Kkeut Korean Medicine Clinic's Dual Laser Technique

Moles are lesions caused by an abnormal increase in melanin pigment in the epidermal or dermal layers of the skin.

Visually, they may appear as simple pigment spots, but the appropriate treatment method varies depending on the location and depth of the mole.

The Er:YAG laser excels at precisely ablating the skin's surface. This can help remove shallow moles in the epidermis without damaging surrounding tissue.

The Er:YAG laser can reduce the possibility of scarring and lead to aesthetic improvement, making it particularly useful for removing facial moles. Following this, treating the deeper parts of the mole with heat from a CO2 laser can remove melanin cells that may remain deep in the skin, reducing the likelihood of the mole recurring. This helps reduce the risk of 'recurrent moles,' which are moles that appear to be removed on the surface but regrow because root cells remain.

Specifically, in the following situations, combining a finishing treatment with a CO2 laser can be beneficial:

- When the mole is slightly raised or feels thick to the touch.

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

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

Flat warts are viral skin lesions caused by human papillomavirus (HPV) infection. They typically appear as widely spread lesions in the epidermal layer, looking like thin, flat, brown or skin-colored small lesions. They are especially common when immunity is weakened and can spread to other areas through self-contact, making early management important.

The Er:YAG laser helps to evenly ablate the epidermal layer. Therefore, it can be used to treat widely spread flat warts

all at once. It has the advantage of removing lesions evenly while minimizing skin burden. However, viral lesions carry a risk of recurrence if only the surface lesion is removed. In such cases, a finishing treatment that applies heat around the lesion with a CO2 laser can provide clinical assistance in reducing the possibility of recurrence by further eliminating virus-infected cells that may remain in the epidermis and its surroundings.

A CO2 laser finish can play a particularly important role in the following situations:

- When the lesion's border is unclear, or it feels widely spread when touched. For individuals with weakened immunity (due to stress, lack of sleep, etc.).

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

- When the lesion is located in frequently touched areas like hands or face, where it can easily spread.

Milia are lesions that appear as small white cysts due to the accumulation of keratin (a protein in the outer layer of skin) within the skin. They are typically found around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are benign lesions unrelated to infection or inflammation.

The Er:YAG laser is a useful method for removing milia. It precisely ablates the skin surface to carefully remove the thin layer of milia, creating a channel for the trapped keratin to be effectively discharged. Afterwards, a light finishing cauterization with a CO2 laser can help reduce the possibility of remaining keratin cells proliferating again and prevent milia from recurring in the same area. However, excessive heat stimulation on the skin can cause hyperpigmentation, so delicate intensity control is necessary.

Situations where a CO2 laser finish can be particularly helpful include:

- When milia repeatedly occur in the same location.

- If there is a history of the lesion reappearing during the recovery process after treatment.

- When aiming for a smooth and natural result during recovery after removing multiple milia.

Syringomas are benign skin lesions caused by excessive proliferation of sweat gland (eccrine gland) tissue in the dermal layer. They primarily appear under the eyes, on the cheeks, and forehead, characterized by multiple small, pearl-like lesions to the touch. 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 remove the skin surface, making it suitable for managing syringomas in sensitive areas like around the eyes. It refines the skin surface while removing the upper part of the sweat gland lesions, with less possibility of scarring or hyperpigmentation after recovery, offering aesthetic advantages. Subsequently, applying heat with a CO2 laser

as a finishing method that causes microscopic thermal damage to the deeper part of the lesion can reduce the activity of sweat glands in the dermis,

and can clinically contribute to preventing syringomas from re-proliferating in the same area. However, because the lesions are located deep, multiple treatment sessions may be required.

Situations where a CO2 laser finish can help improve the condition include:

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

- If there is a history of recurrence despite receiving multiple laser treatments.

- When seeking to achieve the maximum possible recurrence prevention effect with a single treatment.

Skin tags are benign lesions caused by 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 protrusions. They are painless but can be irritated by friction. Generally, a CO2 laser may be more suitable for skin tag removal. The CO2 laser has excellent cutting and hemostatic capabilities, allowing for rapid treatment of multiple lesions. However, for small and thin skin tags, precisely ablating the lesion first with an Er:YAG laser, and then finishing with CO2 laser cauterization of the lesion's base, can help remove the root tissue of the skin tag and contribute to reducing the likelihood of recurrence in that area. Such thermal stimulation can weaken fibrous cells and microvessels in the tissue, offering an advantage in suppressing the regrowth environment of the lesion.

Situations where a CO2 laser finish can be particularly helpful are as follows:

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

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

- When the lesion's root is deep or widely spread (types where a noticeable bump remains after removal).

Thus, by tailoring to the depth and characteristics of the lesion,

combining two laser methods,

the 'Dual Laser Technique'

can play a crucial role in enhancing the completeness of the procedure.

What is the recommended usage period for DuoDERM (sticker) after mole removal?

Mole removal procedures are performed by gently shaving off the surface of the skin, which temporarily applies physical stimulation to the skin.

Therefore, it is very important to properly protect and care for the treated area after the procedure.

Maintaining adequate moisture in the treated area can help accelerate skin recovery and reduce the likelihood of scarring.

For this, we recommend applying products like Duoderm, which is a type of hydrocolloid dressing.

Duoderm can help regenerate new cells by maintaining a moist environment, preventing the wound from drying out. This can help prevent scabs from forming and reduce the likelihood of scarring.

After mole removal, apply Duoderm and replace it every 3-5 days, continuing care for at least 7 days.

Generally, we recommend an total care period of about 10 days.

If you experience discomfort using Duoderm or an allergic reaction, it is important to frequently apply a regenerating cream or moisturizing gel to prevent dryness. Additionally, please apply SPF 50+ sunscreen thoroughly, and be careful not to touch the treated area directly.

Aftercare following mole removal is not just about protecting the wound; it's a process that significantly impacts the final outcome of the procedure.

Inadequate care may lead to unwanted scarring, so it's advisable to continue paying attention and exercising caution even after the procedure.

At our clinic, we provide detailed guidance on post-procedure care to help our patients recover quickly and healthily.

When the procedure is recommended

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• 1. It can be beneficial for those who have experienced discomfort due to moles, seborrheic keratoses (age spots), milia, syringomas, or skin tags.
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• 2. It can also be considered if you have had mole removal procedures before and they have recurred.
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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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• ㆍCare should be taken to avoid direct contact with water on the treated area. (Washing your face is possible with Duoderm attached.)
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• ㆍDuring the skin regeneration period, it is recommended to consistently replace and apply regenerative tape. (Approximately 10 days)
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• ㆍMoles may reappear in the areas where they were removed. If they recur, re-treatment can be considered after approximately 4-6 weeks.
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• ㆍMoles with deep roots are difficult to remove completely in a single session and may require multiple, repetitive treatments.
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• ㆍIt is important to avoid exposing the treated area to UV rays as much as possible. (Always use sunscreen, and we recommend applying it over Duoderm.)
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