Case Presentation
This is a 35‑year‑old woman with two moles on her left upper eyelid, present for over 20 years. Both lesions are light brown in color and raised above the skin surface. One measures 0.4 cm in diameter, and the other 0.2 cm. Clinically, both are benign. The patient requested removal for cosmetic reasons.
CO₂ laser ablation was performed to vaporize the mole tissue together with their roots, ensuring no recurrence.
Precise control of ablation depth was paramount. If the wound is too shallow and the root is not completely removed, recurrence may occur, yet scarring will still be present and unsightly, as a wound is inevitable after each CO₂ laser treatment.
Conversely, if the wound is too deep and excessive normal tissue is removed, unnecessary scarring will form.
In this case, the depth was controlled with great accuracy: the roots were completely eliminated, there was no relapse, and scarring was minimal.
Such precision can only be achieved through extensive experience—hundreds of similar cases—rather than from dermatology textbooks or online videos presented by self‑proclaimed “experts.”
The postoperative photograph, taken six months after laser surgery, shows the scar to be almost invisible, with an excellent cosmetic outcome.
病例報告
這是一位 35 歲女性，左上眼瞼有兩顆痣，已存在超過 20 年。兩顆痣均呈淺棕色，並高於皮膚表面。其中一顆直徑 0.4 公分，另一顆直徑 0.2 公分。臨床判斷均為良性。患者因美容原因要求去除。
手術採用 CO₂ 雷射汽化切除，將痣組織及其根部完全去除，以確保不復發。
精準控制汽化深度至關重要。如果傷口過淺而根部未完全去除，可能會復發，同時仍會留下不美觀的疤痕，因為每次 CO₂ 雷射治療後都必然會有傷口。相反地，如果傷口過深並切除過多正常組織，則會造成不必要的疤痕。
在本病例中，汽化深度控制得極為精確：痣的根部完全去除，沒有復發，疤痕也極小。
如此精準的技術只能透過大量臨床經驗——數百個類似病例的累積——才能達成，而非從皮膚科教科書或某些自稱「專家」的 YouTube 影片中學到。
術後六個月拍攝的照片顯示，疤痕幾乎不可見，美容效果極佳。
Clinical Essay: Challenges in CO₂ Laser Ablation of a Mole on the Upper Eyelid
Introduction
The upper eyelid is one of the most delicate and cosmetically sensitive regions of the face. Removing a mole in this area with CO₂ laser ablation requires exceptional precision and clinical judgment.
Challenges
- Anatomical Sensitivity
- The eyelid skin is the thinnest on the body.
- Even small wounds can cause noticeable contour changes or scarring.
- The proximity to eyelashes and the ocular surface increases the risk of irritation or damage.
- Functional Mobility
- The eyelid is in constant motion during blinking and facial expression.
- Dynamic tension can stretch wounds, delay healing, and increase scar visibility.
- Suturing decisions are complex: while closure may stabilize deeper wounds, it can also distort eyelid contour or impair lash alignment.
- But if the wound is not sutured, it may take a very long time (few weeks to few months) to heal and result in an unsightly scar.
- Circulation and Healing
- Eyelid tissue is very vascular compared to other facial regions.
- Bleeding is commonly seen even a lesion is not over-ablated.
- Risk of Contamination
- Tears, sebum, and cosmetic products can contaminate the wound.
- Patients must be educated to avoid eye rubbing, makeup application, or excessive cleansing during recovery.
- Patient Education and Compliance
- Teaching patients how to protect the wound from daily habits (e.g., rubbing eyes, applying creams, removing makeup) is challenging.
- Patient motivation and compliance are sometimes difficult to achieve, yet they remain critical for optimal healing.
- Physicians must emphasize the importance of meticulous hygiene and avoidance of mechanical stress.
- Cosmetic Visibility
- The eyelid is highly visible.
- Even subtle scars can be conspicuous, making cosmetic outcomes particularly demanding.
Conclusion
Laser ablation of a mole on the upper eyelid is technically demanding due to anatomical delicacy, functional mobility, limited circulation, contamination risks, and cosmetic visibility. Achieving optimal results requires precise depth control, careful wound management, and thorough patient education. Ultimately, surgical experience and judgment are the decisive factors in minimizing scarring and ensuring satisfactory cosmetic outcomes in this high‑risk region.
臨床論文：上眼瞼痣 CO₂ 雷射汽化去除的挑戰
引言
上眼瞼是臉部最為精細且美容敏感的區域之一。在此部位進行痣的 CO₂ 雷射去除，需要極高的精準度與臨床判斷力。
挑戰
解剖學敏感性
- 眼瞼皮膚是全身最薄的皮膚。
- 即使是小傷口也可能造成明顯的輪廓改變或疤痕。
- 靠近睫毛與眼球表面，增加了刺激或損傷的風險。
功能性活動度
- 眼瞼在眨眼與面部表情時持續運動。
- 動態張力可能牽拉傷口、延遲癒合並增加疤痕顯著度。
- 縫合的決策十分複雜：縫合雖可穩定較深的傷口，但也可能造成眼瞼輪廓變形或影響睫毛排列。
- 若不縫合，傷口可能需要數週甚至數月才能癒合，並可能留下不美觀的疤痕。
循環與癒合
- 與其他面部區域相比，眼瞼組織血管極為豐富。
- 即使病灶並未過度汽化，術中也常見出血。
污染風險
- 淚液、皮脂及化妝品均可能污染傷口。
- 必須教育患者在恢復期避免揉眼、化妝或過度清潔。
患者教育與依從性
- 教導患者如何避免日常習慣（如揉眼、塗抹乳霜、卸妝）對傷口造成影響十分困難。
- 患者的動機與依從性有時難以獲得，但卻是最佳癒合的關鍵。
- 醫師必須強調保持嚴格衛生與避免機械性牽拉的重要性。
美容可見性
- 上眼瞼高度顯眼。
- 即使是極細微的疤痕也可能十分明顯，使美容效果的要求更高。
結論
上眼瞼痣的雷射汽化去除在技術上極具挑戰，原因包括解剖敏感性、功能活動度、血管豐富、污染風險及美容可見性。要獲得最佳效果，必須精準控制深度、謹慎處理傷口並加強患者教育。最終結果仍取決於醫師的臨床經驗與判斷，以最大程度減少疤痕並確保滿意的美容效果。