Treatment Method Using Two Lasers

Moles are lesions that occur when melanin pigment cells excessively proliferate in the epidermal or dermal layers of the skin.

While they may appear as simple hyperpigmentation on the surface, the approach to treatment can vary depending on the location and depth of the mole.

The Erbium YAG laser is advantageous for precisely ablating the superficial layers of the skin. When removing shallow moles located in the epidermis, it can naturally shave off the lesion without burdening the surrounding skin.

This procedure reduces the likelihood of scarring and can yield cosmetically satisfactory results, making it particularly suitable for facial mole removal. Subsequently, the process of using a CO2 laser to thermally treat the base of the mole can help eliminate pigment cells that might remain deeper, thereby reducing the chance of the mole reappearing. This can help lower the possibility of so-called ‘recurrent moles’ that grow back even if the surface has disappeared but the root remains.

Especially in the following situations, considering the application of a finishing process using a CO2 laser can be beneficial:

- When the mole is slightly raised or feels thick above the skin upon touching

- If there is a history of the mole reappearing in the same area

- When the lesion is determined to be a nevus located in the deep dermis (e.g., blue nevus, brownish-gray nevus, etc.)

Flat warts are viral skin lesions caused by human papillomavirus (HPV) infection. They typically spread widely within the epidermal layer and appear to the naked eye as thin, flat, brownish or flesh-colored small lesions. They are especially prone to developing when immunity is weakened and can spread to other areas through self-contact, making early management crucial.

The Erbium YAG laser is suitable for uniformly ablating the epidermal layer, helping to manage widely distributed flat wart lesions

simultaneously. It is expected to uniformly eliminate lesions while minimizing damage to the skin. However, viral lesions may have a possibility of recurrence if only the superficial part is removed. In such cases, a finishing process using a CO2 laser to apply thermal energy around the lesion is a clinically viable treatment option to further remove virus-infected cells that may remain in the epidermis and its surroundings, thereby reducing the likelihood of recurrence.

Especially in the following cases, a finishing procedure using a CO2 laser may be considered even more important:

- When the border of the lesion is unclear or feels widely spread out upon touching

- Individuals with weakened immunity (e.g., due to stress, lack of sleep, etc.)

- If there is a history of the lesion recurring multiple times

- When the lesion occurs in areas with frequent contact or easy virus spread, such as hands or face

Milia are lesions that appear as small, white, pocket-like structures when keratin protein gets trapped within the skin. They commonly appear around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are a cosmetic concern unrelated to infection or inflammation.

The Erbium YAG laser is a useful method for removing milia. It precisely ablates the skin surface to open the thin outer layer of the milia, creating a pathway for the trapped keratin to be safely expelled. A light finishing process with a CO2 laser after the procedure can help reduce the possibility of remaining keratinocytes proliferating again, thereby preventing milia from repeatedly appearing in the same area. However, excessive heat stimulation to the skin can cause hyperpigmentation, so careful intensity control is important.

A finishing treatment using a CO2 laser may be particularly useful in the following cases:

- When milia repeatedly reappear in the same location

- If there is a history of lesions reappearing during the recovery period after treatment

- When desiring uniform improvement in skin texture during the recovery process after removing multiple milia

Syringomas are benign skin lesions caused by the excessive proliferation of sweat gland tissue in the dermis. They are typically characterized by multiple small, bead-like lesions appearing under the eyes, on the cheeks, and forehead. They are often influenced by genetics or commonly observed in women in their 20s and 30s.

The Erbium YAG laser can precisely and thinly remove the superficial layer of the skin, making it suitable for treating syringomas in sensitive areas like around the eyes. It refines the skin surface and removes the upper part of the sweat gland lesions, with less concern for scarring or pigmentation after recovery, leading to high cosmetic satisfaction. Subsequently, applying thermal energy through a CO2 laser

a finishing process that causes microscopic damage to the deeper parts of the lesion helps reduce the activity of sweat glands in the dermis,

and is a clinically viable method to prevent syringomas from reappearing in the same area. However, due to the deeply located nature of the lesions, multiple treatment sessions may be required.

