Facial Moles:Laser SurgeryFacial Moles:Laser Surgery

Dr.K.O.Paulose FRCS DLODr.K.O.Paulose FRCS DLO

Consultant ENT SurgeonConsultant ENT Surgeon

Jubilee Hospital,Trivandrum,South IndiaJubilee Hospital,Trivandrum,South Indiawww.drpaulose.comwww.drpaulose.com, , www.snorefreesleep.comwww.snorefreesleep.com

What is Laser?What is Laser?

INTRODUCTION OF INTRODUCTION OF LASERLASER

Laser is an acronym that Laser is an acronym that stands for Light stands for Light Amplification by Amplification by Stimulated Emission of Stimulated Emission of Radiation. Radiation. The first concept of the The first concept of the laser was initiated by laser was initiated by Albert Einstein in 1917.Albert Einstein in 1917.

Types of LasersTypes of Lasers

CO2 Laser

Argon laser

The Nd:YAG (Neodymium:Yttrium-aluminum-Garnet)

The Potassium-Titanyl-Phosphate (KTP)

CO2 LaserCO2 Laser

The CO2 laser is the most versatile laser in The CO2 laser is the most versatile laser in otolaryngology. otolaryngology.

The carbon dioxide (CO2) laser emits a colorless, The carbon dioxide (CO2) laser emits a colorless, infrared light infrared light

wavelength 10,600 nano microns wavelength 10,600 nano microns

Principle: The radiant energy produced by the CO2 laser is Principle: The radiant energy produced by the CO2 laser is strongly absorbed by pure, homogeneous water and by strongly absorbed by pure, homogeneous water and by all biological tissues high in water content. all biological tissues high in water content.

coaxial helium neon laser as aiming beam- red in colourcoaxial helium neon laser as aiming beam- red in colour

How does a CO2 Laser work?How does a CO2 Laser work?

Ability to coagulate, cut, vaporize Ability to coagulate, cut, vaporize

The main constituent of cells-water, readily The main constituent of cells-water, readily absorbs the wavelength of light produced absorbs the wavelength of light produced by the CO2 surgical laser. by the CO2 surgical laser.

The surgeon can control the extent by The surgeon can control the extent by which the laser beam is absorbed into which the laser beam is absorbed into surrounding tissue, resulting in an surrounding tissue, resulting in an extremely precise tissue incision. extremely precise tissue incision.

Indications of Co2 Laser in ENTIndications of Co2 Laser in ENT

Operations for snoring and sleep apneaOperations for snoring and sleep apneaOperations for Allergic Rhinitis,Correcting Operations for Allergic Rhinitis,Correcting deviated Nasal septum, Partial turbinectomy deviated Nasal septum, Partial turbinectomy (LAPT), Choanal atresia, excision of (LAPT), Choanal atresia, excision of RhinophymaRhinophymaOperations for voice disorders, the addition of Operations for voice disorders, the addition of the microspot micromanipulator to the operating the microspot micromanipulator to the operating microscope allows-arytenoidectomy, vocal microscope allows-arytenoidectomy, vocal nodules, early ca lesionsnodules, early ca lesionsOperations for nose bleeds, nasal polyps, Operations for nose bleeds, nasal polyps, Rhinosporidiosis, HaemangiomasRhinosporidiosis, HaemangiomasExcision of Facial Moles, Keloid, ScarsExcision of Facial Moles, Keloid, Scars

Indications of Co2 Laser_contdIndications of Co2 Laser_contd

Ulcers on tongue, check, multiple areas of leukoplakia Ulcers on tongue, check, multiple areas of leukoplakia can be precisely excisedcan be precisely excised

Skin lesions on head, Face and NeckSkin lesions on head, Face and Neck

TonsillectomyTonsillectomy

Tympanotomy, Myringotomy,StapedectomyTympanotomy, Myringotomy,Stapedectomy

(Bronchoscopic indications -management of recurrent (Bronchoscopic indications -management of recurrent respiratory papillomatosis or granulation tissue within the respiratory papillomatosis or granulation tissue within the tracheobronchial tree, excision of selected subglottic or tracheobronchial tree, excision of selected subglottic or tracheal strictures, excisions of bronchial adenomas.).tracheal strictures, excisions of bronchial adenomas.).

Advantages of Laser SurgeryAdvantages of Laser Surgery

Minimal operative bleeding due to coagulation of Minimal operative bleeding due to coagulation of blood vessels minor to 2 mm of diameter. blood vessels minor to 2 mm of diameter. Reduced post operative pain due to minimal Reduced post operative pain due to minimal thermal effect. thermal effect. Increased accuracy of the surgical wound Increased accuracy of the surgical wound Possibility of ambulatory surgery Possibility of ambulatory surgery Quick post op. healing Quick post op. healing Better plastic result of surgical wounds due to Better plastic result of surgical wounds due to minimal scarring (that effect is very obvious in minimal scarring (that effect is very obvious in the post tonsillectomy preservation of the the post tonsillectomy preservation of the tonsillar pillars). tonsillar pillars).

