Dual Laser Removal for Recurrent Flat Warts

Approach to Combined Laser Procedures

Moles are pigmented lesions that occur due to an excessive increase in melanin cells in the epidermal or dermal layers of the skin.

Although they may appear as simple pigmentation, the treatment method varies depending on their depth and location.

The Er:YAG laser is effective in precisely ablating the skin surface. This allows for the removal of shallow moles in the epidermal layer with reduced skin damage and the expectation of natural-looking results.

This procedure minimizes scar formation, leading to aesthetically pleasing results, and can be particularly useful for facial mole removal. Afterwards, a CO2 laser can be used to precisely cauterize the root of the mole with heat. This helps to destroy melanin cells that may remain deep within, reducing the likelihood of mole recurrence. It helps to prevent cases where the surface is removed but root tissue remains, causing the mole to reappear.

A CO2 laser finish can be particularly considered in the following situations:

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

If there is a history of moles recurring in the same area

If diagnosed as a nevus located deep in the dermal layer (e.g., blue moles, grayish-brown moles, etc.)

Flat warts are viral skin diseases caused by human papillomavirus (HPV) infection. They typically spread widely in the epidermal layer and appear as thin, flat, brown or flesh-colored small lesions to the naked eye. They are prone to occurring when immunity is weakened and can spread to other areas through self-contact, so early management is important.

The Er:YAG laser helps to uniformly remove the epidermal layer of the skin. This makes it convenient for treating widespread flat wart lesions

simultaneously. This procedure minimizes skin damage while evenly clearing the lesion area. However, due to the nature of viral diseases, there is a possibility of recurrence if only the superficial part is removed. In such cases, the finishing step of applying subtle thermal stimulation around the lesion with a CO2 laser can positively impact reducing the recurrence rate by further eliminating virus-infected cells that may remain in the epidermis and surrounding areas.

The CO2 laser finishing process is considered even more important in the following cases:

This is considered when the lesion's borders are unclear, when it feels widely spread across the skin upon touch, or for individuals with weakened immunity (due to stress, lack of sleep, etc.).

If there is a history of flat warts recurring multiple times

If the lesions are in locations prone to frequent contact and spreading to other areas, such as hands or face

Milia are small, white, pocket-like lesions formed when keratin, a skin protein, becomes trapped beneath the skin. They are typically observed around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are a cosmetic concern unrelated to infection or inflammation.

The Er:YAG laser can be usefully employed to remove milia. It delicately ablates the skin surface to clear the thin epidermal layer of the milia, creating a pathway for the trapped keratin to be released without difficulty. A light cauterization finish with a CO2 laser after the procedure can help reduce the possibility of remaining keratin cells re-proliferating and prevent milia from reappearing in the same area. However, excessive heat stimulation to the skin may cause hyperpigmentation, requiring delicate intensity control.

Situations where a CO2 laser finish can be particularly helpful include:

If milia have repeatedly occurred in the same location

If there is a history of lesions reappearing during the regeneration period after treatment

If, after removing multiple milia, you desire even skin improvement during the recovery process

Syringomas are benign skin lesions that appear due to the excessive proliferation of sweat gland (eccrine gland) tissue located in the dermal layer. They are typically characterized by multiple small, millet-seed-shaped lesions that can be felt, primarily around the eyes, cheeks, and forehead. They can be hereditary or are commonly seen in women in their 20s and 30s.

The Er:YAG laser can delicately remove the skin epidermis, making it useful for managing syringomas in sensitive areas like around the eyes. This procedure refines the skin surface and removes the upper layer of sweat gland lesions, and with a low possibility of scarring or hyperpigmentation after recovery, it can enhance cosmetic satisfaction. Subsequently, applying thermal energy via a CO2 laser

the finishing process of providing subtle thermal stimulation to the deeper parts of the lesion helps reduce the abnormal activity of sweat glands within the dermis, and

can positively influence preventing syringomas from reappearing in the same area. However, as lesions are often deeply located, multiple treatment sessions may be required.

