Physicians created clinical protocols where pressure dosage, sequence timing, and heart-rate variability replace intuitive variability, transforming facial massage from a touch-based craft into a predictable non-pharmacological therapy that physicians understand.
The integrative health sector is undergoing a noticeable shift. According to a recent review by the American College of Healthcare Sciences (ACHS), published in January this year, a leading trend of 2025 is the transition from occasional spa services to evidence-based wellness and integrative practices focused on quality, safety, and measurable outcomes.
But how do you measure these outcomes? Why does the same facial massage produce completely different results depending on the practitioner — and how can they be made consistent? How can facial massage become not just a pleasant experience but a predictable medical procedure?
These are the questions Nina Katshani has spent years answering. A physician and researcher, she developed Flow-Balance™ — a method built on standardised protocols in which every manoeuvre has a defined physiological aim and a measurable marker. She argues that this approach shifts facial massage from an intuitive, "touch-based craft" to a controlled, non-pharmacological therapy that physicians can understand and integrate into patient care.
Working in Moscow clinics and private practice ten years ago, Nina quickly discovered that patients often sought help not for aesthetics, but for temporomandibular joint (TMJ) pain, chronic facial swelling, tension headaches, and the consequences of long hours in front of screens. Techniques with identical names produced radically different effects depending on the practitioner, in terms of impact, safety, and duration of results.
“The same ‘massage’ in different hands could be either too aggressive or almost useless. This hindered clinical evaluation, training, and conversations with physicians in a shared language,” recalls Katshani. Her medical background in ophthalmology and functional diagnostics pointed to the only viable solution: to stop relying on intuition and build a method where every manoeuvre had a clearly defined physiological aim and a measurable marker.
It was in 2017, after opening her own practice, that she began systematically developing and applying Flow-Balance™ — a system that combines gentle affective touch with lymphatic drainage, myofascial work, and mandatory heart-rate variability (HRV) monitoring.
“It was crucial to me to transition touch from a personal art to a set of reproducible clinical protocols with defined sequences, timing, pressure ranges, and clear control points,” she explains.
As patient numbers grew and colleagues expressed increasing interest, one conclusion became unavoidable: without strict standardisation, the method would remain an author’s technique, not a scalable clinical tool. Traditional massage schools historically evolved as crafts, where outcomes depended on the practitioner’s “feel,” not on dosage and sequence.
“Traditional approaches depend heavily on individual style. Two practitioners may interpret the same patient request differently, altering pressure, speed, and areas of focus. This intuitive variability undermines reproducibility and makes clinical auditing nearly impossible,” notes Nina. This inspired her to define in the protocol every parameter that affects outcomes: pressure of 10–60 g/cm², speed of 1–3 Hz, precise zone order, and the duration of each stage.
The foundation draws on data from the neurobiology of touch, lymphatic drainage, and skin-barrier research, as well as her own pilot series with HRV and dermatological measurements.“For me, reproducibility means that different specialists, following the same protocol, achieve comparable results in similar patients,” she emphasises. This reproducibility allowed the method to expand beyond a single practice and be adopted by clinicians in multiple regions.
Each Flow-Balance™ session begins with an assessment: complaints, standardised photography, palpation of muscular tone, HRV measurement, TEWL (transepidermal water loss), and corneometry. This is followed by thermal preparation, vector-fixed lymphatic drainage, myofascial work on the masticatory and temporal muscles, cervical region, and TMJ, and a concluding post-assessment.
The protocol is built on the principle of a “rigid core — flexible modules”: the foundational structure is non-negotiable, while predefined extensions are added for specific conditions such as acne, oedema, TMJ pain, or digital fatigue. “The rigid core preserves standardisation, and the flexible modules allow for individualisation without sacrificing predictability,” explains Katshani.
All parameters are documented, enabling comparison of results across specialists and clinics. “Every step is linked to a biomarker, not a practitioner’s sensation. That is why we know exactly what works — and why,” she says. This approach is already used by neurologists and rehabilitation specialists, as well as in corporate wellness programs of companies such as Jermuk Group (Armenia), Kul-B / UBC Group, and Musthave (Russia).
Standardisation has turned facial massage from a spa option into a tool physicians can understand and integrate into patient care pathways. Neurologists and dentists use Flow-Balance™ as supportive therapy for TMJ disorders and tension headaches; rehabilitation specialists apply it for stress recovery and digital overload. The method has been implemented in corporate wellness programs of major companies to reduce anxiety and improve employee focus.
“When there is a clearly described sequence, pressure dosage, and effect criteria, physicians can predict outcomes and safely combine touch-based therapy with other methods,” emphasises Katshani. After implementation, results consistently include reduced swelling and inflammation, fewer headaches, increased vagally mediated HRV markers, and improved skin barrier function.
Training has reached a new level: instead of a collection of techniques, specialists receive a clinical algorithm with checklists and objective certification. Graduates of Nina’s courses are implementing the protocols in clinics from Moscow to Yerevan, and her terminology increasingly appears in colleagues’ publications.
Today, Flow-Balance™ encompasses eight peer-reviewed articles with DOIs, a methodological manual with an ISBN and an English edition, award-winning presentations at international conferences in 2025, membership in the Federation of Holistic Therapists (UK), and invitations to jury panels for biotechnology and aesthetic medicine awards.
“We no longer ask people to take our word that ‘it works.’ We show numbers, charts, before-and-after images, objective biomarkers,” says Nina Katshani.
The next step is bringing this experience to the United States. A small clinical studio is planned in California, along with certification programs for American aestheticians and physicians, and joint research on HRV and skin barrier with local experts. The data accumulated since 2017 from hundreds of cases will support pilot projects aimed at integrating standardised manual touch into the U.S. integrative health system — as a precise, safe, and measurable tool for people with chronic pain, anxiety, and digital overload.
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