Xanthelasma Removal in London

Treating your eyelid cholesterol deposits

Xanthelasma palpebrarum are yellowish papules and yellow plaques that can occur in the eyelids and the lower eyelids due to cholesterol deposits in foam cells and lipid-laden histiocytes in the reticular dermis of skin. They are not harmful and are painless. They tend to occur in older adults but can occur at any age. It can have an impact on your appearance and can affect your confidence. There is little evidence to suggest that they associated with high levels of cholesterol in the blood but it would be worth doing a simple blood test to check the blood total cholesterol levels and lipid levels just to be sure that it is not high. Usually the lipid metabolism is normal however. Blood glucose levels are checked to exclude diabetes mellitus. If the Xanthelasmaprogresses to form nodules then this may be termed a Xanthoma. Xanthelasma lesions may be classified as a Xanthoma subtype. Xanthelasma are diagnosed following an assessment from a doctor who is familiar with the condition. Other rare cases and inflammatory skin disorders that are less common in the general population that may appear similar include Sebaceous Cysts and less commonly Sarcoidosis, Necrobiotic Xanthogranuloma, Syringoma, Sebaceous Hyperplasia, Erdheim Chester, Lipoid Proteinosis, and adult onset Asthma with Peri-ocular Xanthogranuloma Syndrome. The yellowish plaques can be treated and there are multiple treatment options.

How Xanthelasma are removed

Xanthelasma can be left alone if they are of no bother. They may increase with time. They can also be treated with a chemical peel with topical Trichloroacetic acid applied to the affected area or by surgery. Other non surgical treatments include laser treatments such as Carbon dioxide or CO2 laser, YAG laser and liquid nitrogen cryotherapy although the can cause scarring. Some doctors may offer treatment with lasers or cryotherapy although this is less common. Mr Ahmad Aziz prefers chemical peels or surgical excision and performs this in Central London.

Why is a chemical peel done

You may consider having a Tricholoacetic acid chemical peel if you are keen to avoid surgery and remove the Xanthelasma. A chemical peel is applied and the Xanthelasma may change in colour and turn pale white at the beginning with the surrounding skin becoming slightly inflamed. Over a period of a few weeks the yellowish plaques will reduce in size. This treatment is effective particularly when the area is small and away from the eyeball. You may require repeated treatments to remove the Xanthelasma entirely.

Why is surgery done for Xanthelasma

Xanthelasma removal surgery is an option if:

Excess skin particularly in the upper eyelids around the Xanthelasma

The Xanthelasma is very close to the eye making a Tricholoracetic acid peel difficult

A Tricholoacetic acid peel has been tried and has not been successful in removing the Xanthelasma entirely

An instant removal of the Xanthelasma is required

Insurance coverage for Xanthelasma removal surgery may depend on your policy. If the surgery is only to improve the cosmetic appearance to give a younger and brighter look the most likely won't be covered by your insurance policy. Xanthelasma surgery is almost always done for cosmetic reasons as the appearance does not affect the peripheral vision and the Xanthelasma surgery cannot be used to improve vision.

Risks

Possible risks of Xanthelasma surgery include:

Infection

Bleeding from the eyelids

Dryness and irritation of the eyes

Difficulty closing the eyes

Scarring (although this is usually put into the eyelid skin crease to hide it as much as possible)

Skin discolouration

Facial asymmetry

A need for follow up surgery

Temporary blurring of the vision

Rarely, loss of vision

Risks associated with surgery more general including anaesthetic reactions and blood clots

To know which risks most apply to you talk to your doctor to understand more about removal with surgery as well as the benefits and if they apply to you. This way you can decide with your doctor if Xanthelasma surgery is a good option. They will ask you about your medical conditions as well as arrange blood tests to check for high cholesterol and triglyceride levels, any lipid disorders with your low-density lipoprotein, diabetes, and any potential systemic diseases such as nephrotic syndrome or severe atherosclerosis and cardiovascular risk factors which increases the risk of myocardial infarction and ischemic heart disease.

How you prepare

 

Before having a Xanthelasma removed with surgery you will meet your oculoplastic surgeon who specialises in Xanthelasma to discuss:

Your medical history including any previous surgery and current eye conditions.

Your expectations with an honest discussion about what can be realistically achieved.

A vision examination to check the eyes prior to surgery.

A physical examination of  the eyelids and lower lids to ensure that this is the correct procedure.

Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.

It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during Xanthelasma surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your Xanthelasma surgery and will tell you how long before the operation.

Stoping smoking several weeks before surgery can help improve the healing after Xanthelasma surgery.

You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation.

What you can expect before the procedure

Xanthelasma removal with surgery is usually done as a day case where you can go home the same day. Your surgeon will inject anaesthetic into your eyelids to numb the area and you can also have medication through a drip to help you relax.

What you can expect during the procedure

 

Your surgeon will make an incision along the Xanthelasma affecting the eyelid, removing some excess skin, and closes the incision to give a natural appearance and hiding the scar within the eyelids natural creases to hide the scar as best as possible. Depending on the location of the Xanthelasma it may not be possible to hide the scar not the skin crease particularly if the lower lid is involved. The scar following the surgery should heal to become fine line that is less noticeable than the Xanthelasma. More severe cases may require reconstructive surgery.

 

What you can expect after the procedure

After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the healing at home.

After surgery you may temporarily experience:

  • Blurred vision from the lubricating ointment applied to your eyes at the time of Xanthelasma surgery

  • Watering of the eyes

  • Sensitivity to light

  • Double vision

  • Puffy, numb eyelids from the anaesthetic and Xanthelasma surgery

  • Swelling and bruising similar to having black eyes which will settle within a week

  • Pain or discomfort

Your doctor will likely suggest you take the following steps after surgery:

  • Use ice packs on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling

  • Gently clean your eyelids and use prescribed medication.

  • Avoid straining, heavy lifting and swimming for a week after Xanthelasma surgery.

  • Avoid strenuous activities, such as aerobics and jogging, for a week.

  • Avoid smoking.

  • Avoid rubbing your eyes.

  • Not to use contact lenses for about two weeks after surgery.

  • Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.

  • Sleep with your head raised higher than your chest for 3 days after the surgery.

  • After a few days, return to the surgeon to have stitches removed, if needed.

Seek medical attention immediately if you experience any of the following:

  • Shortness of breath

  • Chest pain

  • An unusual heart rate

  • Severe new eye pain

  • Bleeding

  • Vision problems

Results

 

Many patients are satisfied with the results of Xanthelasma surgery and benefit from a more youthful appearance and more self confidence with the removal of the Xanthelasma. The results of the surgery can last a lifetime but for others the Xanthelasma may recur with time. 

The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases. 

Scars from the surgery can take months to fully fade but should be within the skin crease if this is possible and be well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.

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