Dual Laser Approach for Skin Lesions

Moles are skin changes caused by an excessive number of melanocytes in the epidermal or dermal layers.

Unlike their appearance on the surface, the appropriate removal method can vary depending on the mole's depth or its location within the skin.

The Er:YAG laser is suitable for precisely ablating the skin surface and is primarily used to remove shallow moles in the epidermal layer while minimizing damage to surrounding areas.

This procedure can reduce the risk of scarring, allowing for cosmetic improvements, including facial mole removal. After removing shallow moles with an Er:YAG laser, a process of thermally coagulating the base of the mole using a CO2 laser may follow. This can help treat melanocytes that may remain deep within the skin, thereby reducing the likelihood of the mole reappearing.

Particularly in the following cases, you might consider combining this with a finishing treatment using a CO2 laser:

- If the mole protrudes above the skin surface or feels raised when touched

- If you have a history of moles reappearing in the same area

- If it appears to be a nevus formed in the deep dermal layer, such as a blue mole or a grayish-brown mole

Flat warts are a viral skin condition caused by human papillomavirus (HPV) infection. They appear as widely spread lesions in the epidermal layer and can look like thin, flat, brown or flesh-colored small lesions. They are prone to occur when immunity is low, and can spread to other areas through self-contact, such as by touching them with hands, requiring management.

The Er:YAG laser is used to evenly remove the epidermal layer and can help

manage multiple lesions simultaneously. This procedure is designed to uniformly remove lesions while reducing the burden of skin damage. However, viral lesions may recur if only the surface is removed. In such cases, a finishing process involving thermal stimulation around the lesion with a CO2 laser can help further coagulate virus-infected cells that may remain in and around the epidermal layer, thereby reducing the recurrence rate.

In the following situations, a finishing treatment using a CO2 laser can be particularly useful:

- If the lesion's borders are indistinct, or it feels flat and spread out when touched (especially when immunity is low, e.g., due to stress or lack of sleep)

- If you have experienced multiple recurrences

- If the lesion is located in an area prone to frequent daily contact and potential spread, such as hands or face

Milia are small, white cysts formed by the accumulation of keratin (a type of skin protein) beneath the skin. They typically appear 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 treatment method that can be used for milia removal. It precisely ablates the skin surface to remove the thin epidermal layer covering the milia, allowing the trapped keratin inside to be expelled. Afterward, a gentle finishing coagulation with a CO2 laser can help reduce the possibility of residual keratinocytes regenerating, thereby preventing milia from reappearing in the same area. However, excessive heat damage can lead to hyperpigmentation, so careful attention must be paid to intensity control during the procedure.

A finishing treatment using a CO2 laser may be particularly recommended in the following cases:

- If milia repeatedly recur in the same area

- If you have experienced lesions reappearing during the recovery process after treatment

- If, after removing multiple milia, you desire a smoother skin texture during the recovery process

Syringomas are benign skin conditions caused by an excessive proliferation of sweat glands (eccrine glands) in the dermal layer. They are characterized by multiple small, millet-like lesions primarily appearing under the eyes, on the cheeks, and forehead. They can be genetically influenced or commonly found in women in their 20s and 30s.

The Er:YAG laser can precisely and delicately remove the epidermis, making it useful for managing syringomas in sensitive areas like around the eyes. It can be used to refine the skin surface and remove the upper part of the sweat gland lesions, and during the recovery process, it can reduce the risk of scarring or hyperpigmentation, leading to cosmetic improvement. Subsequently, applying thermal energy with a CO2 laser

a finishing method that delivers subtle stimulation to the deep tissue of the lesion can contribute to regulating the excessive activity of sweat glands within the dermal layer.

This can help reduce the reappearance of syringomas in the same area. However, if the lesions are deep, multiple treatment sessions may be required.

In the following cases, using a CO2 laser in conjunction can help enhance treatment satisfaction:

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

- If lesions reappeared despite repeated laser treatments in the past

- If you expect improved results in reducing recurrence with a single treatment

Skin tags are benign skin lesions caused by an excessive proliferation of fibrous tissue and blood vessels in the dermal layer. They typically occur in areas where skin folds, such as the neck, armpits, under the breasts, and eyelids, and often appear as small, skin-colored protrusions. They are usually painless but can become irritated due to friction. Generally, the CO2 laser is effective for excising skin tags, offering advantages in relatively quick removal of multiple lesions due to its cutting and hemostatic functions. However, for small and thin skin tags, one may consider first precisely ablating the lesion with an Er:YAG laser, followed by a finishing coagulation of the lesion's base with a CO2 laser. This method can help reduce the possibility of recurrence in the affected area by treating the root tissue of the skin tag. Thermal stimulation can affect fibrous cells and microvessels within the tissue, potentially inhibiting regrowth.

Situations where combining a finishing treatment using a CO2 laser can be particularly useful include:

- If skin tags appear in areas prone to frequent friction, such as the neck or armpits

- If you have experienced recurrence in the same area after skin tag removal

- If the lesion has deep or widely spread roots, potentially leaving a raised mark even after the procedure

Thus, by thoroughly understanding the depth and individual characteristics of each skin lesion,

employing two lasers together,

the 'Dual Laser Technique' is

a comprehensive approach that can contribute to improving satisfaction with treatment outcomes.

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

The procedure for mole removal involves a microscopic adjustment of the skin's surface. During this process, very small wounds may occur on the skin.

Thorough protection and management of the treated area after the procedure significantly contribute to healthy skin recovery.

Especially, moist wound healing, which keeps the treated area hydrated, can positively influence skin regeneration and help reduce the likelihood of scar formation.

For this purpose, we recommend care using DuoDERM, a hydrocolloid dressing.

DuoDERM maintains a moist environment for the wound, supporting the growth of healthy new skin cells. This prevents scab formation, which is beneficial in reducing the likelihood of scarring.

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

Generally, we suggest a total management period of approximately 10 days.

If you experience discomfort or an allergic reaction when using DuoDERM, you should frequently apply a regenerative cream or moist gel to prevent the treated area from drying out. Additionally, it is important to carefully use sunscreen with an SPF of 50 or higher and avoid touching the wound area with your hands.

Post-procedure care after mole removal is not merely about protecting the wound; it is a crucial process that significantly impacts the overall satisfaction and outcome of the procedure.

Neglecting care can lead to scarring, so it is essential to continue to pay attention to the treated area even after the procedure.

We provide detailed explanations of post-procedure care methods to help our patients recover healthily.

Cases where you might consider this procedure

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• 1. Those who have experienced discomfort due to various skin problems such as moles, seborrheic keratoses, milia, syringomas, or skin tags.
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• 2. Those considering re-treatment because moles have reappeared in the treated area after a mole removal procedure.
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General Procedure Steps

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• STEP 01. Pre-cleansing
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• STEP 02. Anesthetic cream application
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• STEP 03. Mole removal procedure
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Important points to remember after the procedure

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• ㆍYou should be careful not to let water directly touch the treated area. (It is recommended to wash your face with DuoDERM attached.)
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• ㆍDuring skin regeneration, continuously replacing the regenerative patch for approximately 10 days can have a positive impact on recovery.
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• ㆍThere is a possibility that moles may reappear in the area removed by the procedure. If necessary, re-treatment can be discussed after 4 to 6 weeks.
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• ㆍDeep-rooted moles may be difficult to remove completely with a single procedure, and in such cases, multiple treatments may be necessary.
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• ㆍIt is extremely important to avoid exposing the treated area to UV radiation as much as possible. Sunscreen (sunblock) use is essential, and applying it over DuoDERM can also be helpful.
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