Kkeut Korean Medicine Clinic's Dual Laser Technique

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

While they may appear to be simple pigment lesions, the approach varies depending on the depth of the skin layer where the mole is located.

The Erbium-YAG laser is advantageous for precisely ablating shallow skin layers, allowing for minimal irritation to surrounding skin and natural results when removing shallow moles located in the epidermis.

This procedure reduces the risk of scarring and can lead to significant aesthetic improvement, especially when removing moles on the face. Subsequently, finishing the root of the mole with heat using a CO2 laser can help treat any remaining melanin cells in deeper layers, reducing the likelihood of recurrence. This positively impacts lowering the risk of 'recurrent moles,' where only the surface is removed, and root cells remain, causing them to reappear.

Especially in the following situations, CO2 laser finishing can be considered:

- If the mole is slightly raised or feels thick to the touch

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

- If diagnosed as a deep dermal nevus that appears blue or greyish-brown

Flat warts are viral skin diseases caused by human papillomavirus (HPV) infection. They appear as small, thin, flat, brownish or flesh-colored lesions that spread widely in the epidermis. They tend to occur when immunity is low and can spread to other parts of the body, so early professional treatment is recommended.

The Erbium-YAG laser is suitable for uniformly ablating the epidermal layer and can be used to treat widely spread flat warts in a single session.

This method can remove lesions evenly while minimizing skin damage. However, due to the nature of viral diseases, removing only the superficial lesions may lead to recurrence. In such cases, a finishing process involving thermal stimulation of the perilesional area with a CO2 laser can help further treat virus-infected cells that may remain in the epidermis and its surroundings, thereby lowering the recurrence rate.

CO2 laser finishing is considered particularly important in the following cases:

- If the lesion's border is unclear, or it feels widely spread to the touch, or if there is concern about weakened immunity (e.g., stress, lack of sleep)

- If there is a history of multiple flat wart recurrences

- If lesions are located on frequently touched areas like hands, face, or areas prone to spreading to other parts of the body

Milia are small, white cystic lesions formed when keratin, a horny protein, gets trapped within the skin. They primarily occur around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are a cosmetic issue unrelated to infection or inflammation.

The Erbium-YAG laser can be usefully employed for milia removal. It precisely ablates the skin surface, removing the thin epidermal layer of the milium and creating a pathway for the trapped keratin to be safely expelled. Lightly finishing with a CO2 laser after the procedure can help reduce the possibility of regrowth of any remaining keratinocytes and prevent milia from reappearing in the same area. However, delicate intensity control is necessary as excessive thermal damage to the skin can lead to post-inflammatory hyperpigmentation.

CO2 laser finishing is particularly recommended in the following cases:

- If milia repeatedly occur in the same location

- If there has been a history of lesions reappearing during the recovery process after treatment

- If a smooth skin texture is desired during the recovery process after removing multiple milia

Syringomas are benign skin lesions caused by the excessive proliferation of sweat glands (eccrine glands) in the dermis. They are characterized by multiple small, bead-like lesions appearing around the eyes, cheeks, and forehead. They are often genetic or commonly observed in women in their 20s and 30s.

The Erbium-YAG laser can precisely and delicately remove the epidermis, making it suitable for treating syringomas in sensitive areas like around the eyes.

It helps to refine the skin surface, remove the upper part of the sweat gland lesions, and offers a low risk of scarring or pigmentation during recovery, making it a viable option from an aesthetic perspective.

Subsequently, applying heat with a CO2 laser to create micro-stimulation in the deeper parts of the lesion is clinically significant in weakening the activity of dermal sweat glands and preventing syringomas from recurring in the same area. However, due to the depth of the lesions, multiple treatments may be required.

In the following cases, combining CO2 laser finishing can positively influence treatment outcomes:

- If numerous syringomas are relatively deeply embedded around the eyes or on the cheeks.

- If recurrence has been experienced despite multiple previous laser treatments.

- When aiming for maximum effort in preventing recurrence with a single treatment.

Skin tags are benign lesions caused by an excessive proliferation of fibrous tissue and blood vessels in the dermis. They typically appear in skin folds such as the neck, armpits, under the breasts, and eyelids, observed as small, skin-colored protrusions. They are painless but can be irritated by friction. Generally, the CO2 laser is more suitable for skin tag excision, as it allows for delicate excision and hemostasis, enabling relatively efficient removal of multiple lesions. However, for small and thin skin tags, precisely ablating the lesion with an Erbium-YAG laser followed by cauterizing the root of the lesion with a CO2 laser can help treat the deep tissue of the skin tag and reduce the likelihood of recurrence in that area. Thermal stimulation can help destroy fibrous cells and micro-vessels within the tissue, inhibiting regrowth.

Considering CO2 laser finishing is recommended in the following cases:

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

- If there is a history of skin tags recurring in the same area after removal.

- If the lesion's root is deep or wide (types that leave a thick skin mark even after removal).

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

using two lasers together,

the 'Dual Laser Technique' is

one of the important approaches that can contribute to enhancing the completeness of treatment.

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

A mole removal procedure is a process that makes subtle changes to the skin's surface, which may leave temporary irritation on the skin.

Therefore, properly protecting and managing the treated area after the procedure has a significant impact on recovery.

In particular, keeping the treated area moisturized helps with faster recovery and reduces the likelihood of scarring.

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

Duoderm helps cells regenerate well by keeping the wound area appropriately moist. Additionally, it delays the formation of scabs, which has the advantage of reducing the possibility of scarring.

It is recommended to apply Duoderm immediately after mole removal and consistently manage it for at least 7 days, changing it every 3 to 5 days.

The total management period can be considered approximately 10 days.

If Duoderm use is uncomfortable or causes an allergic reaction, you can prevent skin dryness by frequently applying a regenerating cream or moisturizing gel. Additionally, be sure to apply SPF 50+ sunscreen meticulously and avoid touching the treated area.

Post-mole removal care is not just about protecting the treated area; it's a crucial step that determines the final outcome.

Neglecting aftercare can lead to scarring, so it's important to continue to pay attention to the treated area even after the procedure.

Our medical staff provides detailed guidance on post-procedure care methods to help patients recover quickly and healthily.

We recommend this procedure to those who:

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• 1. Have experienced discomfort due to moles, lentigines, milia, syringomas, skin tags, etc.
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• 2. Are concerned about recurrence 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 Precautions

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• ㆍBe careful not to let water directly touch the treated area. (We recommend washing your face with Duoderm applied.)
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• ㆍIt is advisable to consistently replace and apply regenerative tape for about 10 days while the skin regenerates.
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• ㆍMoles may reappear in the area where they were removed. In this case, you can consider another procedure after about 2 to 3 months.
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• ㆍDeep-rooted moles may require multiple procedures.
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• ㆍMinimize sun exposure as much as possible. Sunscreen is essential, and applying it over Duoderm can also be helpful.
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