Dialogue with Zhang Yuguang: When we talk about "facial rejuvenation", what are the criteria exactly?
In 2025, the domestic medical aesthetics market stands at a critical juncture.
The public's demand for anti - aging and rejuvenation is increasing day by day. The aesthetic trend has also shifted from blindly following the trend in the past to pursuing natural "natural - looking beauty" and "Eastern beauty".
With the continuous increase in personalized and refined medical aesthetics needs, the update of products and materials on the supply side is also booming. From the classic application of hyaluronic acid to the successive approval of collagen - stimulating materials (such as PLLA Sculptra) and collagen, consumers seem to have a particularly rich choice.
However, there are also many hidden concerns behind the prosperity. On social media, negative cases such as "moon - face" (excessive facial filling), a fake - looking face, and displacement have deterred many people.
So, how should we objectively measure the "youthful state" change before and after medical aesthetics? In the eyes of clinical doctors, what are the characteristics of the main biological materials used for medical aesthetics repair? What are the core reasons for the "moon - face" and fake - looking face?
In response to a series of questions, 36Kr recently interviewed Professor Zhang Yuguang, the chief physician of the Department of Plastic and Reconstructive Surgery at the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. From the perspective of a clinical expert, he shared the objective standards for facial rejuvenation, the in - depth logic of "moon - face" repair, and the key elements to improve the medical aesthetics experience.
The following is the edited conversation:
Setting objective standards for the "youthful" aesthetic
36Kr: According to your observation, what significant changes have taken place in the public's aesthetic trends and demands?
Zhang Yuguang: I believe that in the past 20 years, the Chinese medical aesthetics market has gone through a process from "blindly following the trend" to "self - awakening". Twenty years ago, many people wanted to have the same big eyes and high nose as a certain celebrity. But later, people found that due to different bone structures, blind imitation often led to facial disharmony.
The current trend is to pursue natural beauty and a natural - looking appearance. People have realized that the "youthful state" is the core of beauty. This shift from local organ plastic surgery to overall rejuvenation and skin improvement is, in my opinion, a sign of aesthetic maturity.
36Kr: In the past, evaluating whether a person was "younger (than their actual age)" was often based on subjective feelings. From a medical professional perspective, is there a more objective evaluation standard for facial rejuvenation?
Zhang Yuguang: In the past, the industry lacked a unified objective standard for "facial rejuvenation". In recent years, we have introduced two important objective indicators to help doctors and patients define "youth" from an anatomical perspective.
First, there is the concept of the "facial fold line". Why do Westerners seem to have a more three - dimensional face? Because their facial fold lines are clear. The position of this fold line is: draw a vertical line upward from the outer side of the eyebrow peak, extend it upward to the temporal fossa, and downward through the zygomatic arch. This fold line divides the face into two regions: the anterior face and the lateral face, and the tissue structures and aging mechanisms of the two regions are completely different.
The anterior face is also the area where facial expressions are concentrated. Daily expressions such as laughing and crying mainly rely on this area. The soft tissue and fat layer in the anterior face area are relatively thick, and the core aging feature is the gravitational sagging of fat.
The lateral face is also a functional area. For example, our masseter muscle is located in the lateral face. The tissue in this area is relatively thin, and aging is mainly manifested as the relaxation of the skin and fascia system.
The second important objective indicator is the "facial contour line". The famous anatomist Mendelson discovered that there is a clear ligament connection line on the face. The upper part of this line coincides with the facial fold line we mentioned, and the lower part extends forward to the anterior edge of the mandibular ligament. This ligament line is the benchmark for dividing the "inner and outer facial contour lines".
As people age, the inner contour area of the face will become flat or even sunken. The lateral canthus (the outer corner of the eye) is just located at the edge of the line. This change is because the fat on the face sags and loses, causing the originally plump curve to become a straight line.
Therefore, one of the treatment goals of rejuvenation is to restore the inner contour line from a "straight line" to a plump, upward and forward - protruding "curve" through volume supplementation and repositioning.
For the outer contour, the standard for rejuvenation is the opposite: it is to change from a curve back to a straight line. The outer contour mainly refers to the area from in front of the ear to the mandibular margin. When we often say that "the mandibular margin is not clear", it is essentially a problem with the outer contour.
There are two reasons for the wavy curve of the outer contour: one is the extrusion and accumulation caused by the sagging of the anterior facial fat, and the other is the local accumulation caused by the relaxation of the lateral skin and fascia.
Therefore, the treatment goal for the outer contour is to repair the "wavy curve" formed by relaxation and sagging into a firm "straight line". This is the relatively objective evaluation system for "facial rejuvenation" that I have proposed. Medical aesthetics repair for rejuvenation can be summarized as: changing the inner contour line from straight to curved and changing the outer contour line from curved to straight.
The development trend of medical aesthetics biological materials
36Kr: It's like providing a "measurement standard" for medical aesthetics. But in actual operation, when users choose hyaluronic acid for facial filling and rejuvenation repair, they are particularly worried about some side effects, such as "moon - face" and displacement. Do you think it is caused by the injection material or improper operation?
