68歲女性左邊臉皮膚長了一粒疣，不痕不痛，生長速度快，不須半年就已經長到這個大小。

近鏡觀察此病毒疣。

以二氧化碳激光去除此病毒疣。傷口沒有流血。

手術後5個月覆診。

手術傷口癒合良好，疤痕並不明顯。連部分多餘，不雅的微絲血管也順便被一起除去。由於手術效果良好，患者今次要求以激光脫除左邊眼角的墨痣。白色的藥膏為麻醉膏。

Medical Essay: CO2 laser removal of a wart on left cheek

Nature of a Wart

• Warts are benign skin growths caused by human papillomavirus (HPV) infection.
• They appear as rough, raised lesions, often on exposed areas like the face.
• Although benign, they can grow quickly, spread, and cause cosmetic concerns.

Why Removal Is Necessary

• Cosmetic reasons: Facial warts are conspicuous and may affect confidence.
• Rapid growth: Some warts enlarge quickly, becoming more difficult to treat later.
• Risk of spread: HPV can spread to nearby skin or other individuals.
• Secondary issues: Warts may ulcerate, bleed, or become irritated.

Steps of CO₂ Laser Wart Removal

1

Clinical Assessment

Evaluate the wart’s size, depth, and location before treatment.

• Confirm diagnosis (exclude other lesions)
• Assess vascularity and proximity to sensitive structures
• Apply topical anesthetic cream

2

Laser Setup

Prepare CO₂ laser with appropriate parameters.

• Wavelength: 10,600 nm
• Mode: Ultra-pulsed used to minimalise collateral damage
• Power: typically 2–5 W for facial lesions
• Spot size: 0.2–0.5 mm for precision

3

Laser Vaporization

Target the wart tissue with controlled ablation.

• Focus beam directly on wart surface
• Vaporize layer by layer until lesion is removed
• Avoid excessive thermal damage to surrounding skin

4

Immediate Wound Appearance

Post-laser wound appears as a shallow, whitish crater.

• Minimal bleeding due to coagulative effect
• Surrounding skin intact
• No suturing required

5

Postoperative Wound Care

Ensure optimal healing and minimal scar formation.

• Keep wound clean and dry
• Apply antibiotic ointment daily
• Avoid water contamination (face washing, showering)
• Use sterile dressings if needed
• Limit facial expressions to reduce tension
• Schedule follow-up visits for monitoring

6

Scar Prevention

Implement measures to minimize scar visibility.

• Strict wound care to prevent infection
• Use silicone gel or sheets after epithelialization
• Protect area from sun exposure with sunscreen

Conclusion

Laser removal of facial viral warts with CO₂ technology offers precise ablation, minimal bleeding, and excellent cosmetic outcomes. The key to success lies not only in the laser parameters but also in meticulous wound management—preventing infection, controlling tension, and implementing scar-prevention strategies. With proper care, even deep wounds in cosmetically sensitive areas can heal with almost no noticeable scar.

醫學專題文章：激光脫除面頰病毒疣

疣的本質

疣的本質 疣是由人類乳頭瘤病毒（HPV）感染引起的良性皮膚增生。 它通常表現為粗糙、隆起的皮膚病灶，常見於面部等暴露部位。 雖然屬於良性，但疣可快速增長、擴散，並造成美容上的困擾。

為什麼需要去除疣

• 美容原因：面部疣十分顯眼，可能影響自信心。
• 快速增長：部分疣會迅速變大，日後更難處理。
• 擴散風險：HPV 可傳播至鄰近皮膚或其他人。
• 次要問題：疣可能潰瘍、出血或受到刺激。

CO₂ 激光去除疣的步驟

1. 臨床評估

• 在治療前評估疣的大小、深度與位置。
• 確認診斷（排除其他病灶）。
• 評估血管分布及與敏感結構的距離。
• 塗抹局部麻醉藥膏。

2. 激光設定

• 準備 CO₂ 激光並設定適當參數：
  • 波長：10,600 nm
  • 模式：超脈衝模式，減少周邊組織損傷
  • 功率：面部病灶通常 2–5 W
  • 光斑大小：0.2–0.5 mm，以確保精準

3. 激光氣化

• 將激光聚焦於疣表面，逐層汽化病灶組織。
• 直至病灶完全去除。
• 避免過度熱損傷周邊皮膚。

4. 即時傷口外觀

• 激光後傷口呈淺表、白色凹陷。
• 因凝固作用，出血極少。
• 周邊皮膚保持完整。
• 無需縫合。

5. 術後傷口護理

• 保持傷口清潔乾燥，確保最佳癒合並減少疤痕。
• 每日塗抹抗生素藥膏。
• 避免水污染（洗臉、刷牙、淋浴）。
• 必要時使用無菌敷料。
• 減少面部表情活動，降低張力。
• 定期覆診以監測癒合。

6. 疤痕預防

• 嚴格傷口護理以防感染。
• 上皮化後可使用矽膠凝膠或貼片。
• 使用防曬霜保護患處，避免色素沉著。

結論

利用 CO₂ 激光去除面部病毒性疣，能夠精準汽化病灶，出血少，美容效果佳。成功的關鍵不僅在於激光參數，更在於嚴謹的傷口管理——防止感染、控制張力、採取疤痕預防措施。只要護理得當，即使是深層傷口，在面部這樣敏感的部位也能安全癒合，幾乎不留明顯疤痕。