The above image shows a case of CO₂ laser excision of a mole on the right side of the face performed by Dr. Chung King Lueh. At 6 months post‑operation, the scar is nearly invisible, with no depression. This highlights the effectiveness of precise depth control and meticulous suturing.
By contrast, the two images below depict patients who developed depressed scars after CO₂ laser mole removal on the face. These patients were treated by other practitioners, not Dr. Chung. Their outcomes emphasize the importance of surgical expertise and careful postoperative management in preventing scar depression.
上方圖片顯示的是由 鍾經略醫生 在患者右側面部進行 CO₂ 雷射痣切除的病例。術後 6 個月，疤痕幾乎不可見，且沒有凹陷，突顯了精準深度控制與細緻縫合的效果。
相較之下，下方兩張圖片顯示的是其他患者在面部接受 CO₂ 雷射痣切除後出現凹陷性疤痕的情況。這些患者並非鍾醫生的病例，而是由其他專家操作的結果。 這些案例強調了外科專業技術與嚴謹術後管理在預防凹陷性疤痕中的重要性。
Essay: Preventing Depressed Scars After CO₂ Laser Mole Removal
Introduction
CO₂ laser mole removal is widely used for its precision and ability to minimize collateral tissue damage. However, when the ablation extends into the dermis, there is a risk of leaving a depressed scar, particularly on the face where cosmetic outcomes are paramount. Preventing such scars requires careful planning, meticulous technique, and attentive postoperative care.
Surgical Technique
- Depth Control
- The laser should be used in a controlled ablative mode, vaporizing the mole layer by layer.
- Avoid excessive depth: over‑ablation can destroy dermal collagen and elastin, leading to tissue loss and depression.
- Ensure complete removal of the mole root to prevent recurrence, but balance this with preservation of surrounding dermis.
- Wound Closure
- For deeper defects, primary closure with fine sutures is recommended.
- Suturing reduces wound tension, promotes faster healing, and prevents collapse of the wound bed.
- In cosmetically sensitive areas, non‑absorbable fine sutures (e.g., 6‑0 nylon or Prolene) provide precise edge approximation.
- Hemostasis
- CO₂ laser’s coagulative effect minimizes bleeding, which helps maintain a clean wound bed and reduces inflammation that could impair healing.
Postoperative Care
- Suture Management
- Sutures should remain in place long enough to ensure stability, especially in high‑tension areas.
- Premature removal risks wound dehiscence and depressed scarring.
- Infection Prevention
- Oral antibiotics may be prescribed when wounds are deep or located in areas prone to contamination (e.g., near the mouth or ear).
- Proper wound hygiene is critical, as infection can destroy granulation tissue and lead to atrophic scars.
- Moist Wound Healing
- Application of protective ointments or dressings maintains a moist environment, promoting epithelialization and reducing scar depression.
- Sun Protection
- Post‑laser wounds are vulnerable to hyperpigmentation and poor scar remodeling if exposed to UV light.
- Strict sun avoidance and sunscreen use are essential during the healing phase.
Long‑Term Scar Management
- Scar Massage: Gentle massage after wound closure helps remodel collagen and flatten scars.
- Topical Agents: Silicone gel or sheets can reduce scar depression and improve cosmetic outcomes.
- Follow‑up: Regular monitoring ensures early intervention if scar depression or hypertrophy develops.
Conclusion
Preventing depressed scars after CO₂ laser mole removal requires a combination of precise depth control, appropriate suturing, meticulous wound care, and long‑term scar management. When executed with expertise, the result can be an almost invisible scar, even months after surgery, preserving both facial aesthetics and patient confidence.
論文：如何在 CO₂ 雷射痣切除後預防面部凹陷性疤痕
引言
CO₂ 雷射痣切除因其精準度高、對周邊組織損傷小而廣泛應用。然而，當汽化深入真皮層時，可能導致組織缺損並形成凹陷性疤痕。由於面部美容要求極高，預防此類疤痕至關重要。
手術技術
- 深度控制
- 雷射應以控制的汽化模式逐層去除痣。
- 避免過度汽化：過深會破壞真皮膠原與彈性纖維，造成組織缺失與凹陷。
- 同時需完整去除痣根，以防復發。
- 傷口縫合
- 對於較深的缺損，建議進行 一期縫合。
- 縫合可減少張力、加速癒合，並防止傷口床塌陷。
- 在美容敏感區域，宜使用細緻不可吸收縫線（如 6‑0 尼龍或 Prolene）以確保精準對合。
- 止血
- CO₂ 雷射的熱凝固作用可減少術中出血，保持乾淨的傷口床並降低炎症。
術後護理
- 縫線管理
- 縫線需保留足夠時間以確保傷口穩定，尤其在高張力區域。
- 過早拆線可能導致傷口裂開與凹陷性疤痕。
- 感染預防
- 對於深部或靠近口腔、耳部的傷口，可考慮口服抗生素。
- 嚴格的傷口清潔可避免肉芽組織破壞與萎縮性疤痕。
- 濕性癒合
- 使用保護性藥膏或敷料保持濕潤環境，促進上皮化並減少疤痕凹陷。
- 防曬
- 雷射術後傷口易受紫外線影響，導致色素沉著與疤痕不良。
- 嚴格防曬與使用防曬產品是癒合期的重要措施。
長期疤痕管理
- 疤痕按摩：拆線後進行輕柔按摩，有助於膠原重塑與疤痕平整。
- 外用製劑：矽膠凝膠或貼片可減少疤痕凹陷並改善美容效果。
- 隨訪：定期追蹤，及早處理可能出現的疤痕問題。
結論
預防 CO₂ 雷射痣切除後的凹陷性疤痕，需要結合 精準的深度控制、適當的縫合、嚴謹的術後護理與長期疤痕管理。若執行得當，即使在面部這樣的高美容需求區域，也能獲得幾乎不可見的疤痕，維持良好的外觀與患者自信。