decrease. When doing these exercises, sit in front of a mirror. Consistent practice will rejuvenate your appearance.

EXERSSAGE 1
THE CRANE
The Benefits: This movement will loosen up the sides of the neck which may have shortened and tightened. When the neck is free of tension, the energy will feed the lips and help soften the jaw. This movement will also relieve forward neck strain. The Crane can help prevent the tension from moving into the jaw muscle. Benefits of this exercise include increased flexibility through neck extension, stimulation of the cervical nerve and greater range of motion as a result of the SCM loosening.

THE CRANE (PHOTO 1)

Directions
1. Briskly inhale twice through the nose as you pull your shoulders down and stretch your neck up long and tall. Visualize the front of your neck as tall as the back of your neck, as if it was spiraling up to the sky.
2. Lean your head toward the right shoulder (Photo 1), keeping the neck as long and tall as you can. Briskly exhale twice out of the mouth with a "haah haah" sound.
3. Return head to center. Inhale briskly twice through the nose.
4. Stretch the head toward the left shoulder while exhaling out - "haah haah."
Repeat this Exerssage five times and remember to always do double "haah" breathing.

HINTS
*Keep facing directly forward.
*When you lean the head to either side, you do not want to shorten the neck or lift the shoulders. (Think of lengthening the SCM opposing muscle.)
*As you lean the head toward the same shoulder, stretch the fingers down the sides of the body toward the floor for added resistance, or you can hold light hand weights.

EXERSSAGE 2
THE SLINKY SERIES
The Benefits: These three sets of movements will provide joint mobilization for the jaw and mouth, reduction of jaw tension and reshaping your facial muscles.

JAW SLINK TO THE RIGHT (PHOTO 2)

JAW SLINK TO THE LEFT (PHOTO 3)

Part A - The Jaw Slide
Directions:
1. Look in the mirror. Inhale through the nose and throat. (The nose is just a passageway.) Exhale through the mouth. This is called "haah" breathing. Place your fingers in front of the earlobe.
2. With your lips relaxed and your teeth barely apart and showing slightly, slide the lower jaw all the way to the right in exaggerated slow motion (Photo 2).
3. Repeat the movement, sliding your lower jaw in triple slow motion to the left (Photo 3). I call this movement "tracking."
4. Repeat this tracking movement four times from side to side, moving in super slow motion while "haah" breathing.

Continue exploring further. Place your fingers just in front of the center of your ears again with your teeth barely touching. Open and close your mouth, wiggle your lower jaw from side to side to feel the head of the mandible where your jaw hinges with your cranium. You will feel the jaw hinge jut out beneath your fingers. This is where the facial nerve, the main trunk, is located.

JAW CIRCLE ROTATIONS (PHOTO 4)

JAW CIRCLE ROTATIONS (PHOTO 5)

Part B - Jaw Circle Rotations
Directions:
1. Keep your fingers cupping the jaw hinge (head of the mandible) for support. Continue "haah" breathing.
2. Inhale through your nose. Slide and track your lower jaw slowly all the way to the right as far as you can (Photo 4).
3. Then, making a "haah" sound, exhale through the mouth as you drop your jaw open and, very fluidly and slowly, swing it down and around to the left in a half-circle motion (Photo 5).
4. Make three half-circle rotations to the right. Switch directions and complete three half circles to the left.
5. Release your hands and return to the Active Resting Pose, which is the neutral start and stop position we learned in Lesson One (see Massage & Bodywork, Feb/March 1999).

Part C - Jaw Micro Movement
Directions:
1. Open your mouth 1 inch wide.
2. Start to swirl your jaw hinge in a figure-eight motion, initiating tiny movements like an infinity symbol swirling back and forth.
3. Keep breathing and explore for 1 to 2 minutes with some slow, gentle movements.
4. Make this infinity pattern larger and larger, then shrink it down to a smaller and smaller range.
Note: This micro movement can be practiced throughout your day without a mirror. While it takes time to fully master this movement, all your effort in learning it will be beneficial.

WHIRLING TUNNEL (PHOTO 6)

EXERSSAGE 3
The Whirling Tunnel
Benefits: Opening up nasal passages makes breathing much more effortless.

Directions:
1. Apply a few drops of nasal embrocation on a Q-tip and apply to the inner walls of your nostrils to help unclog the passages.
2. Hold the right nostril shut with the right index finger. With the left index finger, starting at the base of the left nostril, inhale as you massage small, counter-clockwise circles, moving up toward the lower, inner-eye corner (Photo 6).
3. Exhale out of the mouth whenever necessary.
4. Repeat this spiraling movement two more times. Then, switch to the right nostril while closing off the left nostril.
5. Repeat three times.

HINTS
If either nasal passage is clogged, try to take small, quick sniffs of air like you're sniffing gardenias and exhale whenever you need. When you are massaging, try to inhale when you pull away from the nose, stretching the tissue enough to allow you to inhale better.

EXERSSAGE 4
Cheek Sculpt
Benefits: The cheekbones become more clearly defined and lifted.

