Crow’s feet in the corners of the eyes increasingly deep crow’s feet, loss of luster gradually sagging skin, cheeks do not know when the chloasma rose …… mirror in the aging face, reminding us that youth is fading. But as long as we take a closer look, the skin on our body that has not been exposed to sunlight for a long time is still young and beautiful. Why? This means that these changes in our face are not really aging, but photoaging. As the director of the dermatology department at Tongji Hospital, Zhao Jingjun believes that the main external cause of skin aging, especially in exposed areas, is photo-aging, which means that ultraviolet radiation from sunlight accelerates skin aging. We can slow down the process of skin photoaging through a series of medical cosmetic treatments such as laser therapy and injection therapy. “Aging is a natural process that no one can control. However, human beings want to stay young forever, and we as doctors can only slow down skin aging to a certain extent through safe and effective methods. With the continuous progress of medical cosmetic technology, the future of delayed aging will no longer be a dream.” “Skin killer” photoaging Spring Festival this year, Ms. White went to the sunny island of Hainan to take a dip, although well-prepared for the sun, but the skin was still a strong ultraviolet sunburn, usually white skin becomes red, swollen, molting, with more moisturizing skin care products are useless. “This is a typical sunburn, now stop using all cosmetics, only use olive oil or glycerin on the line, after a few days the skin will recover.” Zhao Jingjun said, “Do not underestimate the skin sunburn, the main cause of skin aging is ultraviolet radiation caused by photoaging, so daily protection is very important to delay aging.” Zhao Jingjun said, skin aging has two kinds of internal and external, by the gene-controlled cell metabolism decline caused by the natural aging of the skin, known as endogenous natural aging; skin aging due to external environmental factors, known as external aging. There are many exogenous factors, including ultraviolet rays, cigarette smoke, lifestyle habits, long-term sleep deprivation; long-term work in a dimly lit environment, reading; sentimental or impatient; inappropriate rapid weight loss or lack of physical exercise; work stress, fatigue; long-term exposure to high temperatures, cold, windy, dry environments, sudden changes in the environment, gravity and so on. Among them, smoking can exacerbate skin photoaging and is more pronounced in women than in men, and the amount of smoking is directly related to the degree of wrinkles and gray skin. Recent skin science research has shown that among exogenous factors, photoaging is the number one killer of skin aging. Zhao Jingjun explained that photoaging is due to the damage caused by long-term exposure of the skin to sunlight, prompting premature aging changes in the skin, manifested as roughness, thickening, sagging, deep and coarse wrinkles, localized excessive pigmentation or capillary dilatation, and may even appear a variety of benign or malignant tumors (e.g., solar keratosis pilaris, squamous cell carcinoma, malignant melanoma, etc.). The curative effects of skin photoaging begin to accumulate from the time of exposure to sunlight, so it is emphasized that protection against sun damage should be observed from infancy. In addition, as we age, there are corresponding changes in the structure of the skin, such as the integrity of the epidermal stratum corneum and the thickness of the epidermis pigmentation, etc. All of these factors can affect the reflection, absorption, and penetration of ultraviolet rays in the sunlight, and thus affect the occurrence of photoaging of the skin. Skin color also has an impact on skin photoaging, skin color is mainly determined by the melanin in the epidermis, and melanin has good absorption of various wavelengths of ultraviolet light, so melanin in the epidermis is the defense of dermal tissues from ultraviolet radiation damage to the natural barrier. Photoaging is the most prominent form of external skin aging, and UV radiation, is the main cause of photoaging of the skin. How exactly does UV radiation cause photoaging of the skin? Zhao Jingjun explained that the ultraviolet wavelength range of 200-400 nanometers, can be divided into UVC (short-wave ultraviolet) 200-290 nanometers, the vast majority of the atmosphere is absorbed, does not penetrate into the skin, UVB (medium-wave ultraviolet) 290-320 nanometers, can be penetrated to the basal layer, UVA (long-wave ultraviolet) 320-400 nanometers can penetrate the dermis. Among them, the main damage to the skin is UVA, UVB. UVA in the sunshine dose than UVB up to 100-1000 times, penetration, 30% ~ 50% up to the dermis, so that the skin collagen fibers and elastic fibers degenerative changes, resulting in reduced skin elasticity, flaccid aging. And it is not subject to the season, clouds, glass, water, and can enhance the UVB damage, has a cumulative effect. UVB damage, on the other hand, mainly damages the epidermis, which produces highly reactive free radicals that cause cholesterol to produce carcinogens and damage skin immune cells. “Therefore, we should be more vigilant is UVA. before, we only recognize the UVB damage, now the sunscreen has been aimed at UVA, the choice of sunscreen should pay attention to, UVA protection factor PFA has two to three plus, SPF greater than 30 is better.” Zhao Jingjun said. Injectable cosmetic smoothing wrinkles 20-year-old apple muscle gradually become dry, flaccid; after 30 years old, eyelids gradually loose, small fine lines, crow’s feet gradually appeared; to forty or fifty years old, the skin loses its luster, becomes flaccid and dull, wrinkles deepen, chloasma, age spots climbed on the cheeks, and the old state is gradually highlighted. “Women in this age group also have the strongest demand for medical skin aesthetics.” Zhao Jingjun said. There was once a 55-year-old woman who supported the Great Northwest and returned to Shanghai to work after retirement. Her children were older and she had time to focus on her own beauty. Her facial skin photoaging is very serious, color spots are obvious, there are age spots on the cheekbones, forehead lines, crow’s feet, lines are obvious, for such a patient, the first step is to remove the spots, to solve the problem of facial discoloration, and the second step is to carry out wrinkle removal, which can be done through hyaluronic acid and botulinum toxin injections to fill in the wrinkles. After these two steps are done, they look much younger. In order to realize the dream of anti-aging skin, a series of skin rejuvenation techniques came into being, these techniques include drug treatment, surgical treatment, laser treatment, injection