What is Xanthelasma?
These are small yellowish deposits of fat/cholesterol that tend to form around the eyelids. They often tend to form around the inner corners of the upper and lower eyelids. In some cases they are associated with elevated levels of cholesterol in the bloodstream. If these fatty lumps appear around the eyes it is advisable to see your GP to get a blood test. If cholesterol levels are elevated dietary modifications and/or medications may be started to help reduce the cholesterol level.
The deposits themselves are harmless. So technically nothing needs to be done. However many people will find them a cosmetic nuisance and wish to get rid of them. There are many techniques that can be used to help with removing xanthelasma. These very from surgery with removal of the sections of the skin of the lid to laser techniques involving vaporisation of the affected tissue.
The smaller the lesion the less chance there is of scarring or discolouration of the affected skin. Larger lesions may leave small scars or discolouration within the skin.
There is also a risk of infection. To help with healing Dr Hussein will provide an antibiotic ointment to apply following the surgery. This can be used twice daily for 3 days.
It is important to understand that any removal of xanthelasma does not prevent new lesions from developing in the future.
Dr Hussein favours the use of the Erbium YAG ablative laser in this area. This is because the area is delicate. The skin of the eyelid is the thinnest skin of all. The Erbium YAG allows for precise layer by layer removal of the affected tissue. The procedure can accurately stopped once the last layer of affected tissue has been removed. The likelihood of contractures or scarring reduced due to the minimal possible trauma caused by the Erbium YAG laser.
In order to perform this procedure with the laser Dr Hussein must insert a metal eyeshield into the eye. This resembles a large metal contact lens and it is inserted under the eyelids with a few drops of local anaesthetic and lubricating gel. Dr Hussein has included videos of eyeshield insertion and a video and photos of the Erbium YAG laser xanthelasma removal procedure in this section. Please take a look to inform yourself before coming to see Dr Hussein for a consultation.
Erbium YAG laser is safe for darker skin types and although any type of xanthelasma removal method can result in discolouration of the treated skin, it is much less likely with Erbium YAG laser.
For larger lesions Dr Hussein may perform more than one treatment. This is because shrinkage can be achieved with the first treatment. 6 weeks later a second treatment can be performed to remove the final components of the lesion. This way scarring risk is reduced by performing this two stage removal technique for larger lesions.
Other valid techniques
There are multiple surgical techniques that vary from quite simply just cutting out the affected tissue to using radio surgery to ablate the lesions. Radiosurgery has to be used very cautiously as heat is created in the surrounding tissue that can result in a greater risk of scarring and skin discolouration. Sometimes for small lesions a simple electrosurgical device called a hyfrecator may be used to coagulate the lesions. Both radiosurgery and hyfrecation must be used in experienced hands to obtain the best results.
TCA (Trichloracetic acid)
This is a type of chemical peeling agent that can be used to help with the treatment of xanthelasma. Whilst a little old-fashioned it is still used by many Doctors. This is because of the relative simplicity and low-cost nature of the equipment required. There is however a lot of skill and judgement required with this method. Overtreating can result in scarring and often removal is incomplete as it takes a little guesswork to establish when a lesion has been adequately treated.
This is a simple skin surgical method to remove small lesions. It uses a small circular skin punch to remove the affected area of skin. The skin is then repaired with fine stitches. It will create a small scar by definition. Small lesions are best removes with the more modern techniques that Dr Hussein uses such as Erbium YAG laser ablation.