Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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Laser mole removal is a real technique with a narrow, legitimate use and one structural drawback that decides most cases: it destroys the tissue rather than removing it, so there is nothing left to examine. That is an acceptable trade for a small, flat lesion already assessed as benign in a place where a linear scar would be conspicuous. It is not acceptable for a lesion nobody has properly examined — and those are frequently the same lesions people most want lasered.
What the Laser Actually Does
Ablative lasers vaporise tissue by heating the water inside it. Pigment-selective lasers work differently, delivering energy in extremely short pulses absorbed preferentially by melanin, which fragments the pigment rather than removing the lesion.
In practice this clinic uses a DEKA Smartxide CO2 laser, adding vascular modulation with a DermaV laser at two weeks where the scar would benefit from it. Where pigment remains, a further CO2 treatment is used. The reason for the second step is the most common complaint after laser removal — pigment reappearing months later because melanocytes left in the base repopulated the site.
| Laser | How it works | Where it fits |
|---|---|---|
| CO2 (10,600 nm) | Ablative; strongly absorbed by water, vaporises tissue layer by layer | Removing the raised or surface portion of a lesion |
| Erbium:YAG (2,940 nm) | Ablative, more precisely absorbed by water, less residual heat in surrounding tissue | Finer ablation with less thermal spread; slower to control bleeding |
| Q-switched | Pigment-selective; nanosecond pulses fragment melanin | Residual pigment after ablation, not lesion removal on its own |
Erbium versus CO2 is a real distinction but a secondary one here: the choice between them changes how much surrounding tissue is heated, not whether the specimen survives. Neither leaves anything for a pathologist.
The Objection That Decides Most Cases
A mole removed by excision goes to the laboratory. A mole removed by laser goes into the air.
The consequence is not theoretical. If an early melanoma is treated with laser, the visible lesion disappears, the patient is reassured by that disappearance, and the disease continues in tissue nobody has examined. There is no report, no margin comment and no thickness measurement, because there is no specimen.
Even where a lesion is later re-examined, the measurement that governs melanoma treatment cannot be recovered. Breslow thickness is measured from the granular layer of the epidermis to the deepest tumour cell, and it sets the width of the definitive excision and whether a sentinel lymph node biopsy is offered — with the threshold that changes the conversation sitting at 0.8 mm.
“A shave biopsy that loses the base can cost a patient a sentinel node biopsy they should have been offered.”— Mr Onur Gilleard, Consultant Plastic Surgeon
The same reasoning applies with more force to ablation, which destroys the base entirely. This is why any pigmented lesion with a diagnostic question is excised whole rather than lasered.
Who Laser Suits
Reasonable candidates share a specific profile.
- The lesion is small and flat, or barely raised
- It has been examined with dermoscopy by a consultant and assessed as benign — not merely assumed benign because it has been there a long time
- It sits somewhere a linear scar would be conspicuous: the face, particularly the nose, cheek or around the eye
- The reason for removal is appearance, not concern
- You understand and accept that pigment may return, and that a second treatment is sometimes needed
Who It Does Not Suit
- Any lesion that has changed in size, shape or colour, or that bleeds, itches or will not heal
- Deep or junctional naevi, where the pigmented cells extend well below the reach of ablation — treating these superficially reliably produces recurrence
- Raised, fleshy moles, where shave excision gives a flatter result more predictably
- Anyone with a personal or family history of melanoma, where the threshold for wanting tissue examined should be lower rather than higher
- Lesions where the clinician is uncertain — uncertainty is an indication for excision, not for a technique that removes the evidence
Darker skin adds a further consideration. Ablative treatment carries a higher risk of post-inflammatory hyperpigmentation in Fitzpatrick types IV to VI, and the mark left behind can be more noticeable than the original lesion — covered in mole removal in darker skin.
Laser Against the Alternatives
| Laser | Shave excision | Surgical excision | |
|---|---|---|---|
| Tissue available for histology | No | Partial — base not included | Yes, whole lesion |
| Best suited to | Small, flat, confirmed-benign lesions in visible sites | Raised, clearly benign lesions | Anything with a diagnostic question, and deep lesions |
| Sutures | None | None | Yes |
| Mark left | Flat, round, may be paler or darker than surrounding skin | Flat, round, sometimes slightly depressed | Fine line, placed along a skin crease |
| Pigment recurrence | Possible | Possible | Unlikely if fully excised |
The fuller comparison, including hyfrecation and cryotherapy, is in shaving versus excision.
Assessment First, Then the Method
The sequence matters more than the technique. A £100 consultation covers examination and dermoscopy of the lesions you have come about, and the method follows from what that shows. Removal is £350, each additional lesion at the same visit £200, and histological analysis £180 where the lesion’s features warrant it.
If a clinic offers to laser a mole without examining it with a dermatoscope first, that is the point at which to stop — not because laser is the wrong tool, but because nobody has established whether it is the right one. Book: mole removal or contact the clinic.
Common Questions
- Is laser mole removal safe?
- The procedure itself is low-risk in trained hands. The risk is diagnostic rather than surgical: laser destroys the tissue, so nothing can be examined afterwards. That is safe for a lesion properly assessed as benign and unsafe for one that has not been.
- Am I suitable for laser mole removal?
- Suitable candidates have a small, flat lesion that a consultant has examined with dermoscopy and assessed as benign, in a site where a linear scar would be conspicuous, and are having it removed for appearance. Anything that has changed, anything deep, and any history of melanoma points to excision instead.
- Is erbium better than CO2 for moles?
- Erbium is absorbed more precisely by water and leaves less residual heat in surrounding tissue; CO2 controls bleeding better and ablates faster. It is a genuine distinction, but a secondary one for moles, because neither leaves a specimen to examine.
- Does laser leave a scar?
- It leaves a flat, round mark rather than a line, which is why it is used on the face. The mark may end up paler or darker than the surrounding skin, and hypopigmentation or hyperpigmentation is more likely in darker skin types.
- Can a mole grow back after laser?
- Pigment recurring is common and usually means melanocytes left in the base have repopulated the site. It is not evidence of malignancy, but it does need looking at — recurrent pigment in a treated site is genuinely harder to interpret, which is itself an argument for taking a lesion whole the first time.
- Why is laser unsuitable for deep moles?
- Ablation works from the surface down and reaches only so far. In a deep or junctional naevus the pigmented cells extend below that, so the visible part is removed and the remainder regrows.
- Can the mole still be tested if it is lasered?
- No. There is no specimen. If you want the certainty of a laboratory report, the lesion has to be excised.
- Is laser mole removal available on the NHS?
- Not for cosmetic removal. The NHS removes lesions that are clinically suspicious or causing a problem, and does so by excision so the tissue can be examined. The criteria are in removal on the NHS.
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