[Laser Removal of Protruding Lesions] Focused Removal of Lesions such as Seborrheic Keratosis, Warts, and Skin Tags

Dual Laser Technique

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

Even if they look similar to common pigmented lesions, the appropriate treatment method can vary depending on the location and depth of the mole.

Erbium-YAG laser is useful for delicate and shallow exfoliation, helping to precisely remove shallow moles in the epidermis while minimizing the risk of skin damage.

This procedure is utilized for mole removal, especially on the face, as it reduces the risk of scarring and offers cosmetic improvement. Subsequently, by cauterizing the base of the mole with thermal energy using a CO2 laser, it helps treat melanin cells that may remain in deeper layers, thereby reducing the possibility of mole recurrence. This is useful for preventing recurrent moles where only the surface is removed, leaving the root to grow back.

It is especially recommended to consider the 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 as 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 in the epidermal layer and appear as small, thin, flat, brown or flesh-colored lesions to the naked eye. They are prone to developing when immunity is weakened and can spread to other areas by touching them, thus requiring early and appropriate management.

Erbium-YAG laser is useful for uniformly exfoliating the epidermal layer, making it effective for widely distributed flat warts,

which can help manage them simultaneously. This method is utilized 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 procedure applying thermal energy around the lesion using a CO2 laser can further treat residual virus-infected cells in and around the epidermal layer, contributing to lowering the possibility of recurrence.

Especially in the following situations, combining a CO2 laser finishing treatment can be beneficial:

- If the lesion's boundaries are unclear or it feels flat and spread out to the touch, or if you have a weakened immune system (e.g., due to stress, lack of sleep, etc.)

- If you have experienced multiple recurrences previously

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

Milia are small, white, cyst-like lesions formed when keratin protein gets trapped within the skin. They primarily occur around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are considered an aesthetic concern with no direct link to infection or inflammation.

Erbium-YAG laser can be usefully applied for milia removal. It delicately exfoliates the skin surface to remove the thin epidermal part of the milia, creating an exit pathway 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 milia from recurring in the same area. However, excessive heat stimulation to the skin can cause hyperpigmentation, so precise intensity control is crucial.

Situations where CO2 laser finishing is particularly useful include:

- If milia repeatedly recur in the same location

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

- When seeking 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 dermal layer. They are typically characterized by the appearance of numerous small, bead-like lesions around the eyes, cheeks, and forehead. They often have a genetic predisposition or are frequently observed in women in their 20s and 30s.

Erbium-YAG laser can thinly and 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 aesthetic 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 lower the possibility of syringomas re-proliferating in the same area. However, due to the depth of the lesions, multiple treatments may be required.

Greater synergy can be achieved by combining CO2 laser finishing in the following situations:

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

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

- When seeking to help reduce the risk of recurrence with just one treatment

Skin tags are benign lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermal layer. They primarily occur in areas where skin folds frequently, 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. CO2 laser is generally used for skin tag excision due to its excellent cutting and hemostatic effects, making it useful for efficiently removing multiple lesions. However, for small and thin skin tags, precisely exfoliating the lesion first with an Erbium-YAG laser, followed by finishing cauterization of the lesion's base with a CO2 laser, can help remove the root tissue of the skin tag, thereby reducing the possibility of recurrence in that area. This thermal stimulation can help treat fibrous cells and microvessels within the tissue, contributing to reducing the recurrence environment.

Situations where combining CO2 laser finishing can be particularly useful 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's root is deep or wide (a type where a raised trace might remain after treatment)

Thus, considering the depth and characteristics of the lesions,

the use of two lasers together

– the 'Dual Laser Technique' –

is an approach that can contribute to increasing treatment satisfaction.

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

Mole removal procedures can subtly irritate 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 aid the healing process and help reduce the likelihood of scarring.

For this management, you might consider applying a hydrocolloid bandage like Duoderm.

Duoderm keeps the wound area in a moist environment, promoting new skin growth and reducing unnecessary scab formation, thereby lowering the risk of scarring.

After mole removal, it is recommended to apply Duoderm immediately, change it every 3-5 days, and continue management 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 in recovery.

Post-mole removal care is more than just protecting the wound; it's a critical step that can influence the outcome of the procedure.

Insufficient care can lead to scarring, so it is advisable to consistently pay attention to the treated area even after the procedure.

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 have 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 Removal Procedure
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Post-Procedure Precautions

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• ㆍPlease be careful not to let water directly touch the treated area. (It is recommended 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 approximately 4-6 weeks.
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• ㆍFor deep-rooted moles, multiple procedures may be necessary.
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• ㆍIt is best to avoid sun exposure as much as possible. (Always use sunscreen, and it is recommended to apply it even over Duoderm.)
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