Xanthelasma Removal Glasgow

This condition is the most common cutaneous xanthoma and presents with small yellowish plaques, appearing around the eyelids.

Sometimes it can be associated with hyperlipidaemia, thyroid dysfunction and diabetes and we always recommend you have been seen your GP surgery to exclude such conditions.

Most of our patients don’t have a particularly high cholesterol and this supports the fact that there are other, unknown, factors at play. Sometimes there can be a family history of XP, but again we find often there is none.

XP is more common in females, affecting around 1%, compared to 0.3% in males. While it is typically considered a condition of older people, it may present as early as aged 15yrs and has a peak incidence of 30-50yrs.

While the appearance of XP is typically obvious, on occasions of diagnostic uncertainty we may recommend biopsy for lab confirmation.

XP are totally harmless lesions but our patients find them unsightly and seek to remove them. As we know, anything that ‘complicates’ the face, and particularly the area around the eyes, is typically considered aesthetically negative.

Options for removal include:

Surgery

• Options range from traditional excision, punch excision (smaller lesions) or electrosurgery.
• It may be the ideal option if there is significant skin laxity where surgical blepharoplasty can be combined.
• Downsides include the inevitable scarring and potential ectropion.

Cryotherapy

• This typically uses liquid nitrogen spray and requires multiple sittings.
• Risk of post-procedural pigment abnormality is unpredictable.

TCA (Trichloroacetic Acid)

• Used in cosmetic dermatology as a chemical peel, in high strength (70-100%) it may be useful to treat local problem lesions like XP.
• Pigmentation abnormality, scarring and atrophy are relatively common due to the unpredictable penetration depth.

Laser

• This is our treatment of choice.
• While other lasers may be used, Erbium:YAG (Er:YAG) is the optimal choice.
• It’s more precise than other methods.
• It limits heat by using ‘cold ablation’, significantly reducing the risk of scarring and pigmentation abnormality.

Around your eye, fatty deposits build up, causing Xanthelasma. People of any age can develop the condition, but it is most common in middle-aged and older adults. A Xanthelasma is usually not painful, but if left untreated, it can gradually worsen and cause further discomfort.

Xanthelasma usually does not disappear by itself once it develops. It may in fact become more numerous and larger as it progresses. There is usually no itching or tenderness in Xanthelasma. Cosmetic appearance is usually the top concern for patients with Xanthelasma.

Xanthelasma are benign growths; they do not spread like cancer does. Visual impairment is rare from these growths. The triglycerides can be a sign of Hyperlipidemia, high blood cholesterol and triglyceride levels.

A Xanthelasma is a xanthoma that appears on the eyelids. An xanthoma is a yellowish cholesterol-rich deposit that can form anywhere in the body due to various diseases.

Assessment

At our clinic we carry out a full assessment, check the medical history and then proceed to examination. This involves visually (with magnification) and physically assessing the lesions, as well as checking for any other relevant clinical signs like arcus senilis.

Discussion

A discussion follows confirming the diagnosis and then a consideration of treatment options. We always like to make it clear that a legitimate option is no treatment. This is to ensure our patients have the option to make a truly informed choice.

Treatment may be offered on the day of assessment or at a later date. The patient will decide if they wish to have the procedure, as well as when. We always stress that time to reflect and plan can be useful where there is any doubt about how to proceed.

The procedure

Following skin preparation, local anaesthetic is carefully injected into the relevant areas. We deliberately make the area quite swollen with anaesthesia as this provides enhanced safety and clarity during the procedure. Occasionally a small bruise can result following the injection. Anaesthesia is allowed to develop for at least 10 minutes prior to continuing.

Next anaesthetic eye-drops are instilled so as to numb the surface of the eye. They sting a little but allow the intra-ocular shields (required eye protection for when undergoing laser treatment to the eye region) to be placed with ease and total comfort.

Now lasering can commence and should be completely painless. The erbium laser makes some noise (the absorption of light by the chromophore water is so intense that there is a photo-acoustic reaction) and there is also an additional noise from the plume evacuator and the cold air machine.
Laser treatment may take as little as 10 minutes

Recovery / Aftercare

Removal of XP results in a wound which we liken to falling and grazing your knee. The area is ‘raw’ for a few days and must be managed with gentle cleansing (avoidance of any harsh cleansers or ‘active skincare’) and application of a greasy ointment. We typically give the patient chloramphenicol ointment away to apply (unless they have an allergy to it in which case we recommend vaseline).

Some swelling is normal and this may take a few days to settle.

New skin starts to form within a few days and this process occurs more quickly due to the application of the ointment. Typically by day 9 the new skin has formed and any scab will have come off.

It is normal to have some redness in the surrounding area and this is part of the normal healing response. Increasing redness and associated pain would raise the possibility of infection and should lead to communication with the clinic. That said, infection is very uncommon in this area.

• Recurrence – there is always potential for lesion recurrence. If the cholesterol deposit is very deep (in 40% of patients it may be in the muscle or deeper), it may resurface. As such, it is important to know that a second procedure may be required.
• New XP – over time, further lesions may appear. While this may relate to an uncontrolled raised cholesterol, it can occur in patients who have a normal cholesterol level. Some of our patients have had previous lesion removal only to find that months or years later, new lesions appear. Unfortunately there is nothing we can offer in terms of preventing such an occurrence.
• Infection – a risk following any skin procedure, it is particularly uncommon in the areas affected by XP. But it can still happen which is why we recommend care in managing the wound until the new skin grows.
• Scarring – the areas affected by XP heal very well and scarring is often avoided. Scarring may, however, occur and further light-based therapies may be considered if this is visually concerning.
• Hyperpigmentation (darker skin patches) – this can happen in any patient but is more common with darker skin-types. For as long as the healed skin is pink, we recommend additional sun-protection measures. This may be a new concept to patients with darker skin but it is key to ensuring an optimal recovery.
• Hypopigmentation (lighter skin patches) – While any device approach, including cryotherapy, may result in hypopigmentation, Er:YAG minimises this risk. As the skin around the eyes is already slightly darker, this is a side-effect that we are keen to avoid. Hypopigmentation may be permanent, although there are new emerging therapies that may help to improve the situation if it arises.

Cost

Removal of XP lesions start at £800 and multiples lesions may cost £1200. Additional treatment is typically less and usually starts from £400.

A Xanthelasma can potentially cause the eyelids to droop, which can obscure your vision or will make it difficult to open & close your eyelids. If this describes your symptoms then get in touch with us for a consultation.

Because Xanthelasma removal is considered cosmetic surgery, the chances of it being covered by insurance are very low. However, if it gets to a stage where the symptoms are severe and impairs the vision, then it is likely to be covered by your insurance provider.

A very high number of patients are happy with the treatment they receive for Xanthelasma conditions. They benefit from their more youthful looks and increased self-confidence levels. The results of Xanthelasma surgery can last a lifetime, but it can sometimes reoccur with time.

People with Xanthelasma have elevated lipid levels associated with high cholesterol and certain liver diseases. These are often found to be hereditary in about 50% of patients. The other half of patients tend to have normal cholesterol levels. Xanthelasma is also more common in people of Asian or Mediterranean descent.