Zhang Yuguang: At present, among various fillers, I think hyaluronic acid has unique advantages. First, it is part of our own tissue, with high safety, and there is abundant data from clinical trials and real - world studies. Second, it is effective. After hyaluronic acid injection, immediate results can be obtained. Third, the injection results are predictable. Fourth, the results are reversible. If you are not satisfied with the results, you can dissolve the filler with hyaluronidase.
Problems such as the "moon - face" are not caused by the hyaluronic acid filler itself. The core reasons are improper operation, excessive injection, or the use of non - regular products.
In response to this situation, the logic of current repair treatments has also been further improved. In the past, doctors might simply take a "subtraction" approach, that is, pumping out or dissolving the filler. However, the actual results show that after simply removing the material, the patient's facial condition is still not ideal.
This involves an important mechanism at the cellular level called the "contact inhibition effect". In normal tissues, cells are closely adjacent to each other. This physical contact generates inhibitory signals to prevent excessive cell proliferation. But when a physical gap is left after pumping or dissolving the material, lymph fluid will accumulate in these cavities. Because cells lose the contact inhibition between each other, in order to fill the gap, they will start pathological proliferation.
This explains why after some people pump or dissolve the filler, the "moon - face" phenomenon is not only not solved, but rebounds more severely due to tissue hyperplasia or fluid accumulation.
Therefore, the current logic for treating the "moon - face" is: first pump out or dissolve the material, and then, through technical means, reposition the tissue to a youthful and firm state. Doing this, on the one hand, restores the natural contour of the patient's face in appearance, and on the other hand, physiologically closes the gap through compaction and repositioning, making the tissues fit closely together and allowing cells to regain "contact inhibition", thereby reducing later pathological hyperplasia.
36Kr: What is the reversibility of other biological materials that can be used for filling after injection?
Zhang Yuguang: The treatment of hyaluronic acid is relatively simple. It has a dissolving enzyme, and as a hydrophilic material, it can be effectively treated with suction and dissolution. However, the repair after injecting collagen stimulators (such as PLLA, PCL, etc.) is more challenging. Because this type of material achieves the filling effect by stimulating the growth of the body's own tissue. Once an excessive amount is injected, forming hard lumps or nodules, it is relatively difficult to deal with because it is highly compatible with the body's own tissue and does not have a specific dissolving enzyme like hyaluronic acid.
36Kr: Many experts have mentioned the combined use of collagen regeneration stimulators (such as PLLA) and hyaluronic acid. Is this the mainstream trend in the future?
Zhang Yuguang: Whether to choose combined use depends on the patient's expectations for the results. I usually ask patients: Are you expecting immediate results or long - term results?
If you are pursuing "immediate results" and hope to see a plump apple - cheek and a well - defined contour in a very short period of time (for example, you have an event tomorrow), then hyaluronic acid is the best choice. Because it has strong certainty - you can see the exact effect according to how much you inject. At the same time, it is reparable, and you can dissolve it if you are not satisfied.
If you are pursuing "long - term results", then you can choose collagen stimulators. This type of product takes 1 - 2 months or even longer to stimulate the growth of your own collagen. Of course, after injection, the amount of collagen growth will be affected by personal constitution (such as whether you are a scar - prone person and your own metabolic level), and there is a certain degree of uncertainty.
For patients who want both short - term results and long - term firmness and naturalness, my experience is to carry out "zoned treatment". Hyaluronic acid can be tried on the anterior face (the expression area), and collagen stimulators can be considered for use on the lateral face (the support area). Because the main goal of the lateral face is to achieve skin tightening and compaction, and the firming effect produced by collagen stimulators can be exerted.
36Kr: New concepts in the medical aesthetics market are emerging one after another. What suggestions do you have for consumers to avoid marketing traps?
Zhang Yuguang: I often tell patients that medical aesthetics fillers are different from cosmetics. You can throw away cosmetics if they are not good, but once a filler enters the tissue, some are extremely difficult to correct.
Therefore, I have two suggestions: First, don't easily be a "guinea pig". As a doctor, when choosing products, I first choose products that are regular and strictly used within the scope of indications. I look at whether the product has at least 10 years of clinical retrospective research. Only products that have been verified by long - term and large - scale clinical trials and have guaranteed safety and stability can be used on patients' faces.
Second, choose the right doctor. It is recommended to find a professional doctor who has received regular medical education and whose advice is not solely based on sales performance. If a doctor's advice is based on performance considerations rather than medical needs, medical decisions are likely to be biased.
The final experience of medical aesthetics depends on three elements: product quality, the patient's aesthetic sense, and the doctor's skills and aesthetic sense. The product is the foundation. Brand products with complete clinical data determine the baseline of the experience, while the doctor's level determines the upper limit. Therefore, continuous doctor education (such as the training of Allergan Academy) is particularly important.
In addition, it is also crucial for consumers to improve their aesthetic awareness. Only on the premise of respecting the anatomical basis and pursuing personalized solutions can the unity of safety and beauty be truly achieved.