Characteristics of Combined Treatment with Two Lasers

Moles are lesions that occur when there is an excessive accumulation of melanin pigment in the epidermal or dermal layers of the skin.

While they may appear simple on the surface, it is advisable to apply different removal methods depending on the depth and location of the mole.

Er:YAG laser is effective for precisely ablating the superficial layer of the skin. This can help remove shallow moles located in the epidermis while minimizing damage to surrounding tissues.

When this treatment is used for facial mole removal, it can reduce the likelihood of scarring while achieving cosmetic improvement. Subsequently, using a CO2 laser to gently cauterize the base of the mole and deliver heat can help address melanin cells that may remain deep within. This aims to reduce the possibility of recurrence, which can happen if root tissues remain even if the mole appears to have disappeared on the surface.

In the following cases, finishing with a CO2 laser can be considered:

- If the mole is slightly raised or has a convex shape when touched

- If there is a history of mole recurrence in the same area

- When deep dermal nevi, such as blue or grayish-brown moles, are suspected

Flat warts are skin diseases caused by human papillomavirus (HPV) infection. They typically spread widely in the epidermal layer and are often observed as thin, flat, brownish or flesh-colored small lesions. They are particularly prone to occur when immunity is low, making early treatment advisable.

Er:YAG laser is useful for uniformly removing the epidermal layer, making it effective for widely spread flat wart lesions.

It can be expected to be useful for treating widely spread flat wart lesions in a single session. It helps to uniformly remove lesions while minimizing impact on the skin. However, due to the nature of viral lesions, there is a risk of recurrence if only the superficial lesion is treated. In such cases, a finishing process involving subtle thermal stimulation with a CO2 laser around the lesion can play a clinically positive role in reducing the recurrence rate by further cauterizing remaining virus-infected cells in the epidermis and its surroundings.

In the following situations, CO2 laser finishing treatment may be considered even more important:

- If the lesion borders are ambiguous, feel flat and spread out when touched, and if immunity is compromised (e.g., due to stress, sleep deprivation, etc.)

- If there is a history of multiple recurrences

- If lesions are located in areas prone to frequent contact and easy transmission, such as hands or face

Milia are small, white, pocket-like lesions that form due to the accumulation of keratin (a type of skin protein) beneath the skin's surface. They are typically observed around the eyes, on the cheeks, and forehead, and unlike sebaceous cysts, they are classified as benign lesions unrelated to infection or inflammation.

Er:YAG laser can be effectively used for milia removal. It delicately ablates the skin surface to remove the thin covering of the milia and safely expels the trapped keratin. Finishing with a light cauterization using a CO2 laser after removal can help prevent the regrowth of remaining keratinocytes, thereby preventing milia from recurring in the same location. However, excessive heat damage to the skin can cause post-inflammatory hyperpigmentation, so careful intensity control is required during the procedure.

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

- If milia frequently recur in the same area

- If there is a history of lesions reappearing during recovery after treatment

- If even results are desired during recovery after the removal of multiple milia

Syringomas are benign skin lesions caused by the overgrowth of sweat gland tissue (eccrine glands) in the dermal layer. They typically appear as multiple small, bead-like formations, mainly under the eyes, on the cheeks, and forehead. They are commonly seen due to genetic factors or in women aged 20-30s.

Er:YAG laser can thinly and precisely remove the epidermis, making it suitable for treating syringomas in sensitive areas like around the eyes. The method of gently refining the skin surface and removing the upper part of the sweat gland lesion can reduce concerns about scarring or hyperpigmentation during recovery, leading to cosmetically satisfactory results. At this point, by delivering thermal energy with a CO2 laser,

a finishing process that provides subtle stimulation to the deeper parts of the lesion contributes to weakening the activity of the sweat glands in the dermis, and

can be clinically significant in preventing syringomas from recurring in the same area. However, as lesions are often deep, repeated treatments may be necessary.

In the following situations, considering CO2 laser finishing can have a positive impact on treatment:

- If multiple syringoma lesions are located relatively deeply in areas such as under the eyes or on the cheeks

- If there is a history of recurrence despite having received laser treatments multiple times previously

- If you are hoping for recurrence prevention 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 are typically observed as small, skin-colored protrusions in areas where the skin folds, such as the neck, armpits, under the breasts, and eyelids. They are not painful but can become irritated by friction. CO2 laser is generally primarily used for skin tag excision, offering advantages in rapidly removing multiple lesions due to its precise cutting power and hemostatic effects. However, for small and thin skin tags, a method of delicately refining the lesion with an Er:YAG laser followed by cauterization of the base with a CO2 laser can be useful. This helps manage the root tissue of the skin tag, reducing the likelihood of recurrence in that area, and the thermal stimulation can affect fibrous cells and microvessels within the tissue, contributing to managing the regenerative environment.

Situations where combining CO2 laser finishing can be particularly helpful are as follows:

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

- If there is a history of skin tags recurring in the treated area

- If the lesion has deep or widely distributed roots (a type where a slightly convex trace remains on the skin even after removal)

As such, depending on the depth and type of the lesion,

utilizing a combination of two types of lasers,

the 'Dual Laser Technique' is

an approach that can help enhance the effectiveness of the treatment.

After mole removal, how long should Duoderm (sticker) be applied?

Mole removal procedures can irritate the skin surface.

Therefore, protecting and managing the treated area well plays a crucial role in recovery.

Keeping the treated area moist instead of dry has benefits in aiding recovery speed and reducing the likelihood of scarring.

At this time, we recommend using Duoderm, a type of hydrocolloid bandage.

Duoderm helps the wound area stay moist, preventing it from drying out, which aids in the process of new skin regeneration. It also delays scab formation, reducing the risk of scarring.

It is advisable to apply Duoderm immediately after mole removal, change it every 3-5 days, and continue management for at least 7 days.

It is generally recommended to expect an overall management period of approximately 10 days.

If you experience discomfort or an allergic reaction when using Duoderm, you should frequently apply a regenerative cream or moisturizing gel to prevent dryness. Additionally, you must diligently apply sunscreen with SPF 50 or higher and take care not to touch the treated area as much as possible.

Post-mole removal care is a crucial process that goes beyond simply protecting the treated area; it significantly enhances the completeness of the treatment results.

Neglecting care can lead to marks, so it's advisable to continue paying close attention after the procedure.

Our medical institution provides detailed guidance on post-procedure care to support our patients' healthy recovery.

When the procedure is deemed suitable

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• 1. Individuals who have experienced discomfort due to various skin issues such as moles, seborrheic keratosis, milia, syringoma, or skin tags.
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• 2. Individuals who are concerned about recurrence in the same area after mole removal.
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Procedure Steps

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• STEP 01. Personal Hygienic 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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• ㆍ Avoid direct water contact with the treated area. Washing your face with DuoDERM attached is recommended.
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• ㆍ During skin regeneration, regularly replace and continuously wear the regeneration dressing. Keeping it in place for approximately 10 days is recommended.
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• ㆍ Moles may recur in the treated area. If another procedure is considered necessary, it can be considered after at least 4–6 weeks.
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• ㆍ Deep-rooted moles may require several treatment sessions.
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• ㆍ Avoid ultraviolet exposure as much as possible. Sunscreen is essential, and applying it over DuoDERM is also recommended.
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