Dual Laser Removal of Flat Warts, Considering the Possibility of Recurrence

How to Utilize Dual Laser Treatment

Moles are skin lesions that occur when melanin-producing cells excessively proliferate in the epidermis or dermis.

Unlike their appearance, the method of removal can vary depending on the depth and location of the mole.

Erbium-YAG laser is specialized in delicately shaving off the skin surface. This is useful for removing shallow moles in the epidermal layer while minimizing skin irritation and effectively eliminating the lesion.

This procedure can lead to cosmetic improvements while reducing the possibility of scarring, making it an excellent choice, especially for facial mole removal. Subsequently, using a CO2 laser to thermally refine the root of the mole can help process any remaining melanin cells deep within, preventing the mole from recurring. This can reduce the likelihood of 'recurrent moles,' which appear to be removed but have residual roots.

Consider CO2 laser finishing in the following situations:

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

-If you have a history of a mole recurring in the same area

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

Flat warts are viral skin diseases caused by human papillomavirus (HPV) infection. They appear as widespread, thin, flat, brown or flesh-colored small lesions in the epidermal layer of the skin. They are particularly prone to occur when immunity is low and can spread to other parts of the body, making early management crucial.

Erbium-YAG laser is effective in uniformly removing the epidermal layer, making it useful for treating widespread flat warts

in a single session. This helps remove lesions evenly while reducing skin irritation. However, due to the nature of viral diseases, merely removing the surface lesions may lead to recurrence. In such cases, a finishing process involving thermal stimulation of the perilesional area with a CO2 laser can clinically help reduce the recurrence rate by further refining virus-infected cells remaining in the epidermal layer and its surroundings.

CO2 laser finishing may be particularly important in the following situations:

-If the lesion boundaries are unclear, or it feels flat and spread out to the touch

-If immunity is weakened (due to stress, sleep deprivation, etc.), or if multiple recurrences have already been experienced

-If the lesion is located in frequently touched areas like hands or face, making it prone to spreading

Milia are lesions that appear as small white sacs when keratin protein is trapped within the skin. They primarily occur around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are benign lesions unrelated to infection or inflammation.

Erbium-YAG laser is one of the effective methods for removing milia. It precisely ablates the skin surface to remove the thin epidermis of the milia and creates a channel for the trapped keratin to be smoothly discharged. Subsequently, light finishing with a CO2 laser can help reduce the possibility of remaining keratinocytes re-proliferating and prevent milia from recurring in the same area. However, strong thermal damage to the skin can lead to post-inflammatory hyperpigmentation, requiring careful energy control.

CO2 laser finishing can be particularly helpful in the following cases:

-If milia frequently recur in the same location

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

-When aiming for natural recovery after removing multiple milia

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

Erbium-YAG laser can precisely and thinly remove the epidermis, making it suitable for managing syringomas in sensitive areas like around the eyes. It can refine the skin surface and remove the upper part of the sweat gland lesions, and during recovery, there is less risk of scarring or pigmentation, allowing for satisfactory cosmetic results. Subsequently, using a CO2 laser to apply heat and

provide subtle stimulation to the deeper parts of the lesion in a finishing step can weaken the activity of dermal sweat glands and

help prevent syringomas from recurring in the same area. Due to the depth of the lesions, repeated treatments may be necessary.

In the following situations, combining CO2 laser finishing can aid in improvement:

-If there are relatively deep and numerous syringomas located under the eyes, on the cheeks, etc.

-If recurrence has been experienced despite multiple previous laser treatments

-When aiming to reduce the possibility of recurrence with a single treatment

Skin tags are benign lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermal layer. They commonly occur in 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 often used for skin tag removal, as its efficient cutting power and hemostatic effect can quickly remove multiple lesions. However, for small and thin skin tags, delicately removing the lesion first with an Erbium-YAG laser, followed by finishing the root part of the lesion with a CO2 laser, can contribute to treating the deeper tissues of the skin tag and help reduce recurrence in that area. Thermal stimulation can help regulate fibrous cells and microvessels within the tissue, inhibiting the regenerative environment.

Cases where CO2 laser finishing can be considered include the following:

-If skin tags are located 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 removal

-If the root of the lesion is deep or wide, with the possibility of a mark remaining even after removal

Thus, depending on the depth and characteristics of the lesion,

the 'Dual Laser Technique,'

which combines two types of lasers,

is an important approach to enhance improvement effects.

Post-Mole Removal Care: How Long Should DuoDerm Be Worn?

During the process of mole removal, the skin's surface may be exfoliated, leading to minor damage.

Therefore, proper protection and care of the treated area significantly influence recovery.

In particular, keeping the treated area moist can help skin recovery and contribute to reducing the likelihood of scar formation.

For these reasons, we recommend using Duoderm, a hydrocolloid dressing.

Duoderm manages the wound area in a moist environment, aiding cell regeneration. It can help delay scab formation, reducing the possibility of scarring.

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

Generally, a total management period of about 10 days is recommended.

If you have difficulty using Duoderm or experience an allergic reaction, you can frequently apply a regenerating cream or moisturizing gel to prevent dryness. Additionally, it is important to carefully apply sunscreen with SPF 50 or higher and avoid touching the wound area.

Post-mole removal care is an important step that goes beyond simply protecting the wound and can affect the treatment results.

Neglecting care can lead to the possibility of scarring, so continuous attention is required even after the procedure.

At our clinic, we provide detailed explanations of post-procedure care methods to help patients recover quickly and healthily.

Recommended for

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• 1. Individuals concerned about moles, seborrheic keratosis, milia, syringomas, or skin tags.
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• 2. Individuals concerned about moles reappearing after previous removal.
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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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• ㆍBe careful to avoid direct contact with water on the treated area. (It is recommended to wash your face with Duoderm applied.)
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• ㆍDuring the skin regeneration period, please consistently replace and apply the regeneration tape if possible. (Recommended for approximately 10 days.)
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• ㆍMoles may reappear in the treated area. Re-treatment can usually be considered after 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 UV exposure as much as possible. (Sunscreen must be used, and applying it over Duoderm is also recommended.)
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