Treatment Approach Using Two Lasers

Moles are pigmented lesions that appear in the epidermis or dermis due to the excessive proliferation of melanin cells.

While they may appear as simple pigmentation to the naked eye, moles require customized treatment depending on their depth and location.

Erbium YAG laser is effective in precisely resurfacing the skin surface. This can help remove moles in the superficial epidermal layer while minimizing damage to surrounding tissue.

When removing moles on the face, reducing the risk of scarring can lead to more satisfactory results. Subsequently, the process of gently cauterizing the root of the mole with a CO2 laser can help remove melanin cells that may remain deep within, thereby reducing the possibility of mole recurrence. This is useful in preventing recurrent moles that appear again because root cells remain even after surface removal.

A finishing process using a CO2 laser can be considered, especially in situations such as:

- When the mole's surface is slightly raised or feels firm when pressed

- If you have a history of moles reappearing in the same area

- If diagnosed as a nevus located in the deep dermal layer (e.g., blue nevus, grayish-brown nevus, etc.)

Flat warts are skin conditions caused by human papillomavirus (HPV) infection. They typically spread widely in the epidermal layer and are usually observed as thin, flat, small brownish or flesh-colored lesions. They are particularly prone to appearing when immunity is weakened and can spread through self-contact, such as touching, making prompt management crucial.

Erbium YAG laser is effective in uniformly removing the epidermal layer, making it suitable for widely spread flat wart lesions

to be cleanly removed. It offers the advantage of evenly eliminating lesions while minimizing damage to surrounding skin. However, viral lesions may recur if only the surface is removed, so caution is needed. In such cases, a finishing step that applies thermal stimulation around the lesion with a CO2 laser can be a clinically significant approach to reduce recurrence rates by additionally cauterizing virus-infected cells that may remain in the epidermal layer and surrounding tissues.

A CO2 laser finish may be deemed necessary, especially in situations such as:

- When the lesion's borders are indistinct or feel flat and spread out when touched. Individuals with weakened immunity (e.g., due to stress, lack of sleep, etc.)

- If there is a history of multiple recurrences

- If the lesion occurs in areas prone to frequent contact or easy spreading, such as the hands or face

Milia are skin blemishes that appear as small, white, pocket-like formations due to the accumulation of keratin (a type of skin protein) beneath the skin. They typically occur around the eyes, on the cheeks, and forehead, and are benign lesions unrelated to infection or inflammation.

Erbium YAG laser can be usefully employed for milia removal. It delicately resurfaces the skin, opening the thin epidermal layer above the milium and helping to discharge the trapped keratin. Subsequently, a gentle cauterization finishing process with a CO2 laser can reduce the likelihood of residual keratin cells proliferating and help prevent the recurrent appearance of milia in the same area. However, precise intensity control is necessary, as excessive thermal stimulation can cause hyperpigmentation.

Situations where CO2 laser finishing can be particularly helpful include:

- When milia frequently recur in the same location

- If you have experienced lesions reappearing during the recovery process after treatment

- When desiring a more uniform skin condition at the point of recovery after removing multiple milia

Syringomas are benign skin lesions caused by the excessive proliferation of sweat gland (eccrine gland) tissue in the dermis. They typically appear as multiple small, round, palpable lesions under the eyes, on the cheeks, and forehead. They tend to have a genetic predisposition and are relatively common in women in their 20s and 30s.

Erbium YAG laser can thinly and precisely remove the skin surface, making it applicable for managing syringomas in sensitive areas like around the eyes. It offers the advantage of refining the skin surface, removing the upper part of the sweat gland lesion, and reducing the concern for scarring or pigmentation after recovery. Subsequently, by applying heat with a CO2 laser,

the finishing method that provides subtle stimulation to the deeper parts of the lesion helps to alleviate the activity of sweat glands within the dermis and

can clinically help prevent syringomas from recurring in the same area. However, due to the depth of the lesion, multiple treatment sessions may be required.

In the following cases, CO2 laser finishing can also be considered:

- When multiple syringomas are deeply formed under the eyes, on the cheeks, etc.

- If there is a history of syringomas reappearing even after multiple previous laser treatments

- When seeking to help prevent recurrence with a single treatment session

Skin tags are benign skin lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermis. They primarily occur in areas where the skin folds, such as the neck, armpits, under the breasts, and eyelids, appearing as small, skin-colored, raised bumps. They are usually painless but can become irritated due to friction. CO2 laser is commonly used for skin tag removal due to its excellent cutting and hemostatic effects, allowing for quick treatment of multiple lesions. However, for small and thin skin tags, an approach that first precisely ablates the lesion with an Erbium YAG laser and then finishes by cauterizing the base of the lesion with a CO2 laser can help manage the root tissue of the skin tag, thereby lowering the possibility of recurrence in that area. Thermal stimulation can contribute to inhibiting the regenerative environment by reducing the activity of fibrous cells and microvessels within the tissue.

Situations where CO2 laser finishing can also be considered include:

- When skin tags are located in areas with frequent friction, such as the neck or armpits

- If there is a history of skin tags reappearing in the same area after treatment

- When the root of the lesion appears deep and wide (a form where the skin remains thickened even after removal)

Thus, depending on the characteristics and depth of the skin lesion,

using a combination of two types of lasers

the 'dual laser approach'

can contribute to enhancing the precision and effectiveness of treatment.

After mole removal, how long should I keep the DuoDERM (healing patch) on?

Since mole removal is a procedure that removes the outer layer of the skin, minor damage to the skin will occur.

Therefore, it is very important to properly protect and manage the wound on the treated area.

Keeping the treated area moist, in particular, can help with faster recovery and reduce the likelihood of scar formation.

For this reason, we recommend applying Duoderm, a hydrocolloid dressing.

Duoderm helps keep the wound moist, aiding cell regeneration and slowing down scab formation, which can lower the risk of scarring.

It is recommended to apply Duoderm immediately after mole removal, change it every 3-5 days, and continue management for at least over 7 days.

The total management period we recommend is approximately 10 days.

If using Duoderm is difficult or an allergic reaction occurs, you should manage the area by frequently applying a regenerating cream or moisturizing gel to prevent dryness, meticulously applying SPF 50+ sunscreen, and avoiding touching the wound.

Post-mole removal care is an important process that goes beyond simple wound protection and determines the outcome of the procedure.

Insufficient care can lead to scarring, so continuous attention is needed even after the procedure.

We provide detailed explanations of post-procedure care methods to ensure our patients' quick and healthy recovery.

Who might need the procedure

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• 1. Individuals who have had skin concerns such as moles, age spots, milia, syringomas, or skin tags.
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• 2. Individuals who have had moles removed but experienced recurrence and discomfort.
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Procedure Steps

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• STEP 01. Self-cleansing
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• STEP 02. Apply Anesthetic Cream
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• STEP 03. Mole Removal Procedure
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Post-Procedure Precautions

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• ㆍAvoid direct contact with water on the treated area. (Washing your face is possible with Duoderm applied.)
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• ㆍDuring skin regeneration, please consistently change and apply the regenerative tape if possible. (Recommended for approximately 10 days.)
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• ㆍMoles may reappear in the treated area, and if necessary, a repeat procedure can be considered 4-6 weeks later.
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• ㆍDeep-rooted moles may require multiple procedures.
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• ㆍIt is best to avoid exposure to ultraviolet rays as much as possible. (Sunscreen use is essential, and it is recommended to apply it even over Duoderm.)
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