treatment and so on. Zhao Jingjun said that in the past, doctors mainly used surgical methods to achieve the purpose of rejuvenation, and is still used today. Objectively speaking, the surgical method is indeed effective, reliable and long-lasting, but there are also insurmountable shortcomings, first of all, surgery can only solve the problem of skin laxity, and can not improve the skin texture, skin pigmentation changes brought about by skin aging, pore size and other damages can not do anything about it, but also the pain of the operation and postoperative, lost time and the possible adverse effects of the operation also make people shy away. In the 1970s and 1980s, doctors also used mechanical grinding and chemical peeling methods to treat skin aging, these methods can make some changes in skin texture and lesions, but there are still problems of pain, lost labor, and the efficacy of the problem is not certain. The possible adverse effects include problems such as flushing of the skin in the area of the procedure, infection, scarring, and especially for Asian yellow skin, hyperpigmentation or depigmentation is very tricky. The ideal skin rejuvenation technique should, of course, be efficacious, easy and fast, safe and painless, with no time lost. With the development of medical cosmetology and technology, non-invasive or minimally invasive medical cosmetology technology is gradually emerging, which includes minimally invasive surgery, local injections, skin care and a series of acoustic, light, electricity and other physical methods, with a view to improving the texture of the skin, reducing wrinkles, eliminating the skin surface imperfections, and even play a weight loss and body contouring of the cosmetic effects of the skin, and these are also known as non-surgical skin rejuvenation techniques. In recent years, the domestic demand for cosmetic injections more people, injection, you can smooth out wrinkles, this simple micro-plastic surgery way to slow down the aging of the dream come true. Zhao Jingjun said that common cosmetic injections include, medical cosmetic collagen/hyaluronic acid injections, local correction of tiny depressed scarring and early shallow wrinkles. Botulinum toxin type A injections to eliminate frown lines between the eyebrows, forehead lines and crow’s feet. “Hyaluronic acid, also known as hyaluronic acid, is genetically engineered and synthesized to be 99% similar to hyaluronic acid within the human body and therefore can be absorbed by the body with a high degree of safety. Since hyaluronic acid will be absorbed, the efficacy is usually only maintained for 6-8 months. With the continuous improvement of hyaluronic acid cross-linking technology, hyaluronic acid is absorbed by the body more and more slowly, the maintenance time will be longer and longer. At present, after national approval can be clinically used No. 2 hyaluronic acid, mainly for the elimination of the decree lines.” Zhao Jingjun said, these technologies have been widely used at home and abroad in skin beauty, especially in Europe and the United States, there is a trend to exceed the traditional surgical beauty. However, it should be emphasized that these cosmetic techniques are invasive medical technology, and need to be carried out in the dermatology department or plastic surgery department of the regular medical beauty institutions, and the applicants should also choose to be operated and implemented by experienced experts who have undergone special training. Laser to promote new skin In Tongji Hospital dermatology beauty clinic on the third floor, set up a number of high-end laser treatment room, which is imported from abroad original photon rejuvenation instrument, super pulse carbon dioxide laser, non-exfoliation fractional laser treatment instrument, far infrared ray treatment instrument and other high-end instruments. Every day, there are patients here through laser treatment to drive away wrinkles and restore skin elasticity. Zhao Jingjun said, from the principle of tissue optics and skin aging mechanism, the role of the laser is achieved by heating the target tissue, the so-called photothermal effect. The basic histological changes in skin aging is the dermal collagen fibers, elastic fibers and other tangible components and tissue interstitial reduction, resulting in skin atrophy, skin dryness, wrinkles, skin relaxation and skin pigmentation changes. A large number of tests have proved that the dermal tissue is heated, either directly or through the activation of a series of related cytokines to make collagen cells to produce new collagen, and through the direct vaporization or change of metabolism to get rid of the skin surface pigmentation damage. Photorejuvenation, medically called intense pulsed light therapy, intense light is not a laser, but it can also stimulate the dermis in the production of collagen cells – fibroblasts. After being stimulated by light, it can synthesize more newborn collagen, and naturally the skin can regain its original elasticity and luster. Infrared laser, which has a longer wavelength, can penetrate the superficial and even deeper layers of the dermis, and can also promote the renewal of collagen, also known as laser wrinkle reduction. In addition to stimulating collagen production, it is also very effective on elastin. After sun exposure, the elastin in the dermis denatures, which can make the skin sag. Lasers, intense light, and radiofrequency, all work well on elastin, and all are non-invasive treatments. If the wrinkles are heavier, there are also invasive ways, which used to be laser resurfacing, taking the laser and resurfacing the skin layer by layer from top to bottom. The principle is to grind away the aged skin, because there are appendages in the dermis, and on the appendages there are a lot of stem cells, and the stem cells will grow back into the epidermis and the superficial dermis, and the skin will be improved. This method is still the gold standard for treating photoaging. However, because Chinese people have yellow skin, pigment cells are more active, and when such treatment is performed, the skin elasticity recovers well, and long-lasting discoloration and erythema can easily occur. Therefore, a new type of fractionalized laser technology appeared, and the best clinical application is the non-ablative fractional erbium glass laser, which is not a whole grinding, but with the way of hitting the spot, the large laser beam is broken down into dots of light spots. The tissue in between the dots and the dots, which is not vaporized by the laser, can be repaired horizontally, which makes it very fast. It turns out that while the entire laser resurfacing takes a month to repair, the recovery from the fractional laser takes only a few days, and the skin can appear new in a month.