Dual Laser Removal of Flat Warts with Focus on Recurrence Management

Dual Laser Technique

Moles are skin lesions that appear due to the abnormal proliferation of melanin pigment cells in the epidermis or dermis.

Their appearance is similar to general hyperpigmentation, but the removal method varies depending on the actual location and depth of the lesion.

Erbium YAG laser is effective for precisely ablating shallow lesions in the epidermal layer. Using this laser can gently remove surface moles while minimizing skin damage.

This procedure can lead to cosmetic improvements while reducing the risk of scarring, making it particularly useful for removing moles on the face. After the procedure, delicately cauterizing the base of the mole with a CO2 laser can help remove melanin cells that may remain in the deeper layers of the skin, thereby reducing the possibility of mole recurrence. This method prevents recurrent moles that may regrow after the surface is removed, but the root tissue remains.

Specifically, the finishing process using a CO2 laser can be considered in the following situations:

- If a mole appears slightly raised or feels thick to the touch

- If there has been a history of a mole recurring in the same area previously

- If diagnosed as a nevus located deep in the dermis, such as a blue nevus or grayish-brown nevus

Flat warts are viral skin diseases caused by human papillomavirus (HPV) infection. They typically spread across the epidermal layer, appearing to the naked eye as thin, widely spread, small brown or skin-colored lesions. They are prone to occur when immunity is weakened and can spread to other areas if touched or scratched, so early treatment is recommended.

Erbium YAG laser helps to uniformly remove the epidermal layer. Therefore, it can be useful when treating widely spread flat warts

in one session. This method has the advantage of evenly removing lesions while reducing the risk of skin damage. However, due to the nature of viral lesions, there may be a possibility of recurrence if only the surface is removed. In such cases, a finishing step of applying subtle thermal stimulation to the area around the lesion with a CO2 laser can be a clinically significant approach to additionally remove potentially remaining virus-infected cells in the epidermis and surrounding tissues, thereby lowering the chance of recurrence.

Specifically, CO2 laser finishing may be more necessary in the following cases:

- If the lesion's border is unclear, or it feels flat and spread out to the touch, or for individuals with weakened immunity due to stress or lack of sleep

- If there has been a history of flat warts recurring multiple times

- If the lesion is in a frequently touched area like the hands or face, or an area where it can easily spread to other parts of the body

Milia are lesions that appear as small, white sacs due to the accumulation of keratin (keratin protein) under the skin. They primarily occur around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are a cosmetic issue not directly related to infection or inflammation.

Erbium YAG laser can be effectively used for milia removal. This laser precisely ablates the skin surface to open the thin epidermal layer covering the milia, helping to safely expel the trapped keratin. After milia removal, gently cauterizing with a CO2 laser can help reduce the possibility of residual keratinocytes proliferating again and reduce the recurrence of milia in the same area. However, excessive thermal stimulation can cause hyperpigmentation, so delicate intensity control is important.

CO2 laser finishing is particularly useful in the following cases:

- If milia repeatedly occur in the same location

- If there has been a history of lesions protruding again during the recovery process after the procedure

- If you desire a more even and clean result during the recovery process after removing multiple milia

Syringomas are benign skin lesions caused by the excessive proliferation of sweat glands (eccrine glands) in the dermis. They are characterized by multiple small, bead-like lesions found under the eyes, on the cheeks, and on the forehead. They are often hereditary or relatively common in women in their 20s and 30s.

Erbium YAG laser can delicately and thinly remove the epidermis, making it suitable for managing syringomas in sensitive areas like around the eyes. It helps to clear the upper part of the lesion on the skin's surface, and after recovery, it can be cosmetically beneficial with less risk of scarring or hyperpigmentation. Subsequently, applying thermal energy with a CO2 laser

as a finishing treatment to cause micro-damage to the deeper parts of the lesion can contribute to weakening the abnormal activity of dermal sweat glands,

and it is a clinically significant approach to reduce the recurrence of syringomas in the same area. However, due to the nature of the lesions' depth, multiple treatment sessions may be required.

