Case Report: CO₂ Laser Removal of Two Protruding Light‑Colored Moles on the Right Lower Face
Patient Profile
- Female, 35 years old
- Presented with two protruding but light‑colored skin moles located on the right lower face.
- Main concern: cosmetic appearance. No history of ulceration, bleeding, or rapid growth.
Clinical Features
- Both lesions were raised melanocytic nevi, lighter brown in color compared to typical pigmented moles.
- The bigger lesion was situated near the nasolabial fold, while the smaller one slightly lateral to it.
- Borders were smooth and well‑defined, consistent with benign morphology.
Procedure
- Excision performed by Dr. Chung King Lueh using a CO₂ laser.
- The laser was applied in a controlled ablative mode, vaporizing the lesions layer by layer until the roots were completely removed.
- Given the depth of the defects and the cosmetic sensitivity of the facial region, primary closure with fine sutures was carried out immediately after laser excision.
- Sutures were removed 2 weeks post‑operation once the wounds had stabilized.
Postoperative Course
- Healing was uneventful, with no infection or wound dehiscence.
- At 3 months post‑operation, the scars became less obvious, blending naturally with surrounding skin.
- No depressed scarring or contour irregularity was observed.
- Further improvement of the scars was expected in the following 6 months.
Discussion: This case demonstrates the effectiveness of combining CO₂ laser excision with meticulous suturing in achieving excellent cosmetic outcomes for protruding but lightly pigmented facial moles. The precision of the laser minimized collateral tissue damage, while suturing ensured proper wound edge approximation and prevented depressed scarring.
Conclusion: CO₂ laser excision, when performed with careful depth control and followed by fine suturing, can yield outstanding cosmetic results in facial mole removal. This underscores the importance of surgical expertise and postoperative care in aesthetic dermatology. In this patient, the outcome at 3 months was good, with further improvement expected over the following 6 months
病例報告：CO₂ 雷射切除右下臉兩顆突起但顏色較淺的痣
患者資料
- 女性，35 歲
- 右下臉有兩顆突起但顏色較淺的皮膚痣。
- 主要訴求：美容外觀。無潰瘍、出血或快速增大的病史。
臨床特徵
- 兩顆病灶均為突起性黑色素痣，顏色較淺棕色，與典型色素痣相比更淡。
- 較大的病灶位於鼻唇溝附近，較小的病灶位於其外側。
- 邊界光滑清晰，符合良性形態。
手術過程
- 由 鍾經略醫生以 CO₂ 雷射進行切除。
- 雷射以控制性的汽化模式逐層去除病灶，直至 連同根部完全清除。
- 由於缺損深度及面部美容敏感性，術後立即以細緻縫線進行 一期縫合。
- 術後 2 週拆線，傷口已穩定癒合。
術後過程
- 癒合過程順利，無感染或傷口裂開。
- 術後 3 個月，疤痕逐漸淡化，與周圍皮膚自然融合。
- 無凹陷性疤痕或局部輪廓不規則。
- 預期在接下來的 6 個月疤痕會進一步改善。
討論
此病例顯示，CO₂ 雷射切除結合精細縫合能在去除突起但顏色較淺的面部痣時，達到優異的美容效果。雷射的精準度減少了周邊組織損傷，而縫合則確保傷口邊緣良好對合，避免凹陷性疤痕。
結論
CO₂ 雷射切除若能精準控制深度並結合細緻縫合，可在面部痣切除中獲得卓越的美容結果。此病例術後 3 個月已呈現良好效果，並預期在接下來的 6 個月有進一步改善，凸顯了外科專業技術與術後護理在美容皮膚科中的重要性。
Topic for discussion: pros and cons of removing two facial moles at the same time versus staging the procedures six months apart:
Removing Two Moles at One Go
Pros
- ✅ Single recovery period: Patient undergoes healing once, saving time and reducing disruption to daily life.
- ✅ Cost‑effective: One procedure means fewer clinic visits, anesthesia sessions, and dressing changes.
