Kkeuthan Clinic's Dual Laser Technique

*Moles are one of the skin lesions that appear when melanin cells proliferate excessively in the epidermis or dermis.

Unlike what appears on the surface, the method of mole removal can vary depending on its location and depth within the skin.

Erbium-YAG laser is effective for precisely ablating the skin surface, making it suitable for removing shallow moles in the epidermal layer without damaging surrounding tissue.

It can reduce scarring after treatment, leading to cosmetically favorable results, and is particularly used for facial mole removal. After removing shallow moles with an Erbium-YAG laser, the process continues with CO2 laser to thermally cauterize the base of the mole. This can help destroy melanin cells that may remain in deeper areas, reducing the likelihood of recurrent moles reappearing.

CO2 laser finishing can be considered in situations such as the following:

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

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

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

*Flat warts are viral skin lesions caused by human papillomavirus (HPV) infection. They spread within the epidermal layer and can appear as thin, widely spread brown or skin-colored small lesions. They are particularly common when immunity is weakened, and quick treatment is important due to the possibility of spreading to other areas through self-contact.

Erbium-YAG laser is useful for uniformly removing the epidermal layer and is effective for widely spread flat warts,

helping to clear them in one go. This procedure is designed to minimize skin damage and uniformly remove lesions. However, viral lesions carry a risk of recurrence if only the surface is removed. In such cases, the finishing process of applying thermal damage to the periphery of the lesion with a CO2 laser can have significant clinical importance in reducing the recurrence rate by additionally cauterizing virus-infected cells that may remain in the epidermis and its surroundings.

The CO2 laser finishing process may be particularly necessary in situations such as the following:

-If the lesion's border is not clear, or if it feels flat and spread out when touched (especially in individuals with weakened immunity, e.g., due to stress or lack of sleep)

-If there has been a history of multiple recurrences

-If the lesion is located in an area frequently touched, such as hands or face, where there is a risk of spreading

*Milia are lesions that occur when keratin (a type of skin protein) gets trapped beneath the skin, appearing as small, white cysts. They are primarily found around the eyes, on the cheeks, and forehead, and unlike sebaceous cysts, they are cosmetic concerns unrelated to infection or inflammation.

Erbium-YAG laser is a method that can be used for milia removal. It precisely ablates the skin surface, removing the thin epidermal layer of the milia and creating a path for the trapped keratin to be safely discharged. After removal, a light finishing cauterization with a CO2 laser can help lower the possibility of remaining keratinocytes re-proliferating, thereby preventing the recurrence of milia in the same area. However, excessive thermal damage to the skin can cause hyperpigmentation, so meticulous attention to treatment intensity adjustment is required.

Situations where CO2 laser finishing is particularly useful include the following:

-If milia repeatedly appear in the same area

-If there has been an experience where the lesion reappeared during the regeneration process after treatment

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

*Syringomas are benign skin lesions formed by the excessive proliferation of sweat glands (eccrine glands) in the dermal layer. They typically appear as multiple small, bead-like skin lesions, mainly under the eyes, on the cheeks, and forehead. They can be hereditary or commonly observed in women in their 20s and 30s.

Erbium-YAG laser can precisely and delicately remove the epidermis, making it suitable for treating syringomas in sensitive areas like around the eyes. It can refine the skin surface and remove the upper part of the sweat gland lesions, with less risk of scarring or pigmentation during recovery, leading to positive cosmetic results. Subsequently, CO2 laser applies thermal energy to

the finishing method of creating micro-damage in the deeper parts of the lesion can help weaken the activity of sweat glands within the dermis.

This has significant clinical importance in preventing the re-proliferation of syringomas in the same area. However, due to the depth of the lesions, repeated treatments may be necessary.

In the following cases, combining CO2 laser finishing can help further improve treatment results:

-If multiple syringomas are located in relatively deep areas such as under the eyes or on the cheeks

-If there has been a history of recurrence despite receiving multiple laser treatments previously

-If a better effect in preventing recurrence is desired with a single treatment

*Skin tags are benign lesions resulting from the overgrowth of fibrous tissue and blood vessels in the dermis. They typically occur in areas where skin folds, such as the neck, armpits, under the breasts, and eyelids, appearing as small, skin-colored protrusions. While painless, they can be irritated by friction. Generally, CO2 laser is highly effective for skin tag excision, advantageous for swiftly removing multiple lesions due to its cutting and hemostatic effects. However, for small and thin skin tags, a method of precisely ablating the lesion with an Erbium-YAG laser first, followed by CO2 laser cauterization of the lesion's base, can be considered. This method helps remove the root tissue of the skin tag, thereby contributing to lowering the likelihood of recurrence in that area. Thermal stimulation can destroy fibrous cells and microvessels within the tissue, inhibiting the regeneration environment.

Applying the CO2 laser finishing process together is particularly recommended in the following cases:

-If skin tags appear 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 excision

-If the root of the lesion is deep and widely spread (a shape where a thick mark may remain even after treatment)

Thus, considering the depth and characteristics of skin lesions,

combining two types of lasers

the 'Dual Laser Technique'

is an approach that helps increase treatment satisfaction.

After mole removal, how long should DuoDERM (sticker) be applied?

Mole removal procedures involve removing the outer layer of the skin, and this process can cause minor skin damage.

Therefore, protecting and managing the treated area well after the procedure significantly impacts recovery.

Specifically, keeping the wound area adequately moist can facilitate recovery and help reduce scarring.

At this time, we recommend managing it by applying a hydrocolloid bandage, such as DuoDERM.

DuoDERM maintains a moist environment around the wound, aiding in the regeneration of new cells. It prevents scab formation, which can reduce the likelihood of scarring.

It is recommended to apply DuoDERM immediately after the procedure and manage it for at least 7 days, replacing it every 3-5 days.

The overall management period is recommended to be approximately 10 days.

If using DuoDERM is uncomfortable or if an allergic reaction occurs, please apply a regenerative cream or moisturizing gel frequently to prevent skin dryness. Additionally, be sure to apply sunscreen with an SPF of 50 or higher thoroughly and avoid touching the wound area.

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

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

At our clinic, we provide detailed guidance on post-procedure care to ensure a quick and healthy recovery for our visitors.

Who May Need the Procedure

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• 1. Those who have experienced discomfort due to moles, seborrheic keratosis, milia, syringomas, or skin tags.
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• 2. Those 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 Precautions

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• ㆍIt is advisable to prevent water from directly contacting the treated area. (Washing your face with DuoDERM applied is recommended.)
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• ㆍConsistently replacing and applying the regeneration bandage during the skin regeneration period can aid recovery. (Approximately 10 days are recommended.)
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• ㆍThere is a possibility that moles may reappear in the treated area after the procedure, 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 in a single session, and multiple treatments may be required.
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• ㆍIt is important to avoid exposing the treated area to UV light as much as possible. Sunscreen is essential and we recommend applying it even over DuoDERM.
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