Laser Removal of Various Protruding Skin Lesions such as Skin Tags, Milia, Seborrheic Keratosis, and Warts

Dual Laser Application Method Considering Lesion Characteristics

*Moles are skin lesions caused by an abnormal increase in melanin-producing cells in the epidermis or dermis.

Even if it appears to be simple pigmentation on the surface, the removal method may vary depending on the depth or location of the lesion within the skin layer.

Erbium YAG laser is used for precise ablation of the skin surface. It is expected to be effective in removing superficial moles located primarily in the epidermis, by precisely shaving off the lesion while minimizing stress on the surrounding skin.

This procedure can reduce the risk of scarring and lead to aesthetic improvement. It can be particularly advantageous for mole removal on the face. Subsequently, a process of cauterizing the root part of the mole with heat using a CO2 laser is used to remove melanin cells that may remain deep within the skin. This helps reduce the possibility of 'recurrent moles' that reappear when the root remains after only the surface has been removed.

The finishing process using a CO2 laser can be considered in conjunction, especially in the following situations:

- If the mole is slightly raised or feels thick above the skin when pressed with a finger

- If there has been a previous experience of mole recurrence in the same area

- If it is determined to be a nevus located deep in the dermal layer of the skin (e.g., blue moles or gray-brown moles)

*Flat warts are viral skin lesions caused by infection with the human papillomavirus (HPV). They typically appear spread out in the epidermal layer and are observed as thin, wide-spreading brown or flesh-colored small lesions. They are especially prone to develop when immunity is weakened and can spread to other parts of the body, making early treatment important.

Erbium YAG laser helps to uniformly ablate the epidermal layer, thus helping to improve widespread flat warts

in one go. The goal is to evenly remove the lesions while minimizing stress on the skin. However, viral lesions may have a risk of recurrence if only the surface is removed. In such cases, the finishing process of applying thermal stimulation to the area around the lesion with a CO2 laser helps to additionally cauterize virus-infected cells that may remain in the epidermis and its surroundings. This can clinically help reduce the possibility of recurrence.

In the following situations, the finishing process using a CO2 laser may be further recommended:

- If the lesion's border is not clear or feels flat and spread out when touched, and if immunity is weakened due to stress, lack of sleep, etc.

- If there has been a history of multiple recurrences

- If the lesion is located in areas prone to frequent contact or spread, such as hands or face

*Milia are lesions that appear as small, white, pocket-like structures when keratin (a type of skin protein) gets trapped within the skin. They typically occur around the eyes, on the cheeks, and forehead, and unlike sebaceous cysts, they are aesthetic lesions that appear without infection or inflammation.

Erbium YAG laser is effectively used for milia removal. It precisely ablates the skin surface to open the thin epidermal layer of the milia, helping the trapped keratin to be effectively discharged. Subsequently, a light finishing cauterization with a CO2 laser can help reduce the possibility of remaining keratinocytes re-proliferating, thereby reducing the recurrence of milia in the same area. However, strong thermal stimulation on the skin can cause hyperpigmentation, requiring precise intensity control.

Cases where CO2 laser finishing can be particularly helpful include the following:

- When milia repeatedly appear in the same location

- If there has been an experience of lesions re-emerging during the recovery process after the procedure

- When desiring more even improvement during the recovery process after removing multiple milia

*Syringomas are benign lesions caused by the excessive proliferation of sweat glands (eccrine glands) in the dermal layer of the skin. They are characterized by appearing as multiple small, bead-like skin lesions found under the eyes, on the cheeks, and forehead. They can have genetic factors or commonly appear in women in their 20s and 30s.

Erbium YAG laser can remove the epidermis thinly and precisely, making it effective for treating syringomas in sensitive areas like around the eyes. By refining the skin surface, the upper part of the sweat gland lesion is removed, and aesthetic improvement can be expected with reduced risk of scarring or pigmentation during recovery. Subsequently, applying thermal energy through a CO2 laser,

a finishing method that provides subtle thermal stimulation to the deeper parts of the lesion, can weaken the activity of sweat glands within the dermis and

clinically help reduce the recurrence of syringomas in the same area. However, it is important to be aware that multiple treatments may be necessary due to the depth of the lesions.

In the following cases, combining CO2 laser finishing can have an even more positive impact on the treatment results:

- If multiple syringomas are located relatively deep under the eyes, on the cheeks, etc.

- If there has been a history of recurrence despite receiving multiple laser treatments previously

- When desiring to pay extra attention to preventing 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 appear in areas where skin folds occur, such as the neck, armpits, under the breasts, and eyelids, and look like small, skin-colored bumps. They are painless but can become irritated by friction. Generally, CO2 laser is primarily used for skin tag removal due to its cutting and hemostatic effects, allowing for quick treatment of many lesions. However, for small and thin skin tags, a method of first precisely ablating the lesion with an Erbium YAG laser and then finishing cauterization of the root part with a CO2 laser may be considered. This can help remove the root tissue of the skin tag and reduce the likelihood of recurrence in that area. Thermal stimulation can also affect fibrous cells and microvessels within the tissue, helping to suppress the recurrence environment.

The following cases are recommended for combining CO2 laser finishing:

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

- If there has been an experience of skin tags reappearing in the treated area after the procedure

- If the root tissue of the lesion is deep and widely spread (a type where a raised mark may remain even after the procedure)

Thus, considering the depth and nature of each lesion,

using two types of lasers together,

‘the dual laser treatment’

is an approach that can help increase satisfaction with the procedure.

How long should DuoDERM (sticker) be applied after mole removal?

Mole removal procedures delicately abrade the skin's surface, causing minor damage to the skin.

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

Keeping the treated area moist is particularly beneficial for recovery and reduces the likelihood of scar formation.

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

Duoderm can help maintain a moist environment for the wound, aiding cell regeneration. This slows scab formation, contributing to a lower chance of scarring.

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

The total care period is approximately 10 days.

If using Duoderm is difficult or if a skin allergy occurs, you should apply plenty of regenerative cream or moisturizing gel to prevent dryness. Additionally, it is important to diligently apply sunscreen with an SPF of 50 or higher and to avoid touching the treated area.

Post-care after mole removal is more than just protecting the wound; it's a crucial step that can influence the procedure's outcome.

If proper care is not followed, scars may form, so continued attention is needed even after the procedure.

For a quick and healthy recovery, we provide detailed guidance on post-procedure care methods.

Recommended Candidates

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• 1. Those who have experienced discomfort due to moles, seborrheic keratoses (age spots), milia, syringomas, skin tags, etc.
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• 2. Those who have experienced recurrence after mole removal.
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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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• ㆍBe careful not to let water directly touch the treated area. (It is recommended to wash your face with Duoderm still applied.)
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• ㆍDuring skin regeneration, please consistently replace the recovery tape for approximately 10 days.
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• ㆍThere is a possibility that the mole may reappear in the treated area. In case of recurrence, you may undergo the procedure again after approximately 4 to 6 weeks.
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• ㆍIf the mole had deep roots, complete removal might be difficult with a single procedure, and multiple treatments may be necessary.
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• ㆍIt is best to avoid UV exposure as much as possible. Sunscreen must be used, and it is recommended to apply it even over Duoderm.
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