Xanthelasma Excision

Shens Clinic > Xanthelasma Excision

Information

Xanthelasma palpebrarum (XP) is a benign eyelid disorder that presents as yellowish cholesterol-laden plaques on the skin. It is the most common form of cutaneous Xanthoma. These lesions are structurally made up of numerous xanthoma cells or foam cells.

They are found primarily at the level of the perivascular and perineural tissue, with an indication of concurring fibrosis and inflammation.

Xanthelasma Palpebrarum develops most frequently around the eyelid area. The yellow bumps can be quite large and can occur on both the upper and lower eyelids. They can also appear asymmetrically – one on one upper eyelid and two or three on the other eyelid.

CAUSES OF XANTHELESMA

The majority of patients with Xanthelasma have high levels of cholesterol. You’re more likely to develop these growths if you have:

High LDL (“bad”) cholesterol or low HDL (“good”) cholesterol
Genetic high cholesterol (familial hypercholesterolemia)
Primary biliary cirrhosis – a liver disease that elevates cholesterol levels

Xanthelasma Palpebrarum is most common in people of Asian or Mediterranean descent. Xanthelasma is thought to be an early warning sign of cholesterol buildup within the blood vessels. Over time, cholesterol deposits can form hard, sticky plaques in your arteries. This buildup in the blood vessels can cause atherosclerosis, which in turn can lead to heart disease, heart attacks or strokes.

Xanthelasma may also be linked to other diseases, such as:

Diabetes
High blood pressure
Obesity
Smoking

Should Xanthelasma be removed?

In most cases, Xanthelasma is removed for aesthetic reasons. The condition usually occurs as a small bump, but over time it can expand and grow larger. The yellow bumps themselves are not dangerous, and they do not go on to form any type of skin disease. The worst thing that can happen is that it can become really big and gets in the way of the patient’s vision, as well as obstruct how the eyelids open and close. In such cases, xanthelasma removal is necessary.

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How do you surgically remove Xanthelasma?

Xanthelasma can be cut out by surgical excision. It is the main treatment for excessive Xanthelasma when the bumps start to distort the eye and impede the individual’s eyesight. The surgery is especially needed when the lesion affects the deep dermis and penetration of the underlying muscles.

Xanthelasma removal is performed as an outpatient procedure under local anaesthesia. To reduce the risk of the lesion relapsing, the surgeon cuts the entire xanthelasma out in one surgical procedure. If the yellow bumps are relatively large, the surgeon might recommend combining surgical excision with blepharoplasty to achieve the best possible cosmetic results. The incisions can be closed with dissolvable or non-dissolvable sutures.

What to expect after the procedure?

After the procedure, a small amount of antibiotic ointment is applied to the area. Painkillers might also be provided to ease any discomfort.

After the surgery, the incisions will probably be slightly red and a bit bumpy. In two weeks, they will look much better and will continue to heal. The average downtime is 7-10 days. The stitches are removed after a week or two if the surgeon has used non-dissolvable stitches.

Although the effect of the surgery might be seen immediately, the final results are usually observed in roughly 1 month.

Unfortunately, Xanthelasma can recur after treatment. The best way to reduce the risk of recurrence is to maintain a healthy lifestyle.

What are the other treatment options for Xanthelasma?

In addition to surgery, there are some other methods used to treat Xanthelasma and these include:

Laser treatment. The treatment is done with a fractional CO2 laser and is considered an effective alternative to xanthelasma surgery.
Freezing or cryotherapy. During this treatment, Xanthelasma is frozen with the help of a chemical and then removed.
Electric needle treatment. It uses radiofrequency technology to remove unwanted lesions on the skin.

Although those treatment techniques might be effective, there is a great chance Xanthelasma to come back. When removed via surgery, the percentage of Xanthelasma recurrence is significantly lower.

What is the difference between Xanthoma and Xanthelasma?

Skin lesions caused by fat accumulation in macrophages are called Xanthomas. They usually appear on the overlying skin. It is less common for a xanthoma to develop in the subcutaneous layer.

The presence of Xanthomas is usually an indication of lipid metabolism disorders (dyslipidaemias) or histiocytosis. Xanthomas affect mostly adults. However, children with familial hypercholesterolaemia may also develop them. Race and gender distributions may vary based on the underlying causes.

Xanthelasma is one of the most common types of Xanthoma. In most cases, it forms around the medial canthus of the upper eyelid.

Will I be left with scars after being treated for Xanthelasma removal with surgical excision?

Our Korean-Trained Plastic Surgeon is able to extract the fat pad in the skin with minimal scarring. An excision performed with a conventional scalpel allows the surgeon to completely remove the yellowish cholesterol deposit. The incisions generally heal very well, and over time, they fade in a very fine line or crease.

Is an anaesthetic required for surgical xanthelasma?

This procedure can be done under local anaesthesia.

Is Xanthelasma treatment covered by insurance?

You might get your insurance company to pay for the removal of Xanthelasma if this condition causes visual impairment. Otherwise, Xanthelasma removal is considered a cosmetic procedure and is not insurance climbable.

Will my Xanthelasma come back after treatment?

Sometimes Xanthelasma does return after surgical removal. However, the percentage is far lower than that of alternative treatments such as laser removal. During surgical excision, the cholesterol fat cells are dissected away from the skin, unlike other treatments where the fat is dissolved.

How many treatments are required if I decide to have my Xanthelasmas surgically excised?

Notwithstanding the size and thickness of the Xanthelasmas, one treatment will be usually enough to get rid of these unwanted lesions. In certain cases of deep-rooted Xanthelasma the treatment should be split into two sessions.
During the first session, the main bulk of the Xanthelasma is removed. Usually, the deep-rooted residues should be left untreated to avoid potential damage to the dermis.
One month later, the deep-rooted Xanthelasma residues will have shifted to the superficial layers of the epidermis. During the second session, it will be easy to remove all the remaining Xanthelasma residues with minimal risks of scarring.

Recovery Time

*Average downtime is 7-10 days.
Post-treatment, the patient experiences bruising and swelling with minimal discomfort.
Painkillers will be provided to ease the discomfort.
*Results appear immediately and on average, the final desired result is seen in roughly 1 month.