Are your neck and shoulders aging your face? Quite possibly, yes. (Obviously, we need to talk about this.)

That’s Onyia on the right, swimming in the brisk San Francisco bay at Fjord along with other members of the entrepreneurial moms’ group that we’re part of, thanks to the magical connector Abby Sommerfeld. (I stayed in the floating sauna.)

Last weekend, my friend Onyia, a profoundly gifted rehabilitative massage therapist, gave me the best massage of my life.

It was my first treatment with her, and I’d arrived with searing neck and shoulder pain that wouldn’t go away, even after a trip to the physical therapist and countless hot showers with my trusty Gua Sha stone. Within an hour, Onyia (pronounced like “Anya”) had masterfully combined a mind-boggling number of modalities (including acupressure, Thai massage, cupping, neurofascial release, and intraoral work) to unravel all of that tension in a lasting way.

That alone was enough to make the treatment remarkable, but what really took it over the top was the fact that she worked on the front of my neck, which no one’s ever done before—and I’ve gotten a lot of bodywork done. A lot.

It made me wonder about all of this front-of-the-neck tension, which is increasingly common yet rarely addressed, and the effect that it might be having on our faces. Was it giving gravity a demonic assist, pulling things down even further? Galling! I wanted to dig into it and infuriate myself.

So, I gave Onyia a call and recorded it for you, because here’s the thing that might blow your minds: chronic neck and shoulder tension underlies many of the most common complaints people have about their faces. Puffiness, nasolabial folds, a sagging jawline, and a gradual loss of lift aren’t just about what’s happening within and underneath the skin on our faces. And, while many of the fixes out there can address the symptoms on a temporary basis, they’re not fully addressing this increasingly common cause.

In our interview below, Onyia discusses:

- How neck and shoulder tension are related to facial sagging, sallowness, and the appearance of a double chin

- How the jaw and the tongue impact not only the jawline but also the entire spine

- How left-side lymphatic drainage affects facial puffiness, and how stress makes that worse

- The vagus nerve and the surprising link between constant phone use and anxiety from a postural standpoint

- What to look for in a bodywork practitioner and how often to book appointments

It’s a meaty one, so save it, or make yourself a nice cup of something hot to drink and settle in for what I think is a pretty fascinating read.

Once you finish it, I know you’ll all want to book a treatment with Onyia, and I’m very sorry to tell you that she is fully booked for the foreseeable future. (I know, because immediately after my treatment, I attempted to book follow-ups with her on a monthly basis.) But I’ll follow this post soon with another one featuring her tips for a few at-home moves and postural tips you can safely practice on your own, and I’m organizing a workshop with her at Ayla on Mother’s Day weekend. We all need a little Onyia in our lives.

DARA: First of all, thank you again. I know I’ve said this to you multiple times already, but that massage was amazing, and it feels so good to be able to sleep without searing pain.

ONYIA: It feels good, right? What you have going on is that you’ve developed a pattern that’s worked for a long time—it lets you play violin, strength train, do the things you want to do—but that same pattern is causing pain.

The neck, shoulder, and head involve so many fascial layers, and they all play a role. A lot of people who do the things you do have extremely dominant muscles, and the body doesn’t really distinguish between “tight” and “strong.” It just recruits what it can. So when we don’t consciously support finer movement patterns, the body goes chunkier and more supportive.

But because that area is designed with so many delicate layers, it ends up compressing them, which affects lymph flow, head movement, jaw movement, sinuses, all of it.

DARA: This feels like such a missing piece in the beauty world! So many of us are already familiar with face massage, Gua Sha, buccal massage, work with the fascia, lymphatic massage, all the treatments that can be done with the face—but when you were working on the front of my neck and explaining how the neck muscles pull on the face, it was a revelation. And I imagine neck and shoulder tightness is something you see all the time.

ONYIA: All the time. And different generations show up differently.

With the older generation—after gravity has been working on them for decades—you see how people tend to shrink and compress. The blood flow to different areas becomes less smooth, and depending on what they’ve done in their lives, gravity does its work in different ways: people who’ve worked with their hands, done construction, spent years at a desk, or spent years teaching all show different patterns.

If the head is consistently forward, like with someone who does a lot of driving or academic reading, the compression on the spinal cord and nerves is much more significant than if there’s more dynamic, whole-body movement.

Our generation (Gen X) is interesting because we didn’t have cell phones as children. So the way we loaded stress into our bodies was different—when we were reading and writing, we held our bodies differently. You can see the left-right dominance from writing in the neck and the jaw.

But the younger generation is another story. I’m seeing college-aged people and recent graduates with a really deep cervical curve combined with the effects of phone posture, and the impact on the vagus nerve is significant.

