In an East Side studio, a young woman reclines on a treatment table. With ease and confidence, Vancouver acupuncturist Lisa Davicioni perambulates around her patient, Wendy Eyton, placing needles in her face, head, and limbs. Davicioni locates point after point, most on Eyton's face and head, then taps the ends of tiny, silver pins to set them in place. Needles stick into the tops of Eyton's eyelids so that the red tips cover her closed eyes. Some are so tiny that Davicioni must use tweezers to manoeuvre them. Throughout it all, Eyton never winces or betrays anything but a deep peacefulness.

The treatment is called facial rejuvenation acupuncture. Practitioners consider it both an alternative to cosmetic facial surgery and a means of addressing the concept of beauty from the inside out.

Facial acupuncture can be traced back to the Song Dynasty, AD 960 to 1279, says Virginia Doran, a Connecticut-based acupuncturist interviewed by phone. She has been teaching and developing facial rejuvenation acupuncture for the past decade. According to her Web site (www.holisticbeauty.com/), each session is unique to the individual, and a full treatment is 12 sessions. Doran recommends maintenance sessions once a month or once a season, and says the effect of the treatment can last two to five years. A typical rate per session in Vancouver is $150, says Davicioni, bringing the total cost of the treatment here to $1,800.

After her third session, Eyton says the most profound change she's experienced is in her hair. "It feels healthier, smoother, and not as dry. And skin-it glows a little bit more. And a few wrinkles that were prominent have gone." She claims there are no downsides to the technique. "In fact, I find it almost equally as powerful on an energetic level," she says, adding that a sense of energy runs through her body during sessions.

Doran claims the treatment can take five to 15 years off a face. She and other practitioners say that it can address dark circles under the eyes, pasty colouring, puffiness, sagging, wrinkles, jowls, and dry skin. It works in various ways, not all directly. For example, when you insert a needle into a wrinkle, Doran says, it fills up with collagen and then evens out. For dry skin, an acupuncturist works to balance hormones. Motor points in the scalp can be needled to help tone jowls, and muscle insertions can be released to reduce double chins.

Emotional factors can also influence the way we look, says Davicioni. "If you're feeling good inside, you'll look good, you'll feel confident in who you are," she says. With acupuncture, a practitioner can work on her patient's self-esteem issues or depression while at the same time pressing points to tighten the muscles in the face and relax the jaw, she explains. The result is that "people get rejuvenated; they get healthy. And it's not that plastic look."

Jean Carruthers notes that acupuncture has a psychological benefit that is just starting to be understood by western medicine. The cosmetic surgeon and co-founder of cosmetic Botox was interviewed on the line from her Vancouver office. She says that comparative studies between facial acupuncture and cosmetic surgery have not been done, but she sees no health and safety reason to warn against pursuing acupuncture with a well-trained practitioner.

With regard to cosmetic surgery, Carruthers says that with increased longevity, it's important to look on the outside the way one feels on the inside. "Our skin and physique are important, especially facial skin. So many people just flower when you make them look fresh," she says. "That encourages them to extend everything they can do in every aspect of their lives in an even more positive way than they were doing before." Davicioni believes that the way people feel about themselves influences the way they feel about their appearance. "If you get facial surgery and you have low self-esteem and don't accept who you are, you're going to go and look for something else right afterward. And it will never end. I don't think people are really looking to look beautiful. I think they're looking to feel beautiful."

Doran says for cosmetic therapies to work and last, the practitioner can't just treat symptoms. "If you do some kind of laser treatment for broken capillaries on the cheek but you don't treat the underlying cause, they're going to come back."

Patricia Kitchener is a West Vancouver-based clinical counsellor who specializes in disordered eating and body image. Kitchener notes that when people feel good about themselves, they perceive themselves to be more beautiful in photographs. When some clients say they feel ugly or like they've got jowls, they're really experiencing unattractive emotions they don't know how to process.

However, Kitchener says she has seen "very positive" benefits for some clients who have pursued cosmetic surgery. "When I have seen positive results from somebody doing something drastic, I can't dismiss it," she says. "Anyone taking a reductionist view is simplifying something."

Davicioni warns against working on the physical at the exclusion of the emotional. She says you might fix the symptom but find that another condition replaces it. "You can't separate the body [from the mind]," she says. "You just can't."