​​​​​​​​​​​​​鍾經略醫生【皮膚科碩士 x 美容醫學碩士】課程研究​

​​​​地址 香港中環皇后大道中9號嘉軒廣場

電話 Tel  23630598（註 6 Note 6）

Address: the Galleria, No. 9 Queen's Road Central, Hong Kong

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第一幅圖（術前）：

病灶描述：於右側上唇皮膚黏膜處可見一約 3-4 mm 的乳白色、略呈半球狀隆起之結節性病灶。其表面光滑，邊界清晰，無潰瘍或出血現象。
臨床推測：此病灶外觀符合常見的良性表皮增生性病變，如皮脂腺增生 (sebaceous hyperplasia) 或小的皮膚纖維瘤 (dermatofibroma)。由於其位於美觀區且可能因摩擦而增大，故決定進行切除。

第二幅圖（術後即時）：

手術過程：採用二氧化碳激光 (CO2 laser) 進行精準切除，並以可吸收縫線 (absorbable suture) 閉合創口。
創口描述：病灶已完整移除，形成一圓形、深達真皮層的創面，底部可見鮮紅色肉芽組織及少量滲出液。周圍組織有輕微水腫及充血，為正常的術後急性炎症反應。創緣對合良好，無明顯張力。

第三幅圖（拆線後）：

傷口癒合狀態：於拆線後拍攝，顯示創口已完全上皮化，形成一條細緻、平坦的線狀疤痕。疤痕顏色與周圍正常皮膚接近，僅可見極輕微的色素沉著，整體美觀度佳。
功能與美觀評估：傷口癒合良好，無感染、裂開或肥厚性疤痕等併發症。上唇活動自如，未影響正常功能。此結果顯示手術切除與縫合技術得當，預期疤痕將隨時間進一步淡化。

Figure 1 (Preoperative):

Lesion Description:
A 3–4 mm, milky-white, slightly hemispherical, nodular lesion is observed at the mucous membrane of the right upper lip. The surface is smooth, with well-demarcated borders, and no ulceration or bleeding is present.

Clinical Impression:
The lesion’s appearance is consistent with common benign epidermal proliferative conditions, such as sebaceous hyperplasia or a small dermatofibroma. Given its location in a cosmetically sensitive area and the potential for enlargement due to mechanical irritation, surgical excision was elected.

Figure 2 (Immediate Postoperative):

Surgical Procedure:
The lesion was precisely excised using a carbon dioxide (CO₂) laser, and the wound was closed with absorbable sutures.

Wound Description:
The lesion has been completely removed, leaving a circular defect extending into the dermis. The wound bed reveals healthy, bright red granulation tissue with minimal serous exudate. Mild edema and erythema are present in the surrounding tissue—typical features of an acute postoperative inflammatory response. The wound edges are well approximated with no significant tension.

Figure 3 (Post-Suture Removal):

Wound Healing Status:
Photographed after suture removal, the wound demonstrates complete re-epithelialization, resulting in a fine, flat, linear scar. The scar color closely matches the adjacent normal skin, with only minimal residual hyperpigmentation. Overall cosmetic outcome is excellent.

Functional and Aesthetic Assessment:
Healing has progressed without complications such as infection, dehiscence, or hypertrophic scarring. Lip mobility remains fully intact, with no impairment of normal function. These findings indicate that both the surgical excision and closure technique were performed appropriately, and the scar is expected to continue fading with time.

Clinical Case Report: CO₂ Laser Ablation and Primary Closure of a Whitish Papule on the Upper Lip — Aesthetic and Functional Outcome

Patient Presentation and Lesion Description

The patient presented with a solitary, dome-shaped, whitish papule located on the vermilion border of the upper lip, adjacent to the philtrum. The lesion measured approximately 5 mm in diameter and exhibited a smooth, slightly translucent surface with a pearly hue, suggestive of either a fibrous papule, sebaceous hyperplasia, or a small benign keratotic growth. No signs of inflammation, ulceration, or pigmentary changes were noted. Given its prominent location and potential for cosmetic disfigurement, surgical removal was indicated.

Intervention: CO₂ Laser Ablation with Primary Closure

The lesion was excised using a high-precision pulsed CO₂ laser under local anesthesia. The laser was employed in a controlled ablative mode to vaporize the lesion layer by layer, ensuring complete removal while preserving surrounding healthy tissue. Due to the depth of the lesion extending into the dermis and its proximity to the mucocutaneous junction, a full-thickness defect resulted post-ablation.

In contrast to purely superficial lesions where sutureless healing is often sufficient, this case required primary closure with fine, non-absorbable sutures (6-0 Prolene) to achieve optimal wound edge approximation and minimize scar contracture in this highly mobile and cosmetically sensitive area. Notably, despite the depth of the wound, there was minimal intraoperative bleeding, attributable to the laser’s inherent hemostatic effect through thermal coagulation of microvasculature.

Postoperative Outcome (Suture Removal Day)

At the time of suture removal (typically 5–7 days postoperatively), the wound bed demonstrated robust granulation tissue formation with no signs of infection, dehiscence, or excessive exudate. Epithelialization was well underway, and the incision line was remarkably flat and linear, with only mild erythema along the suture tract. There was no evidence of hypertrophic scarring, atrophy, or contour deformity. The final aesthetic result was deemed excellent, with near-invisible scarring that blends seamlessly with the surrounding lip anatomy.

This outcome underscores the importance of combining precise laser ablation with meticulous surgical technique—particularly in areas of high mobility and aesthetic demand such as the lips.

Technical Considerations and Clinical Expertise

CO₂ laser ablation offers unparalleled precision for removing benign cutaneous lesions, particularly in facial regions. However, when lesions are deep or involve the dermis, especially in anatomically complex zones like the vermilion border, primary closure becomes essential to prevent unfavorable scarring from secondary intention healing.

The operator must balance aggressive ablation for complete lesion removal against conservative depth control to avoid damaging underlying structures such as the orbicularis oris muscle or sensory nerves. Experience is paramount in determining when to transition from laser ablation to traditional surgical closure, and in selecting appropriate suture material and technique for optimal functional and cosmetic outcomes.

Conclusion

This case illustrates the successful application of CO₂ laser ablation combined with primary suture closure for the removal of a whitish papule on the upper lip. Despite creating a deep wound, the procedure resulted in minimal scarring and rapid recovery, highlighting the value of integrating advanced laser technology with fundamental surgical principles. For lesions in high-mobility, high-aesthetic zones, this hybrid approach represents a gold standard in modern dermatologic surgery.

Prepared by Dr. Chung King-Lueh — (Dermatologic Surgery & Laser Therapy)

Disclaimer: All procedures performed in accordance with ethical guidelines and informed consent. Histopathological confirmation was recommended but declined by patient due to classic benign clinical presentation.