- ✅ Symmetry of healing: Both sites heal simultaneously, so the cosmetic outcome is harmonized.
- ✅ Psychological relief: Patient achieves desired cosmetic improvement faster, without waiting months.
Cons
- ⚠️ Greater wound burden: Two wounds healing at once may increase discomfort, swelling, or risk of infection.
- ⚠️ Postoperative care complexity: More sutures and dressings to manage simultaneously.
- ⚠️ Risk of scarring overlap: If both scars heal poorly, the cosmetic impact is doubled.
- ⚠️ Patient anxiety: Some patients may feel overwhelmed by having multiple facial wounds at once.
Removing Moles One After Another (Separated by ~6 Months)
Pros
- ✅ Lower healing burden: Only one wound at a time, easier for patient to manage.
- ✅ Outcome assessment: The first scar’s healing can be evaluated before deciding on the second procedure.
- ✅ Reduced risk concentration: If one scar heals poorly, the other side can be approached differently.
- ✅ Patient reassurance: Staged approach may feel safer for cautious patients.
Cons
- ⚠️ Extended treatment timeline: Cosmetic improvement delayed; patient lives with one mole for longer.
- ⚠️ Repeated recovery periods: Two separate healing phases, doubling downtime and inconvenience.
- ⚠️ Higher cumulative cost: More clinic visits, anesthesia, and follow‑up appointments.
- ⚠️ Potential asymmetry: Healing times differ, so scars may not mature evenly.
Clinical Perspective
In the case performed by Dr. Chung King Lueh, both moles were excised in one session with CO₂ laser and suturing, and the scars were nearly invisible at 6 months. This demonstrates that simultaneous removal can be safe and cosmetically excellent when performed with precise technique and careful postoperative care.
However, for patients with anxiety about scarring, poor wound healing history, or medical comorbidities, a staged approach may be more prudent.
專題討論：同時切除兩顆面部痣與分期（間隔六個月）切除的利與弊
同時切除兩顆痣
優點
- ✅ 一次恢復期：患者只需經歷一次癒合過程，節省時間並減少生活干擾。
- ✅ 成本效益高：一次手術即可，減少診所就診次數、麻醉及換藥。
- ✅ 癒合對稱：兩處傷口同時癒合，美容效果更一致。
- ✅ 心理舒緩：患者能更快達到期望的美容改善，不必等待數月。
缺點
- ⚠️ 傷口負擔較大：同時有兩處傷口，可能增加不適、腫脹或感染風險。
- ⚠️ 術後護理較複雜：需要同時照顧更多縫線與敷料。
- ⚠️ 疤痕風險加倍：若兩處疤痕癒合不良，美容影響更明顯。
- ⚠️ 患者焦慮：部分患者可能因同時有多處面部傷口而感到壓力。
分期切除（間隔約 6 個月）
優點
- ✅ 癒合負擔較小：一次只需照顧一處傷口，護理更簡單。
- ✅ 效果可評估：可先觀察第一處疤痕癒合情況，再決定第二處手術。
- ✅ 降低集中風險：若第一處疤痕癒合不良，第二處可採取不同策略。
- ✅ 患者安心：分期方式對謹慎患者更有安全感。
缺點
- ⚠️ 治療時間延長：美容改善需更久，患者需忍受另一顆痣存在。
- ⚠️ 恢復期重複：需經歷兩次癒合期，增加不便。
- ⚠️ 累積成本較高：診所就診次數、麻醉及隨訪費用增加。
- ⚠️ 癒合不對稱：兩處疤痕成熟時間不同，可能造成外觀不一致。
臨床觀點
在 鍾經略醫生的病例中，兩顆痣於同一次手術中以 CO₂ 雷射切除並縫合，術後 6 個月疤痕幾乎不可見。這顯示若技術精準、術後護理得當，同時切除可安全且達到優異的美容效果。
然而，對於有疤痕焦慮、癒合不良病史或合併症的患者，分期切除可能更為合適。