[Thoroughly with Dual Lasers] Flat Wart Removal Considering Recurrence

Treatment Approach Using Two Lasers

Milia are lesions that appear due to the excessive proliferation of melanin-producing cells in the epidermal or dermal layers of the skin.

Although they may appear to be simple pigmentation, the treatment method can vary depending on the location and depth of the spot.

Erbium YAG laser is used to precisely and gently peel off the skin's surface. This allows for the removal of shallow spots located in the epidermis, minimizing damage to surrounding skin.

Especially when removing facial spots, you can expect a clean improvement while reducing the risk of scarring. Afterward, precisely cauterizing the base of the treated area with a CO2 laser helps destroy melanin cells that may remain deep within. This process can contribute to reducing the possibility of recurrent spots that might reappear even if they seem to have vanished on the surface, due to remaining roots.

In the following cases, it is advisable to consider CO2 laser finishing:

- If the spot is slightly raised or feels thick to the touch

- If there is a history of the same spot recurring in the same area

- When the lesion is determined to be a mole located in the deep dermal layer, such as a blue or grayish-brown spot

Flat warts are viral skin lesions caused by human papillomavirus (HPV) infection. They appear as small, thin, flat, brownish or flesh-colored lesions that spread widely within the epidermal layer. They are particularly prone to occur when immunity is low and are autoinoculable, so early intervention is recommended.

Erbium YAG laser is effective in uniformly removing the epidermal layer. For widespread flat wart lesions,

it can be used for efficient treatment. It is possible to evenly remove lesions without causing significant damage to the skin. However, due to the nature of viral diseases, there is a risk of recurrence if only the surface is removed. In such cases, finishing with a CO2 laser by applying delicate thermal stimulation around the lesion can be a clinically significant approach to reduce the possibility of recurrence by further cauterizing potentially remaining virus-infected cells in and around the epidermis.

In the following cases, CO2 laser finishing can be significantly considered:

- When the border of the lesion is unclear, or it feels flat and spread out to the touch. Or in cases of individuals with weakened immunity (due to stress, lack of sleep, etc.)

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

- When lesions appear on areas prone to frequent contact and easy virus spread, such as hands or face

Milia are small, white, cyst-like lesions that occur due to the accumulation of keratin, a protein, within the skin. They are commonly observed around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are cosmetic concerns unrelated to infection or inflammation.

Erbium YAG laser is effective in removing milia. It precisely peels the skin surface to remove the thin epidermis covering the milium, creating a safe pathway for the trapped keratin to be expelled. Subsequently, a light cauterization finish with a CO2 laser reduces the possibility of residual keratin cells proliferating again. This can help prevent the recurrence of milia in the same area. However, excessive heat stimulation to the skin can cause hyperpigmentation, requiring precise intensity control.

CO2 finishing can be particularly useful in the following cases:

- If milia frequently recur in the same area

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

- When a more uniform skin condition is desired during the regeneration process after removing multiple milia

Syringomas are benign lesions that appear due to the abnormal proliferation of sweat gland (eccrine gland) tissue within the dermis. They mainly occur under the eyes, on the cheeks, and forehead, characterized by multiple small, bead-like skin lesions. They are commonly observed in individuals with a genetic predisposition or in women in their 20s and 30s.

Erbium YAG laser can delicately remove the epidermis, making it suitable for treating syringomas in sensitive areas like around the eyes. It gently refines the skin surface and removes the upper part of the sweat gland lesions, with less risk of scarring or pigmentation during recovery, leading to cosmetic improvement. Subsequently, applying heat with a CO2 laser

A finishing method that causes microscopic damage to the deeper parts of the lesion helps weaken the activity of sweat glands within the dermis.

This can clinically help prevent syringomas from proliferating again in the same area. However, due to the depth of the lesions, multiple treatment sessions may be required.

In the following situations, combining CO2 finishing can contribute to treatment improvement:

- When multiple syringomas are relatively deeply embedded under the eyes or on the cheeks

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

- When the focus is on reducing the possibility of recurrence with a single treatment session

Skin tags are benign skin lesions caused by the excessive proliferation of fibrous tissue and blood vessels in the dermis. They commonly appear in areas where skin folds, such as the neck, armpits, under the breasts, and eyelids, presenting as small, skin-colored protrusions. While painless, they can be irritated by friction. Generally, CO2 laser is widely used for skin tag removal, aiding in the quick removal of multiple lesions due to its excellent cutting and hemostatic effects. However, for small and thin skin tags, a method of first precisely peeling the lesion with an Erbium YAG laser, followed by finishing cauterization of the base with a CO2 laser, can help remove the root tissue of the skin tag. Thermal stimulation helps inhibit the regenerative environment by destroying fibrous cells and microvessels within the tissue.

The following cases are ideal for considering CO2 finishing:

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

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

- Types where the lesion's root is deep or wide, potentially leaving a raised mark even after removal

Thus, depending on the depth and characteristics of the lesion,

using two types of lasers in combination –

the 'Dual Laser Technique' –

is an approach that can help enhance the completeness of the treatment.

How long should I apply DuoDERM (sticker) after spot removal?

The procedure to remove moles is a process of gently exfoliating the skin's surface. During this process, slight physical irritation to the skin may occur.

Therefore, proper protection and care of the treated area are crucial for recovery.

In particular, keeping the treated area moist after the procedure can help skin recovery and minimize scarring.

As part of this care, attaching a hydrocolloid dressing like DuoDERM is often recommended.

DuoDERM helps maintain a moist environment in the treated area, promoting cell regeneration and reducing unnecessary scab formation, thereby lowering the risk of scarring.

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

The overall care period can be considered approximately 10 days.

If DuoDERM is difficult to use or if a skin allergic reaction occurs, apply a regenerative cream or moisturizing gel frequently to prevent dryness. Additionally, carefully apply sunscreen with SPF 50 or higher and take care not to touch the treated area during management.

Post-mole removal care is not just about protecting the treated area; it is a crucial step that can influence the overall procedure results.

If proper care is not followed, there is a possibility of scarring, so continuous attention after the procedure is necessary.

At Kkeut Oriental Medicine Clinic, we provide detailed guidance on post-procedure care methods to help our patients achieve smooth and healthy skin recovery.

Consider this procedure if you have any of the following concerns

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• 1. Those who have had skin concerns such as moles, seborrheic keratoses (age spots), milia, syringomas, or skin tags.
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• 2. Those who have experienced recurrence in the treated area after mole removal.
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Procedure Steps

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• STEP 01. Personal 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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• ㆍAvoid direct contact with water on the treated area. (Cleansing is possible with DuoDERM attached)
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• ㆍDuring skin regeneration, replace and apply the regenerative tape periodically. (Recommended for approximately 10 days)
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• ㆍThere is a possibility that moles may reappear in the treated area, and re-treatment can usually be considered after 4-6 weeks.
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• ㆍFor moles with deep roots, more than one procedure may be necessary.
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• ㆍAvoid exposure to ultraviolet rays as much as possible. (Sunscreen use is essential, and it is recommended to apply it over DuoDERM if possible.)
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