Laser Removal of Protruding Lesions (Skin Tags, Milia, Seborrheic Keratosis, Warts, etc.)

Utilization of Dual Laser Technique

*Moles are pigmented lesions that occur when melanin pigment cells in the skin abnormally increase in the epidermis or dermis.

Although they may look similar on the surface, customized treatment is required depending on the depth and location of the mole.

The Er:YAG laser is advantageous for precisely ablating the skin surface, which can reduce damage to surrounding skin and achieve natural results when removing shallow epidermal moles.

This lowers the possibility of scarring and can help with aesthetic improvement when removing moles on the face. Subsequently, precisely cauterizing the root of the mole with a CO2 laser can remove melanin cells that may remain deep within the skin, reducing the risk of mole recurrence. This is a useful method for preventing recurrent moles that reappear after only superficial removal.

Especially in the following cases, adjunctive CO2 laser treatment may be considered:

- If the mole is slightly raised or feels thick above the skin when touched

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

- When diagnosed as a nevus located in the deep dermal layer, such as a blue mole or a grayish-brown mole

*Flat warts are viral skin diseases caused by human papillomavirus (HPV) infection. They spread widely in the epidermal layer and appear to the naked eye as thin, flat, brown or skin-colored small lesions. They can easily appear when immunity is low, and there is a possibility of self-contact spreading them to other areas, so early treatment is important.

The Er:YAG laser is advantageous for uniformly ablating the epidermis. For widespread flat warts,

it can be useful for efficient management in one go. It helps to evenly remove lesions while minimizing skin irritation. However, due to the nature of viral lesions, there is a possibility of recurrence if only the superficial lesions are removed. In such cases, the finishing process of applying gentle thermal stimulation around the lesion with a CO2 laser can play a positive role in further cauterizing virus-infected cells that may remain in the epidermal layer and its surroundings, thereby reducing the possibility of recurrence.

Especially in the following cases, combining CO2 laser treatment may be necessary:

- If the lesion's border is unclear, or it feels flat and widely spread when touched. This also applies to individuals with weakened immunity (due to stress, lack of sleep, etc.).

- If you have already experienced multiple recurrences

- When the lesion is in an area that is frequently touched, such as the hands or face, or where the virus can easily spread

*Milia are small, white cysts that occur when keratin, a horny protein, gets trapped in hair follicles within the skin. They are typically observed around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are a cosmetic issue unrelated to infection or inflammation.

The Er:YAG laser can be useful for treating milia. It precisely ablates the skin surface to remove the thin covering of the milia, creating a passage for the safe release of trapped keratin. The light finishing process with a CO2 laser after the procedure can help inhibit the re-proliferation of any remaining keratinocytes, thereby reducing the recurrence of milia in the same area. However, excessive thermal stimulation to the skin can cause hyperpigmentation, so delicate control of intensity is important.

Cases where using a CO2 laser together can be beneficial include:

- If milia continuously recur in the same area

- If the lesion has reappeared during the recovery process after removal

- When an even skin texture is desired during the recovery phase after removing multiple milia

*Syringomas are benign skin tumors that result from the abnormal proliferation of sweat gland tissue in the dermal layer of the skin. They are characterized by the appearance of numerous small, bead-like lesions, primarily under the eyes, on the cheeks, and on the forehead. They can be relatively common in women in their 20s and 30s or due to genetic factors.

The Er:YAG laser can delicately ablate the epidermis, making it suitable for treating syringomas in sensitive areas like around the eyes. It refines the upper part of the lesion on the skin surface, and during the post-treatment recovery process, it is expected to reduce the burden of scarring or hyperpigmentation, leading to aesthetic improvement. Subsequently, applying thermal stimulation with a CO2 laser

the finishing process, which involves creating subtle damage to the deeper parts of the lesion, can help reduce the abnormal activity of sweat glands within the dermis.

This can play a positive role in preventing syringomas from reappearing in the same location. However, due to the depth of the lesions, multiple treatment sessions may be required.

In the following situations, synergistic effects can be expected when applying CO2 laser together:

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

- If lesions reappeared despite having received multiple laser treatments previously

- When aiming to increase expectations for recurrence prevention with a single treatment

*Skin tags are benign skin tumors caused by the excessive proliferation of fibrous tissue and blood vessels in the dermal layer of the skin. They commonly occur in areas where the skin folds, such as the neck, armpits, under the breasts, and on the eyelids, appearing as small, skin-colored protrusions. While painless, they can be irritated by clothing or friction. Generally, CO2 lasers are efficient for removing skin tags, rapidly removing many lesions with excellent cutting and hemostatic effects. However, for small and thin skin tags, precisely ablating the lesion first with an Er:YAG laser, and then finishing by cauterizing the root of the lesion with a CO2 laser, can help remove the deep tissue of the skin tag and contribute to reducing the possibility of recurrence in that area. Thermal stimulation is expected to regulate fibrous cells and microvessels within the tissue, thereby inhibiting regeneration.

Cases where CO2 laser must be considered together are as follows:

- If skin tags appear in areas with frequent friction, such as the neck or armpits

- If you have experienced skin tag recurrence in the same area after removal

- If the root of the lesion is deep or wide (a type where the skin remains thick even after removal)

Thus, tailored to the characteristics and depth of the lesion,

combining two types of lasers

the 'Dual Laser Technique'

can be an important approach to increase satisfaction with the procedure.

Curious about the duration of Duoderm (band-aid) usage after mole removal?

Since mole removal procedures involve scraping off the superficial layer of the skin, they will cause some degree of damage to the skin.

Therefore, protecting and managing the wound area well after the procedure is essential.

Keeping the treated area moist is particularly beneficial for skin regeneration, speeding up recovery and reducing the likelihood of scarring.

For this management, we recommend applying DuoDERM, a hydrocolloid dressing.

DuoDERM moistly protects the wound, aiding skin cell regeneration and reducing the formation of unnecessary scabs, which can lessen the burden of scarring.

It is best to apply DuoDERM immediately after mole removal and maintain it for at least 7 days, changing it every 3 to 5 days.

We recommend an overall management period of approximately 10 days.

If DuoDERM use is uncomfortable or causes an allergic reaction, please apply a regenerating cream or moist gel consistently to prevent skin dryness. Additionally, it is advisable to carefully apply sunscreen with SPF 50 or higher and avoid touching the treated area.

Post-mole removal care is not merely about protecting the treated area; it is a crucial process that can influence the outcome of the procedure.

Neglecting aftercare may lead to scarring, so please continue to pay attention and care after the procedure.

At Kkeut Korean Medicine Clinic, we provide detailed explanations of post-procedure care methods to ensure our patients' swift and healthy skin recovery.

Recommended for

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• 1. Individuals who have experienced discomfort due to moles, seborrheic keratoses, milia, syringomas, or skin tags.
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• 2. Individuals who have had moles removed previously but experienced recurrence.
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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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• • Avoid getting water directly on the treated area. You may cleanse while the Duoderm dressing is in place.
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• • During skin regeneration, replace and keep the regenerative tape applied consistently for about 10 days.
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• • A mole may recur at the treated area; re-treatment can generally be considered after 4–6 weeks.
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• • Deep-rooted moles may require multiple treatments for satisfactory results.
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• • Minimize sun exposure. Sunscreen is essential and may also be applied over Duoderm.
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