What are they?
Xanthelasma are benign eyelid growths that look like plaques, and characteristically have a waxy, yellow color. These can commonly grow around the middle corners of both upper and lower eyelids, and can often extend farther along the eyelids as well. Sometimes they grow asymmetrically.
Although these growths can sometimes be associated with higher lipid or cholesterol levels, this is not always the case. It is important to have your blood lipid and cholesterol levels checked regularly if you do have Xanthelasma. However, blood lipid levels are not always a good predictor of the presence of these lesions.
Often, the more significant issue with Xanthelasma is that they can be quite noticeable, and can leave the eyelids with an undesirable appearance due to the distinguishable color. They can occur in patients of all skin colors.
If you have Xanthelasma present, it is very important to have an OculoFacial Plastic Surgeon evaluate your condition before considering treatment, as these skin lesions often have deeper roots that extend into the underlying eyelid muscle layer. As such, they are notoriously a little more complicated to treat, and in many cases, they can have a higher rate of reoccurrence.
If you have Xanthelasma present, it is generally advisable to have your lipid and cholesterol levels checked on a regular basis to ensure that these skin lesions are not indicative of a larger medical problem.
How do you treat them?
Although there are several treatments that are frequently performed for this condition, the best and most effective treatment to remove Xanthelasma while significantly reducing the risk of recurrence is surgical excision.
Other treatment options such as laser ablation, cryotherapy, and chemical cauterization, do not seem to have the same level of effectiveness in treating these lesions, and these treatments frequently will have much higher rates of the Xanthelasma lesions growing back sooner. A major reason for this tends to be due to the deeper roots of these lesions that can only be addressed effectively by surgery.
Often, Dr. Lewen will remove Xanthelasma as an in-office procedure using local anesthesia. If the Xanthelasma are relatively larger in size, Dr. Lewen may sometimes recommend performing a simultaneous blepharoplasty for the affected eyelid(s) in order to achieve the best possible cosmetic result. As the time of your consultation, Dr. Lewen will fully evaluate your Xanthelasma, along with the structure and positioning of your eyelids to determine the safest and most effective way of removing these lesions.
Is the procedure painful?
For those procedures that Dr. Lewen decides are best to do in the office, a quick injection of anesthesia is used to effectively numb the area being treated. Typically, these injections are only minimally uncomfortable for a brief period, lasting 20 seconds or less. Afterwards, you will not experience any discomfort during the procedure itself. For patients who may be somewhat more anxious, Dr. Lewen may also prescribe a light oral sedative that is usually taken about 45 minutes to 1 hour prior to the start of the procedure. In these cases, you will need to have someone present to drive you home after your procedure.
If Dr. Lewen determines that your case may be somewhat more complex, or if you desire additional procedures to be performed at the same time, you may also elect to have this procedure performed in an outpatient surgical center, where you can be treated with IV sedation to help you fully relax for the duration of the procedure. In this case, you will experience no discomfort at all, however, additional facility and anesthesia costs may apply.
Dr. Lewen provides all post-surgical patients with an adequate supply of post-operative pain medication. In our experience with this procedure, most patients do not report an excessive amount of discomfort following Xanthelasma removal. Some mild soreness can be common for the first few days, but most patients who have undergone this procedure will report that they do not require much pain medication at all.
What is the healing process like?
Typically, only mild bruising and swelling is seen after Xanthelasma removal and most patients will report that this improves significantly within the first week or two. Any stitches that are placed are usually removed at about 1 week after the procedure, or they will dissolve on their own.
The potential for scarring can vary greatly depending on the size of the Xanthelasma, the exact location on your eyelids, your skin tone, your attention and compliance with Dr. Lewen’s post-operative instructions, and any history of thicker scar formation in you or in your family. Most often, scar formation in this area is minimal and Dr. Lewen prides himself on paying particular attention to the fine details of proper surgical planning, surgical technique, and post-operative scar management in order to maximize your cosmetic outcome.
As Dr. Lewen discusses with all patients during the consultation, dry eye issues are a very common side effect of any eyelid procedure. Usually, these issues are short-lived and tend to resolve quickly following your procedure. Dr. Lewen will advise you on the best way to proactively prepare for any dry eye issues that you may encounter during your recovery period.
For most patients with Xanthelasma, only one surgical procedure will be enough to yield gratifying results. In rare cases, the lesions can potentially return over time, and additional treatments may be required.
Is this covered by my Insurance?
Xanthelasma are benign lesions that do not carry any potential risk of harm to the body or vision, and do not have the potential to become cancerous. As such, the treatment of Xanthelasma is not covered by most insurance carriers, and is considered to be a cosmetic procedure.