Clinically Relevant Manual One-Shot Learning Technique (MOST) to Personalize Fractional Carbon Dioxide Laser Treatment for Eyelid Scars

Abstract Background Hypertrophic and keloid eyelid scars cause functional and aesthetic problems. Traditional fractional carbon dioxide (CO2) laser treatments require multiple sessions and use uniform parameters regardless of scar characteristics, limiting their effectiveness for complex eyelid scars. Objectives In this study, the authors evaluate the efficacy and safety of the Manual One-shot Learning Technique (MOST) with fractional CO2 laser for personalized treatment of eyelid scars. Methods A retrospective study involved 154 patients with hypertrophic and keloid eyelid scars treated with the MOST fractional CO2 laser. Functional and aesthetic outcomes were assessed utilizing degree of incomplete eyelid closure, ectropion, and Vancouver Scar Scale (VSS). Patients were followed up for a total of 12 months to evaluate outcomes and monitor complications. Results The study included 154 patients (98 males, 56 females; mean age 32.6 ± 14.2 years). A single treatment session resulted in significant improvements, with a mean VSS score reduction of 2.75 ± 1.50 (P = .021), and 57.8% of patients achieving >75% scar clearance. After 1 to 3 treatment sessions, all patients showed significant functional and aesthetic improvements, with incomplete eyelid closure and ectropion significantly reduced (both P < .001), VSS scores decreased by 3.02 ± 1.76 (P < .001), and 90.9% of patients achieved >75% scar clearance. Complications included recurrence (10.4%), hypopigmentation (5.2%), and skin atrophy (5.2%). Conclusions The MOST laser technique significantly improves functional and aesthetic outcomes for eyelid scars with fewer treatment sessions. By personalizing treatment based on tissue response, this approach enhances efficiency while reducing both patient burden and resource use. Level of Evidence: 4 (Therapeutic)