Disadvantages of LaserDisadvantages of Laser

Cost of equipment and maintenance . Cost of equipment and maintenance . (around USD 4000=Rs 4Lakh)(around USD 4000=Rs 4Lakh)

Special surgical skills Special surgical skills

Increased setup time of equipment Increased setup time of equipment

Need of safety eyewear Need of safety eyewear

Increased care for patient safety - Increased care for patient safety - explosion or fire hazard.explosion or fire hazard.

Smoke Smoke

How Laser work?How Laser work?

Laser surgery is the most preferred technique in Laser surgery is the most preferred technique in removing moles. Laser removal of moles is by removing moles. Laser removal of moles is by far the most simple for eliminating moles on the far the most simple for eliminating moles on the skin. In most cases of laser removal anesthesia skin. In most cases of laser removal anesthesia may not be necessary.may not be necessary.

The laser beam will also burn away the mole. The laser beam will also burn away the mole. Depending on the size of your mole, you may Depending on the size of your mole, you may need multiple sessions to completely remove it. need multiple sessions to completely remove it. No scarring , no bleeding, no pain and can be No scarring , no bleeding, no pain and can be done in OPD set up with surface anesthesia.done in OPD set up with surface anesthesia.

Laser on SkinLaser on Skin

Laser effects on skin tissue depend on Laser effects on skin tissue depend on - the power density of the incident - the power density of the incident beam, absorption of tissues at the beam, absorption of tissues at the incident wavelength, time beam is held incident wavelength, time beam is held on tissue, and the effects of blood on tissue, and the effects of blood circulation and heat conduction in the circulation and heat conduction in the effected area.effected area.

Moles:DefinitionMoles:Definition

The medical term for a mole is a nevus The medical term for a mole is a nevus (mole is Latin for “spot.”). Congenital nevi (mole is Latin for “spot.”). Congenital nevi are moles present at birth; acquired nevi are moles present at birth; acquired nevi develop anytime later.develop anytime later.Facial moles are common on face and Facial moles are common on face and neck. It can be flat, and sometimes raised neck. It can be flat, and sometimes raised with hairs .If there is sudden change in with hairs .If there is sudden change in size, itching and ulcers, it should be size, itching and ulcers, it should be removed and sent for biopsy.removed and sent for biopsy.

Methods used to remove facial molesMethods used to remove facial moles

Local excision: One of the mole removal methods Local excision: One of the mole removal methods that have been around the longest is the excision of that have been around the longest is the excision of the mole. This process involves cutting the tissue the mole. This process involves cutting the tissue around the mole using a scalpel, deep enough to around the mole using a scalpel, deep enough to remove even the deep mole cells, and removing the remove even the deep mole cells, and removing the tissue and mole completely. The remaining hole is tissue and mole completely. The remaining hole is then stitched up then stitched up

Electrocautery involves the use of a specialized Electrocautery involves the use of a specialized piece of equipment that burns the superficial layers piece of equipment that burns the superficial layers of skin off. Since the heating device cannot of skin off. Since the heating device cannot penetrate deeper than the superficial layers, raised penetrate deeper than the superficial layers, raised moles, or moles that reach deep into the skin, moles, or moles that reach deep into the skin, cannot be effectively removed in this manner.cannot be effectively removed in this manner.

Why Laser Treatment?Why Laser Treatment?

Laser treatment of nevi (moles) is a Laser treatment of nevi (moles) is a valuable alternative to traditional surgical valuable alternative to traditional surgical excision procedures. Lasers are excision procedures. Lasers are particularly valuable in treating lesions in particularly valuable in treating lesions in anatomic areas which are difficult to anatomic areas which are difficult to approach surgically such as the face, nose approach surgically such as the face, nose lips and ears.lips and ears.

Why Co2 laser?Why Co2 laser?

Laser mole removal is one of the newest mole removal Laser mole removal is one of the newest mole removal methods on the market. Laser mole removal involves methods on the market. Laser mole removal involves using a highly concentrated specialized laser to vaporize using a highly concentrated specialized laser to vaporize the mole tissue.the mole tissue. Laser mole removal is only useful in the removal of flat Laser mole removal is only useful in the removal of flat moles and other superficial moles such as pigmented moles and other superficial moles such as pigmented nevis. nevis. Laser mole removal treatments usually come in series, Laser mole removal treatments usually come in series, and can take as many as three treatments before the and can take as many as three treatments before the mole is fully removed. mole is fully removed. On the positive side, this treatment does not leave any On the positive side, this treatment does not leave any scarring because it only deals with the superficial layers scarring because it only deals with the superficial layers of skin.of skin.

