Effective Application of Combined Laser Treatment

*Moles are pigmented lesions that occur when melanin pigment proliferates excessively in the epidermal or dermal layers of the skin.

Moles are difficult to assess based solely on their visible appearance, and the treatment method may vary depending on their depth or location.

Erbium YAG laser is primarily used to meticulously resurface the outermost layer of the skin. This laser can help gently remove superficial moles in the epidermis while minimizing irritation to the surrounding skin.

The Erbium YAG laser can reduce the concern of scar formation and offer cosmetic improvement, making it a consideration, especially for moles on the face. Subsequently, the process of using a CO2 laser to treat the base of the mole with thermal energy helps address melanin cells that may remain deep within the skin, thereby reducing the likelihood of recurrence. This approach helps lower the chance of moles reappearing due to residual root tissue, even if they have seemingly disappeared from the surface.

Specifically, combining a CO2 laser finish can be considered in the following situations:

-When a mole appears raised or feels thick to the touch

-When there is a history of mole recurrence in a previously treated area

-When diagnosed with a nevus located deep in the dermis (e.g., blue nevus, grayish nevus, etc.)

*Flat warts are skin lesions caused by human papillomavirus (HPV) infection. They typically spread widely across the epidermal layer and appear as thin, flat, small, brown or flesh-colored lesions to the naked eye. They tend to occur when immunity is lowered and can spread to other areas through self-contact, so early management is recommended.

The Erbium YAG laser can be used to evenly resurface the skin's epidermal layer. It has potential utility, especially for flat warts that are widely spread.

Its usefulness is expected when treating widely distributed flat warts in a single session. This method offers the advantage of uniformly removing lesions while minimizing skin irritation. However, due to the nature of viral diseases, there's a risk of recurrence if only the visible parts are removed. In such cases, adding thermal treatment to the area surrounding the lesion using a CO2 laser can help manage remaining virus-infected cells in and around the epidermis, thereby contributing to a reduction in recurrence.

Combining a CO2 laser finish can be deeply considered in the following cases:

-When the lesion's boundaries are unclear, or it feels broad and flat upon palpation, or for individuals with weakened immune function (e.g., severe stress, insufficient sleep, etc.)

-When there is a history of multiple recurrences in the past

-When the lesion occurs in frequently touched areas like hands or face, or in locations where viral transmission is easy

*Milia are small, white, cyst-like lesions formed by the accumulation of keratin (a type of skin protein) within the skin. They are typically found around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they have cosmetic characteristics unrelated to infection or inflammation.

The Erbium YAG laser can be effectively utilized to remove milia. This laser meticulously resurfaces the skin's surface, removing the thin epidermal portion of the milia and creating an exit pathway for the trapped keratin material. A light finishing touch with a CO2 laser after the procedure can help reduce the possibility of remaining keratinocyte regrowth and contribute to preventing milia from reappearing in the same spot. However, excessive thermal stimulation to the skin can cause hyperpigmentation, so precise intensity control is required during the procedure.

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

-When milia repeatedly appear in the same location

-When there is a history of the lesion reappearing during the recovery period after treatment

-When desiring a uniform skin texture during the recovery process after removing multiple milia

*Syringomas are benign skin lesions caused by the excessive proliferation of sweat gland (eccrine gland) tissue in the dermal layer of the skin. They commonly appear as multiple small, bead-like bumps around the eyes, cheeks, and forehead. They can be influenced by genetic factors or are relatively often observed in women in their 20s and 30s.

Given its ability to thinly and precisely treat the epidermis, the Erbium YAG laser can be utilized for syringoma treatment in delicate areas like around the eyes. This laser is used to refine the skin's surface and remove the upper part of the sweat gland lesion. Since there is less concern about scarring or pigmentation after the procedure, cosmetic improvement can be expected.

Subsequently, a finishing process involving the application of subtle thermal stimulation to the deeper parts of the lesion using a CO2 laser can help reduce the activity of sweat gland tissue within the dermis.

This treatment method can help reduce the re-proliferation of syringomas in the same area. However, it's advisable to understand, through consultation with your medical team, that multiple treatments may be necessary due to the deep location of these lesions.

In the following cases, combining a CO2 laser finish can aid in improvement:

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

-When there is a history of recurrence despite having undergone multiple laser treatments in the past

-When desiring to further enhance the effect of reducing recurrence with a single treatment

*Skin tags are benign skin lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermal layer. They commonly appear as small, skin-colored projections in areas prone to friction, such as the neck, armpits, lower chest, and eyelids. While painless, they can be irritated by clothing or external friction. Generally, the CO2 laser is primarily used for skin tag removal, employed for its precise cutting ability and hemostatic effect to efficiently treat multiple lesions. However, for smaller and thinner skin tags, meticulously ablating the lesion first with an Erbium YAG laser, followed by a CO2 laser to finish the base of the lesion, can help manage the root tissue and contribute to reducing the likelihood of recurrence in that area. This thermal stimulation can offer benefits by regulating fibrous cells and microvessels within the tissue to inhibit a regrowth environment.

Situations where combining a CO2 laser finish may be recommended are as follows:

-When skin tags occur 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 base of the lesion is deeply and widely distributed (a type where remnants of the lesion may still feel thick after removal)

Thus, considering the depth and individual characteristics of skin lesions,

applying two types of laser treatments in combination,

the so-called 'Dual Laser Treatment',

can be an effective approach to expect improvement in treatment results.

Information on the application period for regenerative stickers (DuoDerm) after mole removal.

Nevus removal procedures involve physically treating the outer layer of the skin, which may cause temporary irritation to the skin.

Therefore, it is important to properly protect and manage the treated area after the procedure.

In particular, maintaining a moist environment to prevent the treated area from drying out can help the skin recover quickly and reduce the possibility of scarring.

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

Duoderm protects the treated area by keeping it moist, helping cells regenerate well, and reducing unnecessary scabbing, which can lessen the burden of scarring.

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

We can say that the overall management period of about 10 days is appropriate.

If using Duoderm causes discomfort or an allergic reaction, you should consistently apply a regenerating cream or moisturizing gel to prevent the treated area from drying out. Additionally, it is advisable to carefully apply sunscreen with an SPF of 50 or higher and be careful not to touch the treated area.

Post-nevus removal care is a crucial step that goes beyond simply protecting the treated area; it can influence the final outcome of the procedure.

If care is insufficient, there is a possibility of scarring, so we recommend that you continue to pay close attention to aftercare even after the procedure.

At our medical institution, we provide detailed explanations of post-procedure care methods to help patients recover comfortably.

When to consider the procedure

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• 1. Individuals concerned about skin issues such as moles, seborrheic keratosis, milia, syringomas, or skin tags.
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• 2. Individuals who had a mole removed previously but it reappeared.
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Procedure Steps

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• STEP 01. Self-cleansing
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• STEP 02. Anesthetic ointment application
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• STEP 03. Nevus removal procedure
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Post-procedure precautions

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• ㆍAvoid direct contact with water on the treated area. (It is advisable to gently wash your face with Duoderm applied.)
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• ㆍDuring skin regeneration, regularly replace and apply a regenerative tape (such as Duoderm). (Approximately 10 days)
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• ㆍThere is a possibility of the mole reappearing in the removed area, in which case re-treatment can be considered after 4-6 weeks.
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• ㆍDeep-rooted moles may be difficult to remove completely in a single procedure and may require multiple treatments.
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• ㆍIt is best to avoid sun exposure as much as possible. Sunscreen must be used, and it is fine to apply it over Duoderm.
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