- Best Results1-2 sessions
- Treatment Recovery5-8 days
- Procedure Time30 minutes
- Skin SpecialistDr Davin Lim
- Duration of ResultsVariable
- AnaestheticLocal, sedation
- Back to WorkVariable
- Cost$$ Medicare
Xanthelasma are yellow patches commonly found in the inside corners of the eye. In some cases, they involve the upper & lower eyelids. Xanthelasmas are soft plaques of cholesterol deposits. They may be a marker of heart disease.
FactsFacts on Xanthelasmas
- These are soft fatty deposits surrounding the eye
- They can be a maker for increased cholesterol levels
- One third of patients will have elevated blood lipids
- Xanthelasma can be treated with surgery or laser resurfacing
- Keeping cholesterol levels low can reduce recurrence in some
- Xanthelasmas are asymptomatic
What are xanthelasmas?
Xanthelasma is the most common form of lipid or cholesterol skin build up. They are located on the upper and lower eyelids. Xanthelasmas start off as yellow patches & bumps that enlarge over years. They are yellow to orange in colour.
What are your chances of having high cholesterol?
Xanthelasma are associated with elevations in lipids in over one third of cases. If you have signs of xanthelasma it is prudent to see your doctor to see if your cholesterol is elevated. Elevated cholesterol levels are a marker of heart disease & stroke.
How to treat xanthelasma?
My primary treatment is with a laser, either an erbium or a CO2 laser. In most cases one laser resurfacing session addresses 60 to 95% of the lesion. For XXL xanthelasma, you may require two sessions of laser. In some cases, I combine surgery with laser (depending on the size and location).
Other methods to treat xanthelasma include TCA or phenol peels as well as RF ablation. Creams do not work.
Do xanthelasmas come back?
Yes. With laser & or surgical excision, xanthelasma can still return. This is because your skin has a genetic abnormality that predisposes to recurrence. Most patients will have remission for 4-10 years.
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How long does it take to heal following laser surgery?
About 6-9 days, depending on the depth & size of these lesions. You may have some skin colour changes after the laser. This may last 3-6 months. Scarring post laser is very rare, recurrence can be expected in most (usually remission for up to 10 years).
What does laser resurfacing involve?
Laser resurfacing is quite involved as I do this in our operating suites at Cutis. Preoperatively you will be given a chill pill to relax. We then give you an injection of painkiller followed by local numbing injections.
If xanthelasmas are very close to your eyelids, I place an internal metal shield to protect your eyes from the laser. The procedure takes between 20 to 40 minutes, depending on the size, depth, number of lesions.
We then dress the area post laser. You will be on antibiotic ointment & or tablets for 5-9 days post-surgery.
Do not drive in for this procedure as I normally perform this procedure under mild sedation.
Does laser resurfacing hurt?
No. I bomb you out with a relaxing agent as well as a painkiller, plus injections. The entire procedure is painless. Post laser, you will have minimal, if any pain.
What if you leave them alone?
Xanthelasmas are harmless. If they don’t bother you, leave them alone. They usually reach a certain size, then they stop growing.
Will they shrink if you keep your cholesterol levels down or diet?
Nope. They will remain. Though there is an increased risk of hypercholesterolemia with xanthelasma, dieting will have minimal impact on this condition. There are cases of minor involution with the cholesterol lowering drug called Zocor.
How to reduce cholesterol levels?
In a minority of individuals, lowering cholesterol levels can help reduce the formation of new xanthelasma, or prolong remission following laser surgery.
For some people, changes to diet and lifestyle choices may be enough to manage cholesterol. To lower your cholesterol:
- Reduce smoking and alcohol consumption
- Maintain a healthy weight
- Exercise at least 30 minutes five times a week
- Reduce intake of saturated fats, which are found in things like butter
- Discuss medications including statins with your family physician
What are other conditions that look like xanthelasma?
Xanthelasma are common causes of eyelid lesions. Other frequently confused lesions include syringomas, age warts, apocrine hidrocystomas, trichilemmomas, fibrofolliculomas, & other adnexal tumours. Your dermatologist can tell the difference. In some cases, a skin biopsy is required.
How to diagnose xanthelasma?
Your family physician can diagnose xanthelasmas visually by examining the skin around your eyes. If in doubt, you may be referred to a dermatologist for a skin biopsy. Your doctor may order a series of lipid profiles to see if your cholesterol levels are contributing to your condition.
Can chemical peels help treat xanthelasma?
Yes. TCA as a standalone or with Jesser can be effective. Phenol croton oil is more effective. I love my peeling agents; however lasers are more accurate as it gives me more precise depth control.
Can surgery help?
For cases that lie in a natural crease, or for those who have eyelid skin laxity, my preferred option is to excise xanthelasma & lift the upper eyelids. Lower eyelid xanthelasma is a little bit trickier as skin excision has to be conservative or eyelid retraction occurs.
What is the role of a plasma pen?
Plasma pens are great for skin tags & warts. I do not use them to treat the eyelids. They give too much collateral damage to the skin.
Simple cryotherapy by your family physician causes less collateral damage compared to plasma pens.
How much are treatments?
Unfortunately, Medicare does not give you a whole heap back. Private health insurance does not cover this procedure. As a guide patients are out of pocket between $2,890 to $3,990 depending on the extent of laser resurfacing – surgery.
For more budget friendly options, there may be cosmetic GPs that can treat these lesions with spot TCA or even fractional lasers.
Davin’s viewpoint on xanthelasma treatments
Xanthelasmas are common benign eyelid or periocular tumours. The incidence is around 1%. In over a third of cases there are elevated cholesterol levels in the blood. Rarely, this condition is familial (familial dyslipidaemia). Hence, the first step is a fasting lipid level via your GP. With extensive xanthelasma or atypical lesions, other forms of xanthomas are in the differential.
There are rare cases of eyelid xanthomas involving reduction in cholesterol levels (Zocor statin). This is the exceptional, rather than the rule. Lasers provide a good reduction in most cases. In extensive eyelid involvement, I may excise & laser, or perform a two-step procedure. Healing takes place over a week or more.
If there is no access to CO2 or erbium lasers, RF or even cautious cryotherapy may be attempted. Another simple option is application of TCA 35 to 50%, two to three coats. With TCA or phenol peels, 2-4 sessions are required. Xanthelasmas can be recurrent. I cannot predict the timeframe.
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