Laser Removal of Protruding Skin Lesions such as Skin Tags, Milia, Seborrheic Keratosis, Warts, etc.

Strategic Utilization of Dual Laser Procedures

Moles are skin lesions that occur when melanin-producing cells abnormally proliferate in the epidermis or dermis.

Although they may appear to be simple pigmented lesions on the surface, customized treatment is required depending on their actual depth and location.

The Er:YAG laser is advantageous for precisely ablating the skin surface. This allows for the delicate removal of superficial moles in the epidermal layer without damaging surrounding skin.

This procedure reduces the risk of scarring, and significant aesthetic improvement can be expected, especially when removing moles on the face. Subsequently, the process of thermally treating the root portion of the mole with a CO2 laser can help lower the possibility of recurrence by addressing melanin cells that may remain deep within the skin. This helps reduce the risk of so-called 'recurrent moles,' which reappear when only the surface is removed, but the root remains.

CO2 laser finishing may be particularly considered in the following situations:

If the mole is slightly raised above the skin or feels thick to the touch.

If you have a history of a mole recurring in the same spot.

If it appears to be a nevus located deep in the dermal layer (e.g., blue moles, grayish-brown moles, etc.)

Flat warts are viral skin diseases caused by infection with the human papillomavirus (HPV). They primarily spread widely in the epidermal layer and often appear as small, thin, flat, brown or flesh-colored bumps visible to the naked eye. They are more likely to occur when immunity is low, and they can spread to other areas by touching or scratching them, so it is advisable to seek appropriate management early.

The Er:YAG laser helps to uniformly refine the epidermal layer. It can be used to treat widespread flat warts

in a single session. The aim is to evenly remove the lesions while minimizing the impact on surrounding skin. However, due to the nature of viral diseases, treating only the superficial lesions may leave a possibility of recurrence. In such cases, a finishing step of applying gentle thermal stimulation around the lesion with a CO2 laser can be a clinically significant approach to reduce the recurrence rate by additionally treating latent virus-infected cells in and around the epidermis.

CO2 laser finishing is especially carefully considered in the following situations:

When the lesion's borders are unclear or feel widely spread upon touch. When immunity is easily weakened (e.g., stress, lack of sleep, etc.)

When there is a history of flat warts recurring multiple times.

When the lesions are in areas frequently touched or easily spread, such as hands or face.

Milia are small, white, pocket-like lesions that form when keratin, a horny protein, becomes trapped within the skin. They typically appear around the eyes, on the cheeks, and forehead, and unlike sebaceous cysts, they are aesthetic concerns unrelated to inflammation or infection.

The Er:YAG laser can be effectively used for milia removal. It delicately refines the skin surface to remove the thin layer of skin covering the milia, creating a safe pathway for the trapped keratin to be released. The post-procedure finishing process, which involves gently applying heat with a CO2 laser, is expected to reduce the possibility of remaining keratinocytes re-proliferating and prevent milia from recurring in the same area. However, excessive thermal stimulation on the skin can cause hyperpigmentation, so precise intensity control is crucial.

Situations where CO2 laser finishing can be particularly useful include:

If milia repeatedly appear in the same location.

If you have a history of lesions reappearing during the recovery process after a previous treatment.

If you desire a more uniform skin condition during recovery after removing multiple milia.

Syringomas are benign skin lesions caused by the excessive proliferation of sweat gland (eccrine gland) tissue in the dermal layer of the skin. They typically appear as small, bead-like lesions in multiple numbers around the eyes, on the cheeks, and forehead. They can be influenced by genetics or are relatively common in women in their 20s and 30s.

The Er:YAG laser can precisely and thinly treat the epidermis, making it suitable for managing syringomas in delicate areas like around the eyes. This method involves refining the skin surface and removing the upper part of the sweat gland lesions. It can reduce the likelihood of scarring or hyperpigmentation during recovery, easing aesthetic concerns. Subsequently, utilizing heat with a CO2 laser,

the finishing step of applying subtle thermal stimulation to the deeper parts of the lesion is expected to help regulate the abnormal activity of sweat glands within the dermis.

It can clinically help prevent syringomas from recurring in the same area. However, as lesions are often deep, multiple treatment sessions may be required.

In the following situations, considering CO2 laser finishing together can positively influence treatment outcomes:

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

When lesions have recurred despite multiple previous laser treatments.

When aiming to aid recurrence prevention with a single treatment session.

Skin tags are benign skin lesions caused by an excessive growth of fibrous tissue and blood vessels in the dermal layer. They primarily occur in areas where the skin folds, such as the neck, armpits, under the breasts, and eyelids, and are observed as small, skin-colored, wart-like growths. They are usually painless but can become irritated by friction. CO2 lasers are commonly used for skin tag removal due to their excellent cutting and hemostatic capabilities, allowing for rapid treatment of multiple lesions. However, for smaller or thinner skin tags, a method of first delicately refining the lesion with an Er:YAG laser, followed by finishing the base of the lesion with a CO2 laser, can help manage the skin tag's root tissue. This can contribute to reducing the likelihood of recurrence in that area. Thermal energy affects fibrous cells and micro-vessels within the tissue, helping to regulate an abnormal regenerative environment.

Situations where considering CO2 laser finishing is advisable include:

When skin tags are located in areas prone to friction, such as the neck or armpits.

If you have a history of skin tags recurring in the same spot after previous removal.

If the root of the lesion is deep or wide, leaving a slightly raised mark on the skin even after removal.

Thus, tailored to the depth and characteristics of each lesion,

the use of two types of lasers together,

the 'Dual Laser Technique',

is an approach that helps enhance the completeness of the procedure.

How long should DuoDerm (hydrocolloid dressing) be kept on after mole removal?

A mole removal procedure involves minor irritation to the outer layer of the skin.

After the procedure, it is crucial to protect and manage the treated area well.

In particular, keeping the treated area moist helps with skin recovery and can reduce the possibility of scarring.

For this management, applying a hydrocolloid dressing like Duoderm is recommended.

Duoderm keeps the wound moist, aiding the growth of new skin, and delays the formation of unnecessary scabs, which can reduce the burden of scarring.

It is best to apply Duoderm immediately after mole removal, change it every 3-5 days, and keep it on for at least one week.

It is good to keep in mind a total management period of approximately 10 days.

If applying Duoderm is difficult or an allergic reaction occurs, you should frequently apply a regenerative cream or moisturizing gel to prevent the skin from drying out. Additionally, it is necessary to diligently apply sunscreen with an SPF of 50 or higher and manage the area without touching the wound.

Post-mole removal care goes beyond simply protecting the wound; it is a crucial step that determines the overall outcome of the procedure.

Neglecting aftercare can leave unwanted marks, so it's important to consistently pay attention even after the procedure.

We provide detailed guidance on aftercare methods to help patients recover healthily after the procedure.

Recommended for those who

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• 1. Have been concerned about moles, seborrheic keratoses (age spots), milia, syringomas, skin tags, etc.
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• 2. Have had moles reappear after removal
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Procedure Steps

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• STEP 01. Self-Cleansing
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• STEP 02. Apply Anesthetic Ointment
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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; it is recommended to wash your face with Duoderm applied.
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• ㆍDuring skin regeneration, consistently replace the regeneration band and keep it applied for about 10 days.
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• ㆍMoles may reappear on the treated area; in such cases, another procedure can be considered 4-6 weeks after the initial one.
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• ㆍMoles with deep roots may require multiple procedures as a single treatment might not be sufficient.
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• ㆍIt is best to avoid sun exposure as much as possible; always use sunscreen with a high SPF and it is recommended to apply it over the Duoderm as well.
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