Injection therapy has a long history of being used for the treatment of hemorrhoids. However, the previous results on injection therapy for its complication rates and severity were not promising [1]. In this respect, aluminum potassium sulfate and tannic acid (ALTA) therapy could be a new promising option for the treatment of internal hemorrhoids [2]. However, some complications have been reported for ALTA therapy [3]. Thus, the learning of a precise surgical procedure and careful selection of the patients are vital. In addition, over-dosage and injection at an inappropriate location or depth frequently lead to serious complications. Application of ALTA therapy for the treatment of internal hemorrhoids may be a good choice, but still its efficacy for the treatment of external hemorrhoids and skin tags is limited. Thus, the surgeon should consider combined therapy (a hemorrhoidectomy and ALTA therapy) for the treatment of mixed hemorrhoids. Even though ALTA therapy has better treatment results than PAO therapy, well-controlled surgery and patient selection are still needed.