Lentigo

CO2 Laser,

Why It Recurs When Ablated Too Lightly

in One Month

Please Check This Before Reading

Q. If CO2 ablates it, doesn’t it damage the dermis

and leave a scar?

A. The upper part of the dermis may be slightly removed,

but it is a regenerating layer.

Q. I had ten toning sessions,

so why won’t only the lentigo fade?

A. Because melanin is embedded at the base of the epidermis,

toning has its limits.

One-line conclusion.

Lentigo CO2 laser is a procedure that gently removes tissue up to

the upper dermis.

The deciding factor.

Whether it reaches the base of the melanin —

if it is too weak, it recurs within 1–2 months.

What we’ll cover today.

We’ll look at the criteria for choosing between

toning and CO2.

Can lentigo and freckles,

be removed together with a CO2 laser?

Lentigo (lentigo) is a pigmented lesion with melanin embedded at

the base of the epidermal-dermal junction.

Unlike freckles, lentigo sits much deeper

and more distinctly.

Most people who searched for lentigo CO2 laser and came here

have probably tried toning 5 or 10 times,

and experienced it 'lightening and then stopping' at least once.

The tricky part is that toning uses low-energy 1064 nm

to gently break up only epidermal melanin.

But lentigo is below that,

stuck at the base of the epidermis,

so toning can’t reach it.

CO2 is different.

As the 10,600 nm wavelength is absorbed by water,

it shallowly ablates the tissue itself.

So for pigment that is 'embedded' like lentigo,

CO2 is the answer.

Lentigo CO2 laser,

the depth threshold determines the result

Dr. Wi Young-jin’s

key insight

'When abrading lentigo with CO2,

it is okay if the upper dermis is slightly vaporized —

it is a layer that regenerates anyway.

However, if you ablate too lightly,

the melanin base remains in place

and it recurs within 1–2 months.'

— Dr. Wi Young-jin (Beautystone Clinic, Hapjeong)

Among those reading this,

there are probably quite a few who say,

'I had CO2 somewhere else, but it came back

within a month or two.'

About two or three out of ten patients come in with this case.

Here’s what really matters.

When abrading lentigo with CO2, it is okay if the upper dermis

is slightly removed.

It is a layer that regenerates anyway.

In fact, if you ablate too lightly,

the melanin layer at the base of the epidermis remains in place.

Then, within 1–2 months,

it reappears in almost the same spot.

Here’s a case from a 50-year-old client last month.

She had two coin-sized lentigines

above the cheekbone.

She had been receiving toning at another clinic for nearly a year,

but it still wouldn’t fade, so she came in sounding rather resigned.

After one CO2 treatment and two weeks of recovery,

there was almost no pigment mark left.

She was even more surprised than we were

and said, 'I should have done this sooner.'

The key point is that her lentigo was at

the exact depth that is ideal for ablation.

Dr. Wi Young-jin’s key summary

• Lentigo results are determined by how much you ablate.

• The upper dermis can be touched and still regenerate,

  so there is no need to be afraid.

• Under-ablation that leads to recurrence is

  the greater loss.

• Matching the threshold is ultimately

  the path with the least scarring.

Lentigo CO2 laser: how do the first-treatment

and recurrence cases differ?

The approach to a first treatment and a recurrence case

must be different from the start.

Recurrence cases involve skin that has already been injured once,

so pigmentation (PIH) develops more easily.

So it is not just ablation and done;

afterward, a short course of tranexamic acid or low-energy toning

is effective for preventing recurrence.

However, if melasma or vascular pigmentation is mixed in,

CO2 can actually be irritating, so

diagnosis comes first.

Lentigo CO2 laser clinic Q&A,

3 questions we hear often

Q1. Does lentigo disappear all at once with one CO2 laser session?

A. If the depth is right, 7 out of 10 cases are finished in one session,

and only two or three people need the

remaining pigment touched up 2–3 weeks later.

It is not that 'one session' is guaranteed,

but rather 'one session if the depth is right.'

Q2. If I get lentigo CO2 and toning together,

will it fade faster?

A. Not at the same time.

CO2 should be used first to ablate, and after recovery is complete,

toning should be added for residual pigment or PIH management.

If the two overlap in timing, irritation stacks up

and pigmentation becomes darker.

Q3. I heard CO2 ablation leaves a sunken mark

— is that true?

A. It can happen if you ablate too deeply into the deeper dermis,

but it is not truly common —

maybe one or two cases a year at most.

Most often, the much more common problem is

recurrence from ablation that is too light.

It is safest to be aware of the possibility of recurrence and

find the proper depth.

Ultimately, lentigo CO2 is a

fine balancing act of how much to ablate.

If it is too shallow, it comes back;

if it is too deep, it leaves a mark.

In the next article, I’ll explain the timing of UV and medication care

to prevent recurrence after lentigo treatment.

This has been Dr. Wi Young-jin.

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