Dual Laser Combination Technique

*Moles can be seen as lesions that appear when melanin pigment abnormally increases in the epidermis or dermis.

While they may appear as simple pigmentation, the approach can vary depending on the mole's location and depth.

Erbium-YAG laser can be used to precisely refine the skin surface. It helps to shave off shallow moles in the epidermal layer while reducing the burden on the surrounding skin.

This procedure can minimize scar formation and offer cosmetic improvement. It is particularly useful for mole removal on the face. Following this, finishing with a CO2 laser to thermally treat the deeper parts of the mole can help eliminate remaining melanin cells, reducing the likelihood of recurrence. This approach considers cases where the surface of the mole has been removed, but the root remains and may regrow.

Specifically, consider applying CO2 laser finishing in the following situations:

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

- If there is a history of the mole recurring in the same location

- If diagnosed as a deep dermal nevus (e.g., blue nevus, gray-brown nevus)

*Flat warts are viral skin lesions caused by human papillomavirus (HPV) infection. They typically spread widely in the epidermal layer and appear as thin, flat, brown or flesh-colored small lesions to the naked eye. They are particularly prone to occurring when immune function is low, and can spread to other areas through self-touching, thus requiring prompt management.

Erbium-YAG laser can be used to uniformly remove the epidermal layer, making it suitable for widely spread flat warts.

This procedure can be used to clear lesions over a large area in a single session. The goal is to evenly remove lesions while minimizing skin irritation. However, viral lesions may recur if only the surface is removed. In such cases, a finishing process involving subtle thermal stimulation around the lesion with a CO2 laser can further address remaining virus-infected cells in and around the epidermis, which can be considered a method to reduce the likelihood of recurrence.

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

- When the lesion's borders are unclear, or it feels flat and spread out to the touch - For individuals with weakened immunity (e.g., due to stress, lack of sleep, etc.)

- If there is a history of the lesion recurring multiple times

- If the lesion is in an area prone to frequent contact and spreading, such as the hands or face

*Milia are small, white, pocket-shaped lesions that appear when keratin, a horny protein, becomes trapped within the skin. They are commonly observed around the eyes, cheeks, and forehead, and unlike sebaceous cysts, they are aesthetic lesions with little association with infection or inflammation.

Erbium-YAG laser can be used to remove milia. It can precisely refine the skin surface, removing the thin outer layer of the milia and creating an opening for the trapped keratin to be easily expelled. After removal, a light finishing treatment with a CO2 laser can reduce the likelihood of remaining keratinocytes regrowing and help mitigate the recurrent appearance of milia in the same area. However, excessive thermal stimulation to the skin can cause hyperpigmentation, so delicate intensity control is crucial.

The following situations particularly recommend CO2 laser finishing:

- When milia repeatedly recur in the same area

- If there is a history of the lesion reappearing during the post-treatment recovery process

- When an even skin texture is desired after recovery from the removal of multiple milia

*Syringomas are benign lesions caused by an overgrowth of sweat gland tissue in the dermal layer of the skin. They tend to appear as multiple small, round, palpable skin lesions, often found under the eyes, on the cheeks, and forehead. They are relatively common in women in their 20s and 30s or those with genetic predispositions.

Erbium-YAG laser can precisely and finely refine the skin surface, making it suitable for managing syringomas in sensitive areas like around the eyes. This method involves clearing the skin's outer layer and removing the upper part of the sweat gland lesion. After recovery, there is less risk of scarring or hyperpigmentation, offering aesthetic benefits. Next, by applying heat using a CO2 laser,

The finishing step, which involves providing subtle stimulation to the deeper parts of the lesion, can contribute to reducing the activity of sweat glands within the dermis, and

It can also be considered to suppress the recurrence of syringomas in the same area. However, due to the depth of the lesions, multiple treatments may be necessary.

More positive results can be expected when CO2 laser finishing is applied concurrently in the following situations:

- When multiple syringomas are located relatively deep, such as under the eyes or on the cheeks

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

- When one wishes to further focus on reducing recurrence with a single treatment

*Skin tags are benign skin lesions caused by an overgrowth 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 protuberances. While painless, they can become irritated by friction. Generally, CO2 lasers are more frequently used for skin tag removal, as their cutting and hemostatic effects can quickly treat multiple lesions. However, for small and thin skin tags, an approach involving precise initial trimming of the lesion with an Erbium-YAG laser, followed by a final cauterization of the lesion's root with a CO2 laser, can be utilized. This method helps manage the root tissue of the skin tag, reducing the likelihood of recurrence in that area. Thermal stimulation can contribute to inhibiting the regenerative environment by addressing fibrous cells and microvessels within the tissue.

Situations where considering CO2 laser finishing can be beneficial include:

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

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

- When the lesion's root is deep or widely spread (a type where traces still feel thick after removal)

Thus, considering the depth and characteristics of the lesion,

using two types of lasers together,

the 'Dual Laser Technique'

is an approach that can be considered to increase treatment satisfaction.

How long should I use DuoDERM (stickers) after mole removal?

The procedure to remove moles involves exfoliating the outer layer of the skin. This process may leave physical marks on the skin.

Therefore, proper protection and care of the treated area are extremely important.

In particular, keeping the treated area moist helps skin recovery and contributes to reducing scar formation.

For this purpose, it is recommended to use hydrocolloid dressings such as Duoderm.

Duoderm helps keep the wound area moist, facilitating cell regeneration, reducing unnecessary scab formation, and thereby lowering the risk of scarring.

Immediately after mole removal, apply Duoderm and change it every 3-5 days, managing the area for at least 7 days; this is a common method.

We usually recommend a total care period of about 10 days.

If using Duoderm is difficult or if a skin allergy occurs, it is recommended to frequently apply a regenerative cream or moisturizing gel to prevent dryness. Additionally, carefully apply sunscreen with SPF 50 or higher and be careful not to touch the treated area.

Post-mole removal care goes beyond simply covering the wound; it is a crucial step that determines the overall outcome of the procedure.

Neglecting care may result in scarring, so it's best to continue paying attention even after the procedure.

For healthy recovery, we provide detailed guidance on post-procedure care.

People for Whom the Procedure is Recommended

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• 1. Those who have had skin concerns such as moles, lentigines, milia, syringomas, or skin tags.
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• 2. Those who have had moles reappear in the same area after removal.
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Procedure Steps

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• STEP 01. Self-Cleansing
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• STEP 02. Applying Anesthetic Ointment
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• STEP 03. Mole Removal Procedure
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Precautions After Procedure

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• ㆍ Please ensure that water does not directly touch the treated area. (It is recommended to wash your face with Duoderm applied.)
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• ㆍ To aid skin regeneration, consistently replace and apply regenerative tape for approximately 10 days.
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• ㆍ Moles may reappear in the area where they were removed. In this case, you may consider another removal procedure after about 2-3 months.
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• ㆍ If the mole's root is deep, it may be difficult to remove completely in one session, making multiple procedures potentially necessary.
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• ㆍ Minimize exposure to UV light as much as possible. (Always apply sunscreen, and reapply it over Duoderm if possible.)
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