In the following situations, applying CO2 laser finishing together can further enhance the treatment effect:

- When multiple syringomas are located relatively deep under the eyes or on the cheeks

- If there is a history of lesions reappearing despite receiving multiple laser treatments previously

- When aiming to minimize recurrence as much as possible with a single treatment

Skin tags are benign skin lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermis. They commonly occur in areas where the skin folds, such as the neck, armpits, under the breasts, and eyelids, appearing as small, skin-colored protrusions. They are usually painless but can become irritated due to friction. CO2 laser is generally well-suited for skin tag removal, quickly eliminating multiple lesions with excellent cutting and hemostatic effects. However, for small and thin skin tags, precisely shaving off the lesion with an Erbium YAG laser first, followed by a finishing cauterization of the lesion's base with a CO2 laser, can help remove the root tissue of the skin tag, thereby reducing the likelihood of recurrence in that area. Thermal stimulation can usefully inhibit regeneration by damaging fibroblasts and microvessels within the tissue.

The following situations particularly recommend incorporating a finishing process using a CO2 laser:

- 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 removal

- When the root of the lesion is deep or widely spread (e.g., types where a raised mark may remain even after treatment)

Thus, considering the depth and characteristics of the lesion,

the combined use of two types of lasers

the ‘Dual Laser Treatment’

is an important approach that can contribute to enhancing the completeness of the treatment.

Mole removal procedures involve gently scraping off the outer layer of the skin, which can cause physical irritation to the skin during the process.

Therefore, properly protecting and managing the treated area after the procedure is a crucial step for recovery.

Keeping the treated area from drying out is particularly helpful for faster recovery and reducing the likelihood of scar formation.

For this kind of care, we recommend using Duoderm, a hydrocolloid dressing.

Duoderm helps keep the wound area appropriately moist, aiding in the growth of new skin and suppressing unnecessary scab formation, which can reduce the risk of scarring.

It is recommended to apply Duoderm immediately after mole removal and replace it every 3-5 days, managing it for at least 7 days.

You can expect the total management period to be about 10 days.

If Duoderm causes discomfort or an allergic reaction, you should apply a regenerating cream or moisturizing gel frequently to prevent the skin from drying out. Additionally, it is important to meticulously apply sunscreen with an SPF of 50 or higher and avoid touching the treated area with your hands.

Post-mole removal care is more than just protecting the treated area; it is a crucial step that can influence the final outcome of skin recovery.

Neglecting aftercare can increase the likelihood of scar formation, so consistent attention after the procedure is recommended.

To help ensure fast and healthy skin recovery, our medical team provides detailed guidance on post-procedure care.

Who may be suitable for the procedure

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• 1. Those who have had skin concerns due to moles, seborrheic keratosis, milia, syringoma, skin tags, etc.
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• 2. Those who are considering re-treatment because moles have reappeared after a mole removal procedure.
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Procedure Steps

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• STEP 01. Personal Cleansing
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• STEP 02. Anesthetic Ointment Application
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• STEP 03. Mole Removal Procedure
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Post-Procedure Care Instructions

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• ㆍIt is recommended to be careful not to let water directly touch the treated area. (You can wash your face with Duoderm applied.)
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• ㆍWhile skin regeneration is taking place, we recommend consistently replacing and applying the regenerative tape for about 10 days.
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• ㆍThere is a possibility that moles may reappear on the treated area, and re-treatment can usually be considered after 4-6 weeks.
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• ㆍFor moles with deep roots or large sizes, it may be difficult to completely remove them in a single session, and multiple treatments may be required.
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• ㆍIt is best to avoid sun exposure to the treated area as much as possible. (Sunscreen is essential, and applying it over Duoderm is also recommended.)
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