Kkeut Han Clinic's Dual Laser Treatment Method

*Moles are skin lesions that appear due to excessive proliferation of melanin cells in the epidermal or dermal layers.

Although they may appear as ordinary pigmented lesions, the treatment method varies depending on the depth and location of the mole.

Erbium-YAG laser is advantageous for precisely and superficially ablating the skin surface. This allows for the removal of shallow moles in the epidermal layer without putting stress on the surrounding skin.

This treatment is particularly suitable for removing facial moles, as it reduces the risk of scarring and can achieve cosmetic improvement. Subsequently, the step of thermally coagulating the root of the mole using a CO2 laser can help remove any remaining melanin cells deep down, thereby reducing the likelihood of the mole reappearing. This helps reduce the risk of 'recurrent moles' that are only superficially removed, leaving the root behind to grow back.

Especially in the following situations, a finishing process using a CO2 laser may be considered:

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

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

- If diagnosed as a dermal nevus located deep in the dermis (e.g., blue nevus, slate gray nevus, etc.)

*Flat warts are viral skin diseases caused by human papillomavirus (HPV) infection. They occur as widespread lesions in the epidermal layer and are visually observed as thin, flat, small, brownish or skin-colored lesions. They commonly occur when immunity is weakened and can spread through self-contact, making early treatment important.

Erbium-YAG laser is useful for uniformly ablating the epidermal layer. Therefore, it is effective for managing widespread flat wart lesions

at once. This treatment can help uniformly remove lesions while minimizing skin burden. However, due to the nature of viral lesions, there is a possibility of recurrence if only the visible parts are removed. In such cases, a finishing step using a CO2 laser to induce thermal damage around the lesion can be a clinically significant treatment to further remove virus-infected cells that may remain in the epidermal layer and surrounding areas, thereby lowering the possibility of recurrence.

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

- If the boundaries of the lesion are not clear, or if it feels flat and spread out when touched by hand

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

- If the lesion is located in areas prone to frequent contact or easy spread, such as hands or face

*Milia are small, white, cyst-like lesions formed when keratin, a horny protein, gets trapped under the skin. They commonly occur around the eyes, cheeks, and forehead. Unlike sebaceous cysts, they are an aesthetic issue not related to infection or inflammation.

Erbium-YAG laser is a very suitable treatment for removing milia. It micro-ablates the skin surface to remove the thin epidermal layer covering the milia and creates a safe channel for the trapped keratin to be discharged. The process of lightly coagulating with a CO2 laser afterwards can help reduce the possibility of residual keratinocytes proliferating again and prevent milia from repeatedly appearing in the same location. However, excessive thermal damage to the skin can lead to post-inflammatory hyperpigmentation, requiring delicate intensity control.

Situations where CO2 laser finishing can be particularly useful are:

- When milia repeatedly occur in the same location

- When there is a history of lesions reappearing during the recovery process after treatment

- When a more uniform skin condition is desired during the recovery process after removing multiple milia

*Syringomas are benign skin lesions caused by excessive proliferation of sweat gland tissue (eccrine glands) in the dermal layer. They typically appear as small, bead-like, multiple lesions, mainly under the eyes, on the cheeks, and on the forehead. They are often observed in individuals with a genetic background or relatively commonly in women in their 20s and 30s.

Erbium-YAG laser can thinly and delicately remove the epidermis, 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 a low risk of scarring or hyperpigmentation during recovery, leading to good cosmetic results. Subsequently, applying thermal energy with a CO2 laser

a finishing method that causes subtle thermal damage to the deeper parts of the lesion, can help weaken the activity of sweat gland tissue within the dermis,

and can be a clinically significant approach to prevent syringomas from reappearing in the same area. However, due to the depth of the lesions, multiple treatments may be required.

In the following situations, combining CO2 laser finishing can lead to improved treatment outcomes:

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

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

- When aiming for the maximum possible recurrence prevention effect with a single treatment

*Skin tags are benign skin lesions caused by excessive proliferation of dermal fibrous tissue and blood vessels. They primarily occur in skin folds such as the neck, armpits, under the breasts, and eyelids, appearing as small, skin-colored protrusions. They are not painful but can be irritated by friction. Usually, CO2 laser is more suitable for removing skin tags, as its excellent cutting and hemostatic effects allow for quick removal of multiple lesions. However, for small and thin skin tags, the Erbium-YAG laser can first precisely ablate the lesion, followed by a CO2 laser to superficially coagulate the base of the lesion. This method helps remove the root tissue of the skin tag and can reduce the likelihood of it reappearing in the same area. The thermal stimulation from the laser helps to damage fibrous cells and microvessels in the tissue, inhibiting the regeneration environment.

Situations where combining CO2 laser finishing is recommended are:

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

- When there is a history of skin tags reappearing in the same area after removal

- When the root of the lesion is deep and widespread (a type that leaves a slightly raised mark on the skin even after removal)

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

combining two laser treatments,

the 'Dual Laser Treatment Method',

can be an important approach to enhancing treatment satisfaction.

After mole removal, for how long should DuoDERM (healing patch) be applied?

Mole removal procedures involve a process that gently exfoliates the skin's surface, which can cause temporary physical irritation to the skin.

Therefore, properly protecting and caring for the treated area is of utmost importance.

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

For this care, we recommend attaching a hydrocolloid Duoderm dressing.

Duoderm helps maintain a moist environment for the treated area, promoting smooth cell regeneration and delaying scab formation, which can lower the risk of scarring.

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

The total care period is generally recommended to be around 10 days.

If using Duoderm is difficult or if a skin allergy occurs, you should frequently apply a regenerative cream or moisturizing gel to prevent the treated area from drying out. Additionally, it is important to carefully apply sunscreen with SPF 50 or higher and avoid touching the wound directly.

Post-mole removal care is not just about protecting the treated area; it is a process that significantly influences the final outcome.

Neglecting care can lead to scarring, so continuous attention is required even after the procedure.

We meticulously explain post-procedure care methods to help our patients recover comfortably.

We recommend this procedure for those who:

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• 1. Have experienced discomfort due to skin troubles such as moles, seborrheic keratosis, milia, syringomas, or skin tags.
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• 2. Have had moles reappear after previous mole removal procedures.
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Procedure Steps

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• STEP 01. Self-cleansing
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• STEP 02. Anesthetic cream application
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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. (Face washing is possible while Duoderm is attached)
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• ㆍDuring the skin regeneration period, it is recommended to consistently replace and apply regenerative tape for about 10 days.
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• ㆍMoles may reappear in the treated area, and re-treatment can be considered after 4-6 weeks if necessary.
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• ㆍIf a mole has deep roots, it may be difficult to remove completely with a single procedure, and additional treatments may be necessary.
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• ㆍIt is best to avoid sun exposure as much as possible, and sunscreen is essential. (Applying it over Duoderm is also recommended.)
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