Applying a CO2 laser finish together in the following situations can lead to even better treatment outcomes:

If a large number of syringomas are relatively deeply distributed under the eyes, on the cheeks, etc.

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

If expecting the effect of reducing recurrence with a single treatment

Skin tags are benign skin lesions caused by the excessive proliferation of fibrous tissue and blood vessels within the dermis. They typically appear in areas where the skin frequently folds, such as the neck, armpits, under the breasts, and eyelids, observed as small, skin-colored protrusions. They are usually painless but can become irritated due to friction. Generally, a CO2 laser can be more effectively used for skin tag removal. The CO2 laser is advantageous for rapidly removing many lesions due to its excellent cutting and hemostatic capabilities. However, for smaller or thinner skin tags, a method of delicately removing the lesion's surface first with an Er:YAG laser and then cauterizing the base with a CO2 laser can be applied. This method helps manage the root tissue of the skin tag, reducing the likelihood of recurrence in that area. Thermal energy contributes to inhibiting the regrowth environment of the lesion by destroying fibrous cells and microvessels within the tissue.

Situations where combining a CO2 laser finish is particularly helpful are as follows:

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

If there is a history of skin tags recurring in an area where removal treatment was previously received

If the base of the lesion is deep or widely established (a type where raised traces may remain even after removal)

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

combining two types of laser procedures

'Dual Laser Treatment' is

a method that can contribute to increasing treatment satisfaction.

What is the recommended duration for using DuoDERM (regenerative tape) after mole removal?

The procedure for removing moles involves a process that causes minor damage to the skin's surface.

Therefore, it is important to properly protect and manage the treated area.

Recovery is smoother when the treated area is kept moist, and this can help reduce the possibility of scar formation.

For this management, it is recommended to apply a hydrocolloid dressing such as Duoderm.

Duoderm creates an optimal moist environment for the wound area, aiding in the cell regeneration process. This can contribute to reducing the risk of scar formation by delaying scab formation.

Immediately after mole removal, apply Duoderm. It is effective to consistently manage the area for at least 7 days, changing it every 3 to 5 days.

Approximately 10 days is a period that requires consistent care.

If you have difficulty using Duoderm or experience an allergic reaction, you should manage the area using other methods. Frequently apply a regenerative cream or moisturizing gel to prevent dryness, meticulously use sunscreen with an SPF of 50 or higher, and be careful not to touch the wound area.

Post-mole removal care is not just about protecting the wound; it is a crucial step that can affect the outcome of the procedure.

Neglecting care can lead to scarring, so it is advisable to continue consistent care after the procedure.

Our clinic provides detailed guidance on post-procedure care methods to help patients recover quickly and healthily.

We recommend this procedure for those who

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• 1. Those who have been experiencing skin concerns such as moles, seborrheic keratosis, milia, syringomas, or skin tags
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• 2. Those who are concerned about moles reappearing after a previous mole removal procedure
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Procedure Steps

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• STEP 01. Self-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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• ㆍ시술 부위에 물이 직접 닿는 것을 피해주시기 바랍니다. 듀오덤을 붙인 채로 세안하는 것이 좋습니다.
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• ㆍ피부 재생이 이루어지는 동안 재생 테이프는 꾸준히 교체하여 붙여주시는 것이 좋습니다. 약 10일 정도 유지가 권장됩니다.
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• ㆍ제거된 부위에 점이 다시 나타날 가능성이 있으며, 이 경우 4~6주 이후 재시술을 고려할 수 있습니다.
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• ㆍ뿌리가 깊은 점은 한 번의 시술로는 완전히 제거가 어려워 여러 차례 시술이 필요할 수 있습니다.
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• ㆍ자외선 노출은 가급적 피하는 것이 중요합니다. 자외선 차단제는 필수적으로 사용하시고, 듀오덤 위에 덧바르는 것도 좋습니다.
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