Dual Laser Treatment Technique

*A mole is a skin change that appears when melanin-producing cells abnormally increase in the epidermis or dermis.

Even if it appears to be a simple pigmented lesion on the surface, the treatment method may vary depending on the location and depth of the mole.

Erbium-YAG laser is suitable for precise epidermal exfoliation, helping to remove shallow moles on the surface while minimizing damage to surrounding skin and promoting natural removal.

This procedure can reduce the burden of scar formation, allowing for cosmetic improvement, and can be particularly useful for facial mole removal. Subsequently, using a CO2 laser to cauterize the root of the mole with heat helps remove any melanin cells that may remain deep, reducing the likelihood of mole recurrence. This is significant in reducing the risk of recurrent moles where surface cells are removed but root cells remain and grow back.

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

- When the mole is slightly raised or feels thick to the touch

- When there has been a history of mole recurrence in the same area

- When diagnosed as a nevus located deep in the dermal layer (e.g., blue nevus, gray-brown nevus, 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 lesions to the naked eye. They are more likely to occur when immunity is weakened and can spread through self-contact, so early intervention is recommended.

The Erbium-YAG laser is used for uniform exfoliation of the epidermal layer, helping to improve widely distributed flat warts

in a single session. It minimizes skin damage while evenly treating the affected 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, a finishing process involving CO2 laser to apply thermal stimulation around the lesion can be a clinically significant approach to reduce recurrence rates by additionally cauterizing any remaining virus-infected cells in the epidermis and surrounding areas.

CO2 laser finishing may be particularly important in the following situations:

- When the lesion's borders are indistinct or when it feels widely spread upon touch

- When there has already been a history of multiple recurrences

- When the lesion is on an area prone to frequent contact and easy spreading, such as the hands or face

*Milia are lesions that appear as small, white, grain-like bumps when keratin (a type of protein) gets trapped in tiny pockets within the skin. They primarily occur around the eyes, on the cheeks, and forehead, and unlike sebaceous cysts, they are not related to infection or inflammation.

The Erbium-YAG laser is effectively used for milia removal. It finely shaves the skin surface to open the thin layer covering the milia, creating a pathway to safely extract the accumulated keratin inside. A subsequent light cauterization with a CO2 laser helps reduce the risk of residual keratinocytes re-proliferating and can help prevent milia from repeatedly forming in the same area. However, excessive heat stimulation to the skin can cause hyperpigmentation, requiring careful intensity control.

CO2 laser finishing is particularly useful in the following situations:

- When milia repeatedly occur in the same area

- When the lesion has reappeared during the recovery process after treatment

- When, after removing multiple milia, you desire smooth skin texture regeneration during the recovery process

*Syringomas are benign skin lesions caused by an excessive proliferation of sweat glands (eccrine glands) in the dermal layer. They are characterized by multiple small, firm, bead-like lesions appearing under the eyes, on the cheeks, and forehead. They can be influenced by genetics or are relatively common in women in their 20s and 30s.

The Erbium-YAG laser is advantageous for thin and precise epidermal removal, making it useful for treating syringomas in sensitive areas like around the eyes. It helps refine the skin surface to eliminate the upper part of the sweat gland lesions and can enhance cosmetic satisfaction by reducing the risk of scarring or hyperpigmentation during the post-treatment recovery process. Subsequently, irradiating with a CO2 laser

to induce subtle thermal damage to the deeper parts of the lesion can clinically help suppress the activity of dermal sweat glands,

and prevent syringomas from re-proliferating in the same area. However, due to the depth of the lesions, multiple treatments may be necessary.

In the following cases, combining with CO2 laser finishing can yield even better improvement:

- When multiple syringomas are relatively deeply seated under the eyes, on the cheeks, etc.

- When there has been a history of recurrence even after multiple previous laser treatments

- When aiming to enhance recurrence prevention with a single treatment

*Skin tags are benign skin lesions caused by an excessive proliferation of fibrous tissue and blood vessels in the dermal layer. They primarily occur in areas where the skin folds, such as the neck, armpits, under the breasts, and on the eyelids, appearing as small, raised, skin-colored growths. They are usually painless but can become irritated due to friction. CO2 laser is commonly used for skin tag removal due to its excellent cutting and hemostatic effects, allowing for quick treatment of multiple lesions. However, for small and thin skin tags, a method involving precise superficial exfoliation with an Erbium-YAG laser, followed by CO2 laser cauterization of the root part of the lesion, can help remove deep skin tag tissue, thereby reducing the risk of recurrence in that area. Thermal stimulation contributes to inhibiting the recurrence environment by denaturing fibrous cells and microvessels within the tissue.

The following situations particularly benefit from combining CO2 laser finishing:

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

- When there has been a history of skin tags recurring in the same area after treatment

- When the root tissue of the lesion is deep or wide, potentially leaving a raised mark even after treatment

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

using a combination of two types of lasers,

the ‘Dual Laser Treatment’

can help enhance treatment satisfaction.

After mole removal, how long should DuoDERM (healing patch) be applied?

Mole removal is a procedure that delicately exfoliates the skin surface, which may temporarily leave small wounds on the skin.

Therefore, protecting and managing the wound site well after the procedure is a crucial part of the recovery process.

Keeping the wound site moisturized, especially to prevent it from drying out, can aid in recovery and contribute to reducing the likelihood of scar formation.

For these reasons, we recommend managing the area by applying DuoDERM, a hydrocolloid dressing.

DuoDERM helps keep the wound site moist, assisting the new skin growth process and preventing unnecessary scabs, thereby reducing the possibility of scarring.

It is recommended to apply DuoDERM immediately after the mole removal procedure and continue consistent management for at least 7 days, changing it every 3-5 days.

You can expect a total management period of approximately 10 days.

If using DuoDERM causes discomfort or an allergic reaction, you should frequently apply a regenerative cream or moisturizing gel to prevent skin dryness. Additionally, it is important to carefully apply sunscreen with an SPF of 50 or higher and avoid touching the treated area.

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

Neglecting aftercare may lead to scar formation, so it is advisable to continue paying close attention to the treated area even after the procedure.

To aid in a quick and healthy recovery, we also provide detailed guidance on post-procedure care methods.

Recommended for

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• 1. Recommended for those who have skin concerns such as moles, lentigines, milia, syringomas, or skin tags.
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• 2. Also applicable to those who have had moles removed in the past but are concerned about their recurrence.
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Procedure Steps

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• STEP 01. Self-Cleansing
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• STEP 02. Anesthetic Cream Application
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• STEP 03. Mole Removal
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Post-Procedure Precautions

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• ㆍYou should avoid direct contact with water on the treated area. Facial cleansing is possible while DuoDERM is applied.
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• ㆍIt is recommended to consistently replace and apply the regenerative patch during skin regeneration. Maintain this for approximately 10 days.
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• ㆍMoles may reappear in the removed area. If re-treatment is necessary, it can generally be considered after 2-3 months.
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• ㆍDeep-rooted moles may be difficult to remove completely in a single session, and multiple treatments may be required.
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• ㆍIt is crucial to minimize sun exposure as much as possible. Always use sunscreen, and it is also good to apply it over DuoDERM.
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