CHEEK SCULPT (PHOTO 7)

Directions:
1. Apply sculpting oil along cheekbones.
2. Place hands in prayer position. Keep your fingers together and spread your thumbs apart (photo 7).
3. Place the arched pad of thumbs at the base of the nose. (You may feel tenderness.)
4. Lean your head into the thumbs while pressing them under the zygomatic bone close to the nostril. This will likely increase the tenderness. (Note: This can relieve pain in the lower teeth and can help to reduce a headache or toothache.)
5. Press inward and upward while "haah" breathing.
6. Stop, and press out the tender points as you continue to breathe.
7. Using the thumbs, sculpt along the cheekbone five times.

You can rest your elbows on the table for added resistance.

EXERSSAGE 5A
Chin Point
Benefits: Reduces facial tension from clenching and bruxing, and brightens complexion. The trigeminal facial nerve is responsible to the motor fiber for any chewing action. The masseter and temporalis close the jaw so it can chew and bite. If your teeth do not fit together properly, you will always need to be relieving yourself of facial tension (unless you have this corrected). The second branch of the trigeminal nerve helps to relieve pain in the lower teeth. This movement runs from the midline of the mentalis through the labii inferioris and stops within the depressor anguli oris.

CHIN POINT (PHOTO 8)

Directions:
1. Apply aromatherapy-sculpting oil along the chin, following the jawbone just past the sides of the mouth.
2. Starting at the chin center, stroke three times with the pads of your first three fingers using a deep, flat pressure.
3. Place your fingers at the tip of the chin each time you begin the stroke. Repeat this three times.
4. Look for a pressure point as you follow the chin line just down from the mouth corners (Photo 8). Stay on the point while proceeding to Exerssage 5B.

EXERSSAGE 5B
Chin Point Pulsing
Benefits: Helps improve circulation; improves facial nerve conductivity; releasing tender points helps lengthen fibers. Counting your breaths will help lengthen them. The combination of pressure, movement and heat from your fingers helps provide immediate relief from tenderness.
Note: There is a seven-count breath with a two-count hold which will increase the effectiveness of this Exerssage. Work to balance your inhalation with your exhalation.

Directions:
1. As you massage in outward circles, gradually add pressure to the point while breathing deeply.
2. Exhale slowly as you gently pump the tenderness out of the point.
Note: It is likely you will experience some degree of tenderness when you put pressure on this point.

HINTS
Press deeply enough so you can feel the sensation of tenderness, but not to the point of pain. The tenderness should diminish within three to six weeks as you practice pulsing this acupressure point. If you have extreme tenderness, this may be due to imbalanced nerve conductivity, which may require microcurrent treatment.

EXERSSAGE 6

CLAMSHELL EAR (PHOTO 9)

CLAMSHELL BEHIND HEAD (PHOTO 10)

Clamshells
Benefits: Massaging this area will lift the cheeks, reduce jaw clenching, relax the forehead and enliven the eyes.

Directions:
1. Tilt your head back; begin "haah" breathing while opening the jaw as wide as you can.
2. Using the fingertips, use tiny, rapid circles to massage the sides of your head, starting above the top of the front of the ear at the hairline and working up to the temples, maintaining a strong traction-like motion (Photo 9).
3. Look for little peas that are tender to your fingertip touch. Use deep, rapid circular movements.
4. Lengthen your neck and relax your shoulders.
5. Now move to the medial portion of the temporalis and massage from the base of the ear upward, looking for the little peas of tension.
6. Keep the jaw open. Continue "haah" breathing. At the posterior portion of the temporalis, work behind the earflap upward at the angle of the cheekbones (Photo 10).
7. Release your fingertips. Soften your wide-open Moon pose and return to start position - the Active Resting Pose.
Note: If the temporalis is inflamed, you may even feel pain or pressure behind the eyes. Tendinitis of the temporalis can shift the position of disc and condoyles out of balance, as well as the occlusion. Microcurrent treatment is indicated here.

Summary
For 12 years, I pioneered a pain clinic offering massage treatment which specialized in the face and upper body. Cases ranged from auto accidents, improper orthodontics, mistakes from cosmetic surgery, stress-related TMJ with tendinitis, malocclusion with TMJ, occlusion with tendinitis, headaches, sinus pressure and pain, cleft palate, Bell's palsy and other facial impairments. Most of these patients had been through the medical/dental mode being told nothing was wrong, they should live with the pain and try to forget about the symptoms, and even that they needed counseling. Many of these patients wondered if they would ever recover. I saw the need for teamwork. I saw the need for the therapist to be interactive with the client.

What has evolved over time is a new approach to beauty and health which combines a rigorous understanding of the muscular-skeletal and neurological structure of the face and body with gentle, non-invasive, specifically designed interventions which can significantly correct many facial flaws and enhance an overall sense of well-being, both physically and emotionally in all of us as we age.

Sabrina Stevens, an LMT/holistic beauty care specialist offers a self-help beauty care series and customized facial massage treatments, workouts and training. Stevens explores non-surgical alternatives to reshape facial expression and combines this research with her training in cross-cultural traditions of healing to formulate the Sabrina Stevens Systemsª, a form of non-surgical restructuring. She can be reached by e-mail at starface@lava.net; visit www.starface.com; fax her at 808/923-0099 or call her at 808/651-6737.

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james@active-health.org