Dual Laser for Flat Warts, Reducing Recurrence

Dual Laser Application Method Considering Lesion Characteristics

Moles are pigmented lesions that occur when melanocytes proliferate excessively in the epidermis or dermis.

Although they may appear as a single pigmented lesion on the surface, the appropriate treatment method varies depending on the depth and type of the mole.

The Er-YAG laser is primarily used for precise resurfacing of the skin surface. This can help remove shallow moles located close to the epidermis while minimizing stress on the surrounding skin.

This laser can reduce the possibility of scarring and offer cosmetic improvements, making it particularly useful for treating facial moles. Following this, a CO2 laser is used to carefully cauterize the base of the mole with heat. This process can help treat any melanocytes that may remain deep in the skin, thereby reducing the likelihood of the mole reappearing. It contributes to lowering the probability of ‘recurrent moles’ that regrow from remaining roots even after the mole appears to be removed from the surface.

CO2 laser finishing is especially recommended for the following types of moles:

-When the mole is slightly raised above the skin surface or feels thick to the touch.

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

-If diagnosed as a nevus located in the deep dermis (e.g., blue nevi, slate gray nevi, etc.).

Flat warts are a viral skin disease caused by human papillomavirus (HPV) infection. They primarily spread widely in the epidermal layer, appearing as thin, flat, small brown or flesh-colored lesions. They frequently occur when immunity is weakened and can spread through contact between different body parts, making early management advisable.

The Er-YAG laser is used for delicate resurfacing of the epidermal layer. This allows for the efficient treatment of widespread flat warts.

They can be managed efficiently in a single session. It allows for even removal of lesions while minimizing stress on the skin. However, viral lesions have a chance of recurrence if only the surface is treated. In such cases, the finishing process of applying subtle thermal stimulation around the lesion with a CO2 laser can clinically help reduce the risk of recurrence by additionally cauterizing any residual virus-infected cells in the epidermal layer and surrounding areas.

CO2 laser finishing may be particularly necessary in the following cases:

-When the borders of the lesion are indistinct or it feels flat and spread out to the touch. -Individuals with weakened immunity due to stress, lack of sleep, etc.

-Those with a history of recurrent flat warts on multiple occasions.

-When lesions appear on areas frequently touched, such as hands or face, or areas where the virus can easily spread.

Milia are small, white cystic lesions formed by the accumulation of keratin (a type of skin protein) beneath the skin. They are commonly observed around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are a cosmetic concern unrelated to infection or inflammatory reactions.

The Er-YAG laser can be effectively used for milia removal. It precisely ablates the skin surface, removing the thin epidermal layer covering the milia, and creates a pathway for the trapped keratin to be safely discharged. After the procedure, a gentle cauterization finish with a CO2 laser can help reduce the regrowth of residual keratinocytes and prevent milia from recurring in the same area. However, excessive thermal stimulation to the skin can lead to hyperpigmentation, thus, careful intensity control is crucial.

CO2 laser finishing is particularly considered in the following situations:

-When milia frequently recur in the same location.

-When there is a history of lesions reappearing during the recovery process after a previous procedure.

-After removing multiple milia, and expecting an even skin texture after recovery.

Syringomas are benign skin lesions caused by the abnormal proliferation of sweat glands (eccrine glands) in the dermis. They are characterized by the appearance of multiple small, bead-like lesions that can be felt under the eyes, on the cheeks, and on the forehead. They have a genetic predisposition and are commonly seen in women in their 20s and 30s.

The Er-YAG laser can handle the epidermis thinly and delicately, making it suitable for treating syringomas in sensitive areas like around the eyes. By refining the skin surface, it removes the upper part of the sweat gland lesions, and by reducing the possibility of scarring or hyperpigmentation after recovery, positive cosmetic outcomes can be expected. Subsequently, a CO2 laser is used to apply heat to

The finishing process, which involves applying subtle stimulation to the deeper part of the lesion, helps regulate the activity of sweat glands in the dermis,

and can clinically help prevent syringomas from proliferating again in the same area. However, due to the inherent depth of the lesions, multiple treatment sessions may be required.

In the following situations, combining with CO2 laser finishing can be expected to improve treatment outcomes:

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

-When recurrence has occurred despite having received multiple laser treatments previously.

-When the focus is on recurrence prevention with a single treatment session.

Skin tags are benign skin lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermis. They frequently appear in areas where the skin folds, such as the neck, armpits, under the breasts, and eyelids, and are observed as small, skin-colored protrusions. They are usually painless but can be irritated by friction. Generally, CO2 lasers are primarily used for skin tag removal, and with their precise cutting and hemostatic capabilities, multiple lesions can be removed relatively efficiently. However, for small and thin skin tags, a method of precisely ablating the lesion surface with an Er-YAG laser followed by cauterizing the base with a CO2 laser can be considered. This can help treat the root tissue of the skin tag and reduce the risk of recurrence in that area. Thermal stimulation can influence fibrous cells and microvessels within the tissue, playing a role in regulating the regenerative environment.

Cases where CO2 laser finishing is worth considering include the following:

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

-If there is a history of skin tags recurring in the same area after treatment.

-When the root of the lesion is deep or broad (in cases where the skin might remain thick after removal).

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

using two types of lasers together,

this ‘Dual Laser Technique’

can help increase treatment satisfaction.

After mole removal, how long should DuoDERM (hydrocolloid dressing) be applied?

Procedures to remove moles involve shaving off the outer layer of the skin, and this process leaves physical traces on the skin.

Therefore, properly protecting and managing the wound area after the procedure is very important.

In particular, keeping the treated area from drying out can help with recovery and reduce scarring.

For this kind of management, the use of Duoderm, a hydrocolloid dressing, is often recommended.

Duoderm protects the wound area from drying out, helping new cells regenerate and delaying scab formation, thereby contributing to a lower chance of scarring.

Immediately after mole removal, apply Duoderm, change it every 3-5 days, and manage it for at least 7 days; this is a common recommendation.

The overall management period is generally considered appropriate at about 10 days.

If Duoderm use is difficult or a skin allergic reaction occurs, you can prevent skin dryness by consistently applying a regenerating cream or moisturizing gel. Additionally, it is necessary to diligently apply sunscreen with SPF 50 or higher and avoid directly touching the treated area.

Post-mole removal care is a crucial step that goes beyond mere wound protection and can influence the outcome of the procedure.

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

At our clinic, we provide detailed explanations of post-procedure care methods to ensure our visitors can recover healthily.

Candidates for the procedure

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• 1. Individuals with skin lesions such as moles, seborrheic keratoses (age spots), milia, syringomas, or skin tags on their face or body.
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• 2. Individuals who have previously had moles removed but have experienced recurrence.
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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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Precautions for Post-Procedure Care

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• ㆍCare is needed to prevent direct water contact with the treated area. (Facial cleansing is possible while Duoderm is attached.)
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• ㆍDuring the skin regeneration period, it is recommended to consistently change and apply the regenerative tape for about 10 days.
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• ㆍMoles may reappear in the removed area, in which case re-treatment can be considered after 4-6 weeks.
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• ㆍDeep-rooted moles may require multiple treatment sessions.
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• ㆍMinimizing exposure to ultraviolet (UV) light is crucial. (Sunscreen is essential, and applying it over Duoderm can also be helpful.)
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