Flat Wart Dual Laser Removal (Focus on Recurrence Management)

Dual Laser Approach Considering Lesion Characteristics

*Moles are pigmented lesions that occur when melanin pigment cells abnormally proliferate in the epidermal or dermal layers of the skin.

Even if they look the same on the surface, the appropriate treatment method may vary depending on the location or depth of the mole.

Erbium YAG laser is primarily used for precise resurfacing of the skin surface. When removing moles shallowly located in the epidermis, it can help selectively remove only the lesioned area while minimizing impact on surrounding skin.

This laser can reduce the risk of scarring and achieve clean treatment results, making it particularly suitable for facial mole removal. Following this, a CO2 laser can be used to thermally treat the root of the mole. This helps reduce the likelihood of moles recurring by treating melanin cells that may remain in deeper areas. It can be useful in preventing moles from recurring from remaining roots after only the surface has been removed.

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

- When the mole lesion is slightly raised above the surface, or feels bumpy to the touch.

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

- When the lesion is judged to be a nevus located in the deep dermal layer (e.g., blue nevus, brown nevus, etc.)

*Flat warts are viral skin lesions caused by human papillomavirus (HPV) infection. They typically appear as widespread, flat, brownish or skin-colored small lesions in the epidermal layer, visible to the naked eye. They are prone to appearing when immunity is weakened and can spread to other areas by self-contact, so it is important to consult a medical professional early and begin appropriate management.

Erbium YAG laser is useful for uniformly removing the epidermal layer and is effective for widespread flat warts,

which can be treated in one go. This can remove lesions evenly while reducing skin burden. 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 subtle thermal stimulation around the lesion using a CO2 laser can clinically help reduce the likelihood of recurrence by further treating remaining virus-infected cells in the epidermis and surrounding areas.

Particularly in the following situations, combining a CO2 laser finish can be considered:

- When the lesion's boundaries are unclear or it feels widespread to the touch. Also, when immunity is weakened (due to stress, lack of sleep, etc.).

- If there is a history of flat warts recurring multiple times.

- When lesions are located in areas frequently touched or prone to viral spread, such as hands or face.

*Milia are lesions that appear as small white sacs due to the accumulation of keratin (a type of skin protein) beneath the skin. They are primarily observed around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are benign lesions not directly associated with infection or inflammation.

Erbium YAG laser can be effectively used for milia removal. It precisely ablates the skin surface to open the thin epidermal layer covering the milia, creating a pathway to remove the accumulated keratin inside. A light finishing process with a CO2 laser after the procedure can help reduce the re-proliferation of any remaining keratinocytes, thereby lowering the chance of milia reappearing in the same location. However, excessive thermal stimulation to the skin can cause hyperpigmentation, so delicate intensity control is important.

A CO2 laser finish may be particularly considered in the following cases:

- If milia repeatedly recur in the same area.

- If you have experienced the lesion reappearing during the recovery process after treatment.

- If you expect more uniform and smoother skin results during the recovery process after removing multiple milia.

*Syringomas are benign tumors that result from the excessive proliferation of eccrine sweat gland tissue in the dermal layer. They are characterized by multiple small, bead-like lesions appearing around the eyes, cheeks, and forehead. They may have a genetic component or are relatively common in women in their 20s and 30s.

Erbium YAG laser can finely and delicately treat the epidermis, making it suitable for treating syringomas in sensitive areas like the periorbital region. This laser refines the skin surface and removes the upper part of the sweat gland lesions, leading to good cosmetic outcomes by reducing the likelihood of scarring or hyperpigmentation during the post-treatment recovery process. Next, by delivering thermal energy through a CO2 laser,

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

can have clinical significance in reducing the likelihood of syringomas recurring in the same area. However, due to the depth of the lesions, multiple repeat treatments may be necessary.

Improved treatment outcomes can be expected when combining CO2 laser finishing in the following cases:

- When multiple syringomas are located relatively deep in areas such as around the eyes or cheeks.

- If you have a history of syringomas recurring despite having received multiple laser treatments previously.

- When aiming to enhance recurrence prevention with a single procedure.

*Skin tags are benign skin lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermal layer. They typically appear as small, skin-colored protuberances in areas where skin folds occur, such as the neck, armpits, under the breasts, and eyelids. They are painless but can cause discomfort due to friction. Generally, CO2 laser is more effectively used for skin tag removal due to its excellent excisional and hemostatic capabilities, allowing for rapid treatment of many lesions. However, for small and thin skin tags, an approach can be applied where the lesion is first precisely ablated with an Erbium YAG laser, followed by a thermal finish to the root of the lesion with a CO2 laser. This can help reduce the likelihood of recurrence in that area by treating the entire root tissue of the skin tag. Thermal stimulation can affect fibrous cells and microvessels within the tissue, contributing to the regulation of the re-proliferation environment.

Cases where combining a CO2 laser finish is recommended are as follows:

- When located in areas frequently subjected to friction, such as the neck or armpits, where skin tags can be easily irritated.

- If there is a history of skin tags recurring in the same area after removal.

- When the lesion's root is deep and widespread (a form prone to leaving raised marks even after treatment).

As such, considering the characteristics and depth of the lesion,

using two types of lasers in combination

the ‘Dual Laser Approach’

can play a crucial role in increasing treatment satisfaction.

What is the recommended duration for applying DuoDERM (hydrocolloid dressing) after mole removal?

Since mole removal procedures involve gently peeling off the skin surface, they can cause minor damage to the skin.

Proper protection and care of the treated area significantly impact recovery.

In particular, keeping the treated area moist is crucial for promoting faster healing and reducing the likelihood of scarring.

For this type of care, the use of Duoderm, a hydrocolloid dressing, is often recommended.

Duoderm helps maintain a moist environment for the wound, aiding in cell regeneration. It can suppress scab formation, thereby reducing the chance of post-procedure scarring.

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

Generally, about 10 days of care may be required.

If using Duoderm is uncomfortable or if an allergic reaction occurs, you should apply a regenerating cream or moisturizing gel frequently to prevent dryness. Additionally, it is important to carefully apply sunscreen with SPF 50 or higher and avoid touching the treated area.

Post-mole removal care can significantly influence the procedure's outcome, beyond just simple wound protection.

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

We provide detailed guidance on post-procedure care methods to help patients recover quickly and healthily.

Recommended Candidates for the Procedure

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• 1. Individuals who have experienced skin concerns such as moles, seborrheic keratoses, milia, syringomas, or skin tags may consider the procedure.
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• 2. Individuals whose moles have reappeared in the same area after removal and require further treatment.
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Procedure Steps

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• STEP 01. 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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• ㆍ시술 부위에 직접적으로 물이 닿지 않도록 주의해야 합니다. (듀오덤 부착 후 세안하는 것을 권장합니다.)
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• ㆍ피부 재생 기간 동안에는 재생 테이프를 약 10일 정도 꾸준히 교체하여 부착하는 것이 좋습니다.
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• ㆍ제거된 부위의 점은 다시 나타날 수 있으며, 필요 시 4~6주 이후부터 재시술을 고려할 수 있습니다.
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• ㆍ뿌리가 깊은 점의 경우 여러 차례의 시술이 필요할 가능성이 있습니다.
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• ㆍ자외선 노출은 가능한 한 피하는 것이 좋습니다. (자외선 차단제 사용은 필수이며, 듀오덤 위에도 덧바르는 것을 권해드립니다.)
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