The vagus nerve—sometimes called the wandering nerve—wraps around the esophagus, into the chest, and around the heart. You can do a lot of work on it through the head, jaw, neck, and breath.

When someone is lying in bed looking at their phone, or holding their head forward and rotating to one side, those upper neck muscles are turned on in a completely different way than when you’re trying to sleep. There’s almost a holding pattern that develops. And when you combine that with less dynamic movement overall, you get eye strain, more migraines, more anxiety from the neck tension—and nobody is touching the front of the neck or the collarbones, where so much of this lives.

DARA: No one has ever massaged the front of my neck before.

ONYIA: Right! And in massage school, they literally tell you, “Don’t go there.” They call it the danger triangle. But I’m the kind of person who, when told not to do something, wants to understand why…and sometimes that curiosity leads somewhere really useful. The front of the neck, the inside of the jaw, the abdomen: these are areas where we hold so much, whether it’s emotional, physical, or mental. If we only ever address the back of the neck and the back of the body, the front just keeps getting tighter and tighter.

And our muscles don’t really complain when they’re tightening; they complain when they’re being pulled on. So when someone is hunched at a computer and the back of their neck hurts, yes, those muscles are tight, but they’re what we call “long tight.” The real work is in the front.

There’s a muscle called the SCM — the one that pops out when you turn your head — that runs from behind your ear all the way to your collarbone. It’s the only neck muscle that crosses from back to front. It has trigger points throughout, and because it attaches to the collarbone, tightness there impacts your shoulder mobility, your ribs, and your breath. When those upper neck muscles are tight, we recruit them for breathing and end up stuck in shallow, upper-chest breathing. You can do gentle Gua Sha, nerve flossing, and careful trigger point work on the SCM and the front of the neck, and that can make an enormous difference.

DARA: Can you talk about how that tension shows up on the face?

ONYIA: Yes. So, when the front of the neck is tight and we’re only addressing the back, the front keeps getting tighter. A muscle that’s already half-contracted has half the action potential — it can only go to a fraction of its full strength. When we have all that pull into the neck, and the front of the neck is chronically contracted, you’re more likely to develop what looks like a double chin and a droopy quality to the face, because the skin is being pulled forward with nothing to counteract it.

From an aesthetic perspective, your eyes, cheekbones, jaw, and the skin around your neck can all be supported through bodywork that essentially creates a lift. We also did cupping on you, and you saw the marks: those are from stagnant blood coming back to the surface. When a muscle can’t fully relax, blood flow can’t move in and out smoothly. That stagnation leads to discoloration in the skin, because circulation is compromised.

The other important piece of this is the relationship between the heart and the face. When you’re developing in utero, your heart is literally right next to your face. The fascia of the heart and the fascia of the face are directly interconnected. As you develop, the heart drops—down through the throat, into the chest cavity, eventually surrounded by the ribs—but that fascial connection remains. The face and the heart are more fascially similar to each other than the face is to the back of the head or the back of the neck.

DARA: That is wild.

ONYIA: Right? So when people are grieving, or going through heartache, or carrying enormous stress, that can literally come up into the face.

And the reverse is also true: when you do heart-opening work, like diaphragm release, you’re affecting the fascia of your face at the same time. The top of the diaphragm wraps around the heart and becomes the pericardial sac. When you take a deep breath into your chest, you’re actually moving the fascia of your face as your chest opens.

But when we’re in that collapsed forward posture—front of the neck tight, chest caved in—we’re not only compressing the breath, we’re constricting the fascia of the face and the heart simultaneously.

DARA: Ugh, as if anyone going through grief or heartache needed to also be clobbered by a droopy face.

ONYIA: Exactly. And I’m seeing this a lot right now. In the past several weeks, so many of my clients in the tech world have been carrying this enormous weight—the anxiety around AI, the fear of job loss, the 80-hour weeks, the feeling that they can’t come up for air. I’m seeing a lot of tech neck, but I’m also seeing something deeper: the heart is just overwhelmed. And it shows up in the face and the front of the body in ways that no serum is going to fix.

DARA: And then there’s the jaw situation …

ONYIA: The jaw is really important, too. Outside of the spine, it’s the first bone to develop in utero. It exists to allow us to take in nourishment and communicate; it’s almost primal. And there are so many things that shape the jaw: chronic sinus issues, early feeding patterns, emotional history. Children who cried a lot, or who learned not to cry because their needs weren’t met, hold that in the jaw.

There’s intraoral work you can do, and sinus cavity work through the roof of the mouth; the impact on the neck is profound, because the first two vertebrae of the spine are actually behind the jaw. If you look at someone’s profile, you can only see the lower portion of their neck bones because the upper two are covered by the jaw. So jaw tension pulls on everything, including the trigeminal nerve, which is where migraines often originate.