In the following cases, combining CO2 laser finishing can yield synergistic effects:

- If multiple syringomas are located relatively deep under the eyes or on the cheeks

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

- If the goal is to achieve the maximum possible recurrence prevention effect with a single session

Skin tags (acrochordons) are benign lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermis. They primarily occur in areas where skin folds, such as the neck, armpits, under the breasts, and eyelids, appearing as small, skin-colored protrusions. They are painless but can be irritated by friction. Generally, CO2 laser is commonly used for skin tag removal, as its excellent cutting ability and hemostatic effect can quickly treat many lesions. However, for small and thin skin tags, precisely ablating the lesion with an Erbium YAG laser, followed by cauterizing the base with a CO2 laser, can help remove the root tissue of the skin tag, thereby contributing to reducing the possibility of recurrence in that area. Thermal stimulation has the effect of denaturing fibrous cells and microvessels in the tissue, inhibiting the environment for recurrence.

Combining CO2 laser finishing is expected to yield better results in the following cases:

- If skin tags are located in high-friction body areas like the neck or armpits

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

- If the lesion's root is deep and widely spread (a type that may leave a thick mark even after treatment)

Thus, by matching the depth and nature of the lesion,

applying two types of laser treatments together,

'Dual Laser Technique'

can be an important strategy for enhancing the completeness of the treatment.

After mole removal, how long should I keep the DuoDERM (sticker) on?

Mole removal procedures cause damage by applying physical stimulation to the skin surface.

Therefore, properly protecting and managing the treated area is very important.

In particular, maintaining a moist environment in the treated area can contribute to skin recovery and reduce the risk of scar formation.

For this purpose, it is recommended to use Duoderm, a hydrocolloid dressing.

Duoderm can help maintain moisture in the wound area, aiding in skin cell regeneration. This helps inhibit scab formation, reducing the likelihood of scarring.

Immediately after mole removal, apply Duoderm and change it every 3-5 days. It is recommended to maintain this care for at least one week.

A total management period of approximately 10 days can be considered.

If Duoderm use is difficult or an allergic reaction occurs, you can frequently apply a regenerating cream or moisturizing gel to prevent dryness. At the same time, carefully apply sunscreen with SPF 50 or higher and be careful not to touch the treated area.

Post-mole removal care is not merely about protecting the treated area; it is a crucial step that affects the treatment outcome.

Neglecting care can lead to scarring, so it is advisable to maintain continuous attention even after the procedure.

At Kkeut Oriental Medicine Clinic, we provide detailed explanations on post-procedure care methods for rapid skin recovery and maintaining healthy results.

Recommended Candidates

• 
  
• 
  
• 1. Those concerned with moles, seborrheic keratosis, milia, syringoma, or skin tags.
• 
  
• 
  
• 
  
• 2. Those who have experienced recurrence after previous mole removal.
• 
  
• 
  

Procedure Steps

• 
  
• 
  
• STEP 01. Personal Cleansing
• 
  
• 
  
• 
  
• STEP 02. Anesthetic Ointment Application
• 
  
• 
  
• 
  
• STEP 03. Mole Removal Procedure
• 
  
• 
  

Post-Procedure Precautions

• 
  
• 
  
• ㆍCare is needed to prevent water from directly touching the treated area. (Please cleanse your face after applying Duoderm.)
• 
  
• 
  
• 
  
• ㆍDuring the skin regeneration period, it is recommended to consistently change and apply the regenerative tape for about 10 days.
• 
  
• 
  
• 
  
• ㆍThere is a possibility that moles may reappear in the removed area. Re-treatment can be considered after 4-6 weeks.
• 
  
• 
  
• 
  
• ㆍDeep-rooted moles are difficult to remove completely in a single session, and may require multiple treatments.
• 
  
• 
  
• 
  
• ㆍMinimize exposure to UV rays. Sunscreen is essential, and applying it over Duoderm can also be helpful.
• 
  
•