Flat warts have spread across my face and keep coming back after removal. How should treatment be planned instead?
Director Kim Serim ·
When flat warts have spread across the face, removing only the visible lesions with a laser often leaves hidden ones that surface nearby 1-2 months later. In these cases, Serene Clinic combines laser removal with intralesional immunotherapy, injecting a small amount of MMR vaccine into the warts 4 times at 3-week intervals over about 3 months, then clears any remaining lesions with an Er:YAG laser at the 3-month mark. We cannot guarantee the warts will not return, but this approach tracks both removal and the immune response so new lesions can be handled within the treatment period.
At a glance
- Who it is for
- Adults with many flat warts across the face, or warts that keep returning after removal
- What is included
- Intralesional immunotherapy (MMR) ×4 + Lavieen + Er:YAG removal + 1 retouch at 3 months + LDM ×2 + wound dressing
- Schedule
- Immunotherapy every 3 weeks, 4 sessions, about 3 months in total
- Recovery
- Laser scabs for about 1 week; injection-site pain or swelling for 1-2 days
- Not offered to
- Children, people who are pregnant or planning pregnancy, and people with significantly weakened immunity
- Price
- Full face 1,190,000 KRW, neck add-on 300,000 KRW (as of the October 2026 menu)
Why do new warts keep appearing if I only have them removed?
If flat warts have spread across the face, the lesions you can see are not all of them. The virus has already entered the surrounding skin, and some lesions are still too small to notice.
So even after every visible wart is removed, new ones commonly appear around the same area about 1-2 months later. In the clinic, it is hard to tell whether these spread during treatment or were already hidden and surfaced later. Either way, for the patient the experience is the same: "I had them removed and they came back."
What finally clears flat warts is the body's own immune system. The laser reduces the lesions that are there now, and the immune response deals with the virus that remains. That is why Serene Clinic plans full-face flat wart treatment as a 3-month course rather than a single removal.
How does intralesional immunotherapy work?
Intralesional immunotherapy means injecting a very small amount of MMR (measles, mumps, rubella) vaccine into a few warts so the body mounts an immune response at that spot. On Serene Clinic's menu it is listed as "wart vaccine injection."
This response may not stay limited to the injected wart. In a study of patients with multiple flat warts in which MMR was injected every 2 weeks into only the largest wart, 62.5% of the 40 patients in the MMR group saw all of their warts clear[1]. At Serene Clinic, we also see cases where other flat warts that were not injected shrink at the same time.
In a randomized trial of 112 people with multiple warts (not limited to flat warts), 80.4% in the MMR group had complete clearance, with an average of 4 injections. Six months later, 2 of 56 had a recurrence[2]. Put the other way, this treatment does not work for everyone. Some people respond slowly, which is why laser removal is planned alongside it.
Injecting MMR vaccine into warts is not an approved route for the vaccine; it is a method doctors choose based on research evidence. We explain this before treatment.
Why 4 injections at 3-week intervals?
It takes time for the immune response to develop and for changes to show in the warts. Serene Clinic injects once every 3 weeks and checks whether the warts are flattening or fading and whether any new ones have appeared.
By the end of the 4th session, about 3 months have passed since the first injection. Because we examine the same skin repeatedly over those 3 months, lesions that were not visible at the first removal can be treated while they are still small.
The injection site may be swollen and sore for a day or two, and some people notice itching or mild flu-like achiness. These usually settle on their own.
What do Lavieen and the Er:YAG laser each do?
The Er:YAG laser thinly shaves away visible flat warts. Its wavelength spreads less heat to the surrounding skin, which makes it easier to control depth on the face, where scarring and pigmentation are a concern.
Lavieen is a 1927 nm thulium laser that delivers fine, even heat to the outer layer of facial skin. Before shaving the lesions, Serene Clinic first treats the outer layer of the whole face with Lavieen. The aim is to also cover the surrounding skin, where small lesions that have not yet surfaced may be present.
However, there are no comparative studies yet showing that using Lavieen first and then the Er:YAG laser reduces flat wart recurrence. This sequence is one Serene Clinic chose based on clinical experience, which is why we check progress in person throughout the 3 months.
What happens over the 3 months, and in what order?
| First visit | Consultation, photo record of lesion distribution, Lavieen + Er:YAG removal, LDM soothing care after the wound dressing is applied, first immunotherapy injection |
|---|---|
| About 1 week after the first procedure | Protect the area with the wound dressing until the scabs fall off on their own |
| Weeks 3 · 6 · 9 | Immunotherapy sessions 2-4, check for new lesions and response |
| About 3 months | 1 Er:YAG retouch for remaining or newly appeared lesions, LDM soothing care after the wound dressing is applied |
The detailed schedule is adjusted after consultation depending on the number of lesions and how quickly you heal.
How is recovery managed after treatment?
Small scabs form where the Er:YAG laser was used and fall off within about a week. During this time, a wound dressing is applied, as a patch or a gel, to protect the area. Picking off scabs makes pigmentation more likely to remain.
LDM is an ultrasound-based soothing treatment. You receive it once right after the first procedure and once right after the 3-month retouch, after the wound dressing is applied, to help redness and sensitivity settle after the laser.
During treatment, use sunscreen carefully and pause scrubs, peels and anything that rubs the skin. If you shave the area, an electric shaver helps reduce new lesions.
Who is this treatment not suitable for?
MMR is a live vaccine made with weakened viruses, so it is not used for people who are pregnant or plan to become pregnant within 4 weeks, or people with significantly weakened immunity, such as those taking immunosuppressants. The same applies to anyone who has had a severe allergic reaction to MMR or its components (gelatin, neomycin)[3].
Serene Clinic does not treat flat warts in children. If you have only a few lesions, per-lesion removal may make more sense than this program, so we decide together after the consultation.
Price (as of the October 2026 menu)
| Flat Wart 3-Month Intensive Program (full face) | 1,190,000 KRW |
|---|---|
| Add neck | 300,000 KRW |
Includes: wart vaccine injection (intralesional immunotherapy) ×4, Lavieen, Er:YAG removal, 1 retouch at 3 months, LDM ×2, wound dressing. If you have only a few lesions, we quote per-lesion removal prices.
Frequently asked questions
What if the warts are gone before all 4 injections?
Whether to continue the remaining sessions is discussed with the director while checking for new lesions. For fast responders, the schedule may be shorter.
Once the 3 months are over, will they never come back?
We cannot promise that. Flat warts can return when you are tired or your immunity drops, so if you notice small lesions after treatment, we recommend coming in early.
Does an HPV vaccine like Gardasil prevent flat warts?
HPV types 3 and 10, the main causes of flat warts, are not covered by the Gardasil 9 vaccine, and there is no evidence yet that it prevents or treats flat warts. Gardasil is a vaccine for preventing cervical cancer and genital warts.
Can I keep going to work during treatment?
For about a week after the first procedure, you will need to apply a wound dressing, as a patch or a gel. On days with only an immunotherapy injection, the site may be slightly swollen, which usually does not interfere with daily life.
References
- Fawzy MM, Nofal A, Alakad R. Intralesional antigen immunotherapy for the treatment of plane warts: a comparative study. Dermatol Ther. 2020;33(6):e13807.
- Sallam M, Awad A, Hamdy S, State A. Intralesional measles, mumps, and rubella vaccine versus vitamin D for treatment of warts: a randomised clinical trial. Indian J Dermatol Venereol Leprol. 2026;92(2):285-291.
- McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-04):1-34.
This article is general medical information. Results and how long they last vary from person to person. Any treatment can cause side effects such as redness, swelling or pain, so please decide after a consultation.