Laser Removal:The Easy WayLaser Removal:The Easy Way

Laser surgery is the most preferred Laser surgery is the most preferred technique in removing moles. Laser technique in removing moles. Laser removal of moles is by far the most simple removal of moles is by far the most simple for eliminating moles on the skin. In most for eliminating moles on the skin. In most cases of laser removal anesthesia may not cases of laser removal anesthesia may not be necessary.be necessary.

Need Biopsy ?Need Biopsy ?

The laser beam will also burn away the The laser beam will also burn away the mole. Depending on the size of your mole, mole. Depending on the size of your mole, you may need multiple sessions to you may need multiple sessions to completely remove it. No scarring , no completely remove it. No scarring , no bleeding, no pain and can be done in OPD bleeding, no pain and can be done in OPD set up with surface anesthesia.set up with surface anesthesia.

If suspect malignancy,Biopsy neededIf suspect malignancy,Biopsy needed

Co2 Laser MachineCo2 Laser Machine

Inside the Laser MachineInside the Laser Machine

Co2:Laser TechnologyCo2:Laser Technology

Co2 Laser BeamCo2 Laser Beam

Testing Co2 LaserTesting Co2 Laser

Laser:PrescisionLaser:Prescision

Co2 LasersCo2 Lasers

Portable Co2 LaserPortable Co2 Laser

Parts of Co2 laserParts of Co2 laser

ENT Clinic Set UpENT Clinic Set Up

Diode LaserDiode Laser

Laser SurgeonLaser Surgeon

Laser SafetyLaser Safety

Laser GogglesLaser Goggles

Eye protectionEye protection

Laser Resistant GlassLaser Resistant Glass

Eye PadEye Pad

All staff should wear All staff should wear

ANESTHESIAANESTHESIA

LOCAL ANESTHESIA

For local superficial For local superficial anesthesia xylocaine anesthesia xylocaine spray 10 % + For spray 10 % + For infiltration anesthesia infiltration anesthesia xylocaine 2 % + 1: xylocaine 2 % + 1: 100.000 adrenaline 100.000 adrenaline solution.solution.

Laser Excision Under LALaser Excision Under LA

Co2 Laser Surgery for Facial MoleCo2 Laser Surgery for Facial Mole

Facial Mole Removal by LaserFacial Mole Removal by Laser

Facial Mole #034Facial Mole #034

Hairy Mole #029Hairy Mole #029

Laser Mole : #029Laser Mole : #029

Laser Facial Mole #042, #043Laser Facial Mole #042, #043

Laser Mole #051Laser Mole #051

Laser Mole #012Laser Mole #012

Laser Mole #013Laser Mole #013

Laser Mole #013Laser Mole #013

Laser Mole #013Laser Mole #013

Laser Mole #013Laser Mole #013

Laser Mole #013Laser Mole #013

Laser Facial MoleLaser Facial Mole

Laser Facial Mole:2Laser Facial Mole:2

Laser Facial Mole:3Laser Facial Mole:3

Laser Facial Mole In JubileeLaser Facial Mole In Jubilee

Laser Mole Neck #027Laser Mole Neck #027

Laser Facial Mole:LALaser Facial Mole:LA

Laser Facial Mole:LALaser Facial Mole:LA

Laser Mole EarLaser Mole Ear

Laser Mole Eye BrowLaser Mole Eye Brow

Laser Moles in The NeckLaser Moles in The Neck

Laser Moles on the NoseLaser Moles on the Nose

Laser Moles on FaceLaser Moles on Face

Laser Moles on Face-2Laser Moles on Face-2

Laser Facial Mole #011Laser Facial Mole #011

Laser Moles on Head and NeckLaser Moles on Head and Neck

Diode Laser in ENTDiode Laser in ENT

Diode Laser in Nose -2Diode Laser in Nose -2

Laser Moles in the EarLaser Moles in the Ear

Laser Removal Moles on FaceLaser Removal Moles on Face

““Scars on my Heart”Scars on my Heart”

Some scars won’t fadeSome scars won’t fade

Scars on the HeartScars on the Heart

Keloid on BCG ScarKeloid on BCG Scar

Keloid Ear lobeKeloid Ear lobe

Laser Excision KeloidLaser Excision Keloid

Keloid Excision by LaserKeloid Excision by Laser

Keloid Ear Lobe:LaserKeloid Ear Lobe:Laser

All Healing Comes From GodAll Healing Comes From God

All healing comes All healing comes from Godfrom God whether it whether it is supernatural or is supernatural or through a surgeon through a surgeon or a physician. He is or a physician. He is still the source of still the source of our healing. our healing.

I am the LORD who heals you, says God

THANK THANK YOUYOU

Presented By Dr.K.O.Paulose FRCS DLOPresented By Dr.K.O.Paulose FRCS DLOJubilee Hospital Trivandrum, south IndiaJubilee Hospital Trivandrum, south India

www.drpaulose.comwww.drpaulose.com www.snorefreesleep.com www.snorefreesleep.com