I had a number of moles removed 3 months ago from my face. These where raised moles and had some pale brown pigmentation in them. After Laser removal of these moles, they came back heavily pigmented and in one case, larger than the original mole and it seems to be spreading. My cosmetic surgeon advised for me to do more laser treatments or exerision, but told me he cannot guarantee that it will improve. Any advice as to the best way to remove the pigmentation? See before and after photo. Thanks.
What is the Best Way to Remove Pigmentation After Laser Mole Removal?
Doctor Answers 4
Do not laser moles
Lasers are an effective tool for certain skin conditions but should be used selectively and in my opinion mole removal should not be done with a laser. Mole removal needs to be done surgically to leave the most optimal scar and to evaluate the mole histologically to rule out any abnormalities.
Laser Surgery for Removing Moles
I feel that it is never appropriate to use a laser as your primary treatment for removing a mole. Regardless of how "benign" a mole may appear, a biopsy may still reveal it to be atypical. Using a laser to improve the appearance of a mole will alter its look and make it more difficult to observe for precancerous changes in the future. The majority of a mole can be removed very easily, and less expensively, using a shave biopsy technique. This typically results in a minimal scar, making the mole much less visible. It also has the added benefit of having tissue to send for microscopic examination, at least for reassurance purposes. The best way to remove the deeper pigmentation that was left behind from your laser treatment would be to do a simple surgical excision of the area with suture closure to give you the best cosmetic result. This should result in a linear scar that will be much less visible.
Pigment removal after Laser Surgery
Sometimes pigment returns or intensifies after laser surgery of moles or after moles have been shaved off because not all of the cells that make pigment were removed. For that reason I prefer to remove the moles surgically because I can be certain that pigment will not return and because I will have a pathological record of each mole. So the only way to guarantee removal is by surgical excision and sutured closure. Other options inlcude repeated laser treatments or cryotherapy (liquid nitrogen treatment). Talk to you surgeon, and if you're not satisfied with the options, get a second opinion from a dermatologist.
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I would recommend that you see a board certified facial plastic surgeon for an evaluation. I would possibly favor complete surgical excision. However, with any procedure, you will be trading in the mole for a potential scar.