People come in for appointments with me saying they can’t turn their head, and a huge part of that comes down to those upper cervical vertebrae. If we address the jaw, the entire spine flows more freely.

And then there’s the tongue, which is one of the most underappreciated muscles. There are tongue massage and release techniques that affect everything all the way down the neck. The TikTok content about jaw exercises for a defined jawline—there’s actually real anatomy behind that. What we do with the inside of our mouth affects us all the way to our shoes.

DARA: And lymphatic drainage is part of all of this, too. Tell us more about that.

ONYIA: Where the lymphatic system is concerned, you might already know that in breast cancer, there’s a higher incidence on the left side. Part of that is because the left lymph nodes in the upper body—the armpit, collarbone, and neck—are responsible for roughly three-quarters of the upper torso and abdomen, while the right side handles only the upper right quadrant. So the left side simply has to work harder. When we add more stress—whether that’s emotional stress, muscle tension, or reduced range of movement in the shoulders or neck vertebrae—we’re loading a system that’s already working at capacity. That’s when we feel puffy in the face, around the eyes, and in the neck.

I see both left and right chronic neck pain, but the most persistent cases tend to be on the left. The right side usually has a clear cause: a mouse, a number pad, or some other work setup that requires a lot of rightward rotation. But when there’s no dominant reason, the left tends to be the one that holds on.

DARA: So now that we’ve established how important all of this is, and given that it’s impossible to get an appointment with you, what guidance can you provide for people who are looking for good bodyworkers? What should they look for, what questions should they ask, and what credentials matter?

ONYIA: I’d encourage people to find massage therapists who are constantly learning. Our bodies are still not fully understood, and there are so many perspectives and modalities. The ones I’ve come to rely on most, especially for the neck, include:

Neurofascial release. Most people have heard of myofascial work; fascia is the thin connective tissue that wraps around every muscle fiber and muscle group, giving us that gliding quality of movement. It gets sticky when there are adhesions or inadequate interstitial fluid flow. Neurofascial work goes one layer deeper: the fascial sheath around the nerve itself can get sticky, and that’s where nerve gliding comes in. Look for someone who’s trained in nerve flossing or hands-on neurofascial work.

Lymphatic massage. It’s gentle and can feel strange if you haven’t had it; the practitioner will linger in certain areas and lightly pulse. It won’t feel like a typical relaxation massage. But especially after surgeries or during high-stress periods, it can be really powerful for getting things flowing.

Gua Sha and cupping. You want to be careful about where cupping happens—the shoulder and upper trap are good areas, and the front of the chest, but you don’t want cups on the front of the neck without significant experience. Gua Sha around the collarbone, under the jaw, around the ear and skull is particularly good for lifting the cheeks and eyes and relieving pull tension. It’s also something you can learn to do yourself.

Intraoral work. There are many approaches—direct trigger point work on the muscles inside the mouth, craniosacral, myofascial, and neurofascial—and they can be combined. Working inside the mouth allows access to the whole tongue base, the sinus cavities via the roof of the mouth, and muscles that you simply cannot reach from outside.

Craniosacral therapy. This is something I love, especially when combined with other approaches. It’s a very subtle modality, but the integration with myofascial and neurofascial work can produce remarkable results.

Also worth mentioning: if someone has had a car accident and never had the front-of-neck muscles addressed—those anterior muscles that tighten in a whiplash scenario—none of the other work is going to create as much change as it could if that root level isn’t first worked on and made more supple.

ONYIA: The ideal frequency of bodywork really depends on the person and what they’re doing with their body.

For maintenance, once a month or once every three weeks works well for many people. Those under higher stress may need more. But I also see people who come in once every four to six months, and that’s genuinely enough because they’re doing real work on their own in between.

Part of what I like to do in sessions is help people understand their patterns and then educate them on what to watch for and what to do when things start building. It’s not about waiting until you’re in pain. It’s about recognizing early signals—tension in the jaw, a change in your breath, a niggling pain in the shoulder—and addressing it then. Do a little Gua Sha, take a break from the screen, or do some nerve flossing instead of getting to the end of the day in serious pain and unable to sleep.

(How adorbs is Onyia? Here she is with her family. If you’re in the Bay Area and you’d like to join us at Onyia’s workshop at Ayla on Saturday, May 9, send a note to Maria at creative@aylabeauty.com.)

About Onyia:
Onyia Pemberton is a rehabilitative massage therapist with extensive knowledge of musculoskeletal health science and injury rehabilitation. On top of her massage therapist certification, she’s completed over 2500 hours of continuing education and advanced training in modalities including neurofascial, craniosacral, vagus nerve, and intraoral therapy along with Gua Sha, cupping, and Thai massage. Learn more about her here.