why remove them?
People have been preoccupied with facial moles since ancient times. Moles were considered a sign of evil in medieval Europe - witches and devil-worshippers were often shown with prominent moles. Moles were also thought to be marks of beauty during the 17th to 18th century. In modern times however, moles with hairs and protrusions are once again considered an aesthetic defect.
Moles are clusters of melanocytes - cells that produce colour (pigment) on the skin. Usually circular or oval, they may be flat or raised, smooth or rough, pigmented or skin coloured, and may even contain hairs.
Many people want to have moles removal done because
- they are worried about skin cancer
- they feel self-conscious about their moles
Proper mole removal by a medical professional is essential.
Unqualified practitioners such as spa or facial consultants often produce scarring, incomplete removal or can miss important diagnoses like skin cancer!
to remove moles safely and effectively
Ultrapulse CO2 laser
CO2 laser is strongly absorbed by water in cells. Laser energy vaporizes a layer of skin cells together with a surrounding zone of coagulation. Ultrapulse CO2 produces very short pulses of laser energy with high peak power. The amount of tissue vaporisation vs coagulation can be tailored, allowing for precise vaporisation of only the abnormal tissue without causing too much collateral damage.
Radiofrequency ablation for Mole Removal
High frequency radiofrequency is strongly absorbed by water in cells causing vaporization or coagulation depending on the waveform. It can be used to dissect out moles or coagulate them. Insulated needles can also be used to treat buried moles while sparing the skin surface, reducing the downtime and chance of scarring.
Surgical excision for Mole Removal
Moles that extend through most of the dermis or that need to be sent to the laboratory to be examined under the microscope should be surgically excised. Cold steel, ultrapulse CO2 or high frequency radiofrequency are used to dissect out the lump. The direction and position of the incision are designed to camouflage the scar. The resultant wound is closed with a tension-free layered technique using absorbable and non-absorbable sutures according to plastic surgical principles to produce an aesthetically pleasing result.
1Aesthetics's View on Mole Removal
dr wan's perspective
Most moles are benign and patients seek removal for cosmetic reasons. However, it is important to be vigilant for something more sinister. Any skin growth that looks or sounds suspicious for cancer should be excised and sent for examination to rule out cancer. It is common for patients to try to get their moles removed cheaply at beauty salons. While this can sometimes work, Dr Wan believes that this exposes patients to unnecessary risk, particularly of missing or delaying the diagnosis of skin cancer.
The major concerns that patients have with mole removal are that the mole may recur or that scarring will result. To ensure the best outcome, it is important to ensure that all the abnormal mole tissue is removed while limiting the collateral damage to the surrounding tissues. Dr Wan uses ultrapulse CO2 and high frequency radiofrequency that can provide tunable amounts of ablation and coagulation to vaporize precisely only the mole cells. Fine control over the destruction of abnormal tissue limits collateral damage and the risk of complications such as scarring or post inflammatory hyperpigmentation.
Not all lumps should be vaporized. Bigger, deeper moles (especially those with hairs) that occupy much of the dermis may result in depressed scarring if vaporized. Excision usually produces a better overall result in these cases.
To Dr Wan, the most important factors are how to remove the mole safely and completely with the best aesthetic outcome. Hence, pre-procedural analysis and planning is important, as is a wide variety of precise methods to remove the mole together with fine judgement as to how much tissue to remove. Lastly, the wound closure technique is very critical for the final result. Dr Wan’s previous surgical training during plastic surgery rotations has equipped him with exposure to various plastic surgical techniques such as V-Y plasty, M-plasty, geometric closure, etc that allows him to advise patients on the most suitable method to use.
Topical medication, as well as sun damage protection, should be adhered to reduce the risk of complications after mole removal. After the skin surface has healed, early prophylactic fractional laser should be instituted to blend the treated area with the surrounding skin and make the final result much more inconspicuous.