Exposed Lesion Removal, Visible Skin Laser Treatment

Dual Laser Technique

Moles are skin lesions that appear due to the excessive proliferation of melanin pigment cells in the epidermis or dermis.

Although their appearance may resemble common pigmented lesions, the appropriate treatment method can vary depending on the mole's location and depth.

The Er:YAG laser is useful for delicate and shallow ablation, helping to precisely remove superficial moles in the epidermis while minimizing the risk of skin damage.

This procedure helps reduce the risk of scarring and offers cosmetic improvement, making it particularly useful for mole removal on the face. Following this, using a CO2 laser to cauterize the base of the mole with thermal energy helps treat any remaining melanocytes in deeper layers, thereby lowering the possibility of recurrence. This is effective in preventing recurrent moles that might regrow if only the superficial part is removed and the root remains.

It is especially recommended to consider a finishing process using a CO2 laser in the following cases:

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

- If you have previously experienced a mole recurring in the same area

- If diagnosed with a dermal nevus (e.g., blue nevus, gray-brown nevus, etc.)

Flat warts are viral skin diseases caused by human papillomavirus (HPV) infection. They typically spread widely across the epidermal layer and appear as small, thin, flat, brown or flesh-colored lesions. They are more likely to occur when immunity is weakened and can spread to other areas through self-touching, thus requiring early and appropriate management.

The Er:YAG laser is useful for uniformly ablating the epidermal layer, making it effective for widely distributed flat warts,

and can help manage them simultaneously. This method is used to evenly remove lesions while minimizing the risk of skin damage. However, due to the nature of viral lesions, there may be a possibility of recurrence if only the superficial part is removed. In such cases, a finishing treatment using a CO2 laser to apply thermal energy around the lesion can further treat residual virus-infected cells in and around the epidermis, helping to reduce the likelihood of recurrence.

In the following situations, combining a CO2 laser finishing treatment can be particularly beneficial:

- If the lesion's border is not clear or feels flat and spread out when touched, or if you have a weakened immune system (e.g., due to stress, lack of sleep, etc.)

- If you have already experienced multiple recurrences

- If the lesions appear in areas that are frequently touched or can easily spread, such as the hands or face

Milia are small, white, cyst-like lesions formed when keratin (a type of skin protein) becomes trapped beneath the skin. They commonly occur around the eyes, on the cheeks, and forehead, and unlike sebaceous cysts, they are generally considered a cosmetic issue with no direct link to infection or inflammation.

The Er:YAG laser can be effectively used for milia removal. It delicately ablates the skin surface to remove the thin epidermal part of the milium, creating a path for the trapped keratin to be safely expelled. A light finishing cauterization with a CO2 laser after the procedure can help reduce the possibility of residual keratinocytes proliferating again and prevent recurrent milia in the same area. However, precise intensity control is crucial, as excessive thermal stimulation to the skin can lead to hyperpigmentation.

Situations where CO2 laser finishing is particularly useful include:

- If milia repeatedly recur in the same location

- If you have experienced the lesion re-emerging during the recovery process after treatment

- When aiming for a more even result during the recovery process after removing multiple milia

Syringomas are benign skin lesions caused by the excessive proliferation of sweat gland tissue (eccrine glands) in the dermis. They typically appear as multiple small, bead-like lesions found under the eyes, on the cheeks, and forehead. They often have a genetic predisposition or are frequently observed in women in their 20s and 30s.

The Er:YAG laser can delicately remove the epidermis, making it suitable for managing syringomas in sensitive areas like around the eyes. This method refines the skin surface, removes the upper part of the sweat gland lesions, and can lead to cosmetic improvement by reducing the risk of scarring or hyperpigmentation during recovery. Subsequently, applying heat with a CO2 laser

a finishing process that provides subtle thermal stimulation to the deeper parts of the lesion can help reduce the activity of sweat glands within the dermis,

and can be a clinically significant approach to reduce the likelihood of syringomas recurring in the same area. However, due to the depth of the lesions, multiple treatment sessions may be required.

In the following situations, combining a CO2 laser finishing treatment can yield even greater synergy:

- When multiple syringomas are situated relatively deep, such as under the eyes or on the cheeks

- If lesions have recurred despite receiving multiple laser treatments in the past

- When seeking to help reduce the risk of recurrence with just a single treatment session

Skin tags are benign lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermis. They primarily occur in areas where skin frequently 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, CO2 lasers are primarily used for skin tag excision due to their excellent cutting ability and hemostatic effect, making them effective for efficiently removing multiple lesions. However, for small and thin skin tags, precisely ablating the lesion first with an Er:YAG laser, followed by a finishing cauterization of the lesion's base with a CO2 laser, can help remove the root tissue of the skin tag and reduce the likelihood of recurrence in that area. This thermal stimulation can help treat fibrous cells and microvessels within the tissue, contributing to a reduced recurrence environment.

Situations where combining a CO2 laser finishing treatment can be even more beneficial include:

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

- If you have experienced skin tags recurring in the same area after treatment

- If the lesion has a deep or wide root (a type where a raised mark might remain even after treatment)

Thus, by considering the depth and characteristics of the lesion,

utilizing two types of lasers together,

‘Dual Laser Technique’

is an approach that can contribute to increasing treatment satisfaction.

After mole removal, how long should I apply DuoDERM (healing patch)?

Mole removal procedures can subtly stimulate the skin's surface, potentially causing minor damage.

Therefore, it is crucial to protect and manage the treated area well.

Keeping the treated area moist can help aid the recovery process and reduce the likelihood of scarring.

For this type of care, you might consider applying a hydrocolloid dressing like Duoderm.

Duoderm keeps the wound area in a moist environment, helping new skin grow well, and can reduce unnecessary scab formation, thereby lowering the risk of scarring.

Immediately after mole removal, apply Duoderm, change it every 3-5 days, and continue care for at least 7 days.

Generally, about 10 days of care may be recommended.

If Duoderm use is uncomfortable or causes an allergic reaction, you should frequently apply a regenerative cream or moisturizing gel to prevent dryness. Additionally, diligently applying sunscreen with SPF 50 or higher and avoiding touching the treated area can aid recovery.

Post-mole removal care is more than just protecting the wound; it is a crucial step that can affect the outcome of the procedure.

Inadequate care can lead to scarring, so consistent attention after the procedure is advisable.

We provide detailed explanations of post-procedure care methods to help our patients achieve a quick and healthy recovery.

Those Considering 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 who had moles reappear after previous removal and are considering re-treatment.
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Procedure Steps

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• STEP 01. Personal Cleansing
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• STEP 02. Anesthetic Cream Application
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• STEP 03. Mole Treatment
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Post-Procedure Precautions

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• ㆍTake care to avoid direct contact with water on the treated area. (It is best to wash your face with Duoderm applied.)
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• ㆍDuring the skin regeneration period, it is advisable to consistently change and apply the regenerative tape for about 10 days.
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• ㆍThere is a possibility that moles may reappear in the treated area, and re-treatment is possible after about 4-6 weeks.
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• ㆍFor moles with deep roots, multiple procedures may be necessary.
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• ㆍIt is best to avoid sun exposure as much as possible. (Always use sunscreen, and applying it over Duoderm is recommended.)
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