Removal of xanthelasmas – a summary
| What is being removed | Yellowish deposits in the eyelid skin (xanthelasmas) |
|---|---|
| Methods | CO2 laser or radiowaves; for more extensive lesions, a surgical approach is considered |
| Anaesthesia | Local |
| Before the procedure | Check-up, and at the doctor's discretion, a check of the lipid profile |
| Season | From autumn to early spring, for sun protection |
| Number of interventions | In the case of deeper and more extensive changes, additional intervention is sometimes required |
| Recurrence | It is possible, regardless of the chosen method |
| Price | In the current dermatology price list |
What are xanthelasmas and how to recognise them?
Xanthelasma (lat. Xanthelasma palpebrarumare flat or slightly raised yellowish changes caused by the accumulation of lipids in skin cells. They appear on the upper and lower eyelids, individually or on both eyes, and are most commonly soft, smooth and clearly demarcated.
Changes usually develop gradually, over months. They are more frequent in older people, but can also appear earlier, regardless of gender.
Not every light bump around the eye is xanthelasma. Through examination, they are distinguished from other changes in that region, such as milia and syringomas, in order to choose the appropriate procedure.
Do xanthelasmas mean high cholesterol?
The development of xanthelasmata may be linked to hereditary and metabolic factors, as well as to conditions such as lipid disorders, diabetes, obesity or liver disease. They can, however, also occur in people with completely normal cholesterol and triglyceride levels.
Because of this, a doctor may suggest checking total cholesterol, LDL, HDL and triglycerides, along with additional tests depending on the health condition. Not every patient needs to have a wide panel of tests.
Removal of deposits and the treatment of any lipid disorder are two separate things. Regulating laboratory values is important for health, but it does not lead to the regression of already formed changes on the eyelids.
How is the removal method chosen?
The choice depends on the size, depth and arrangement of the changes, their proximity to the eyelid margin, skin quality and previous treatments. The doctor assesses the expected benefit, the course of healing and the possibility of a visible mark.
For larger or deeper deposits, a surgical approach is also evaluated, while laser and radiowave methods are most commonly chosen for smaller and more superficial lesions. No single method is best for all patients — a plan is made according to the findings.
Smaller-diameter changes are generally easier to remove, so a check-up makes sense even when deposits are just starting to become noticeable.
Methods of removing xanthelasmas
Removal of xanthelasma with CO2 laser
CO2 laser is an ablative laser technology that enables layered tissue removal while preserving the surrounding skin. In the case of xanthelasmas, the lesion is removed layer by layer, and the energy simultaneously coagulates tiny blood vessels, so bleeding during the procedure is minimal.
The treatment is performed under local anaesthesia and is scheduled during the period of reduced UV radiation, from autumn to early spring, in order to reduce the possibility of subsequent pigmentation. After the procedure, swelling, redness and a scab may occur, and the depth of the treatment affects the duration of healing.
Removal of xanthelasmata using radiowaves
The radiowave method uses high-frequency energy for the controlled removal of lesions, without mechanical pressure and without classic scalpel cutting. The procedure is performed under local anaesthesia and is brief, depending on the size and number of lesions.
The suitability of the method is assessed by examination — it is most often suited to clearly demarcated and more superficially positioned lesions. After the procedure, a thin scab forms, and the doctor explains the expected course of recovery and whether a single intervention or gradual removal is planned.
Eye protection during the procedure
The eyelid region requires a specific treatment plan. The procedure is performed with eye protection and a controlled depth of action, and before it begins, the doctor checks whether you have had any previous interventions on your eyelids or eyes and whether there are any vision issues.
Contact lenses are removed before the procedure, and makeup is not applied on that day.
When additional intervention is required
With deeper and more extensive lesions, a single intervention is sometimes not sufficient to remove the change completely. When this is anticipated, the doctor explains it in advance, along with a follow-up plan, so that the remainder of the lesion is treated once the skin has recovered.
Further treatment of the remainder of an existing lesion is not the same as the recurrence of xanthelasma after successful removal.
What do the examination and preparation look like?
During the examination, the doctor assesses changes and discusses with you your previous treatments, chronic conditions, the medication you are taking, allergies, and any previous procedures on your eyelids or eyes.
It is useful to bring available lipid test results and a list of your medication. A photograph of the condition may help with preliminary communication, but the final treatment plan is determined during an in-person examination.
If you are unsure which change is being referred to, the first step is dermatological examination.
Recovery and care after removal
In the first few days, redness, swelling and a scab are possible at the treated site. The skin surface heals when the scab falls off spontaneously, usually within seven to ten days, while the swelling subsides sooner. The evening out of the skin colour takes longer and may continue for weeks after healing.
Scabs are not to be removed, and only the skincare recommended by the doctor is to be used. Instructions regarding washing, make-up, physical activities and sun protection are provided after the procedure, depending on the extent of the treatment.
The date of the follow-up appointment and the return to normal activities are determined by the extent of the treatment and the course of healing.
Do scars remain and can xanthelasmas return?
The aim of the treatment is the removal of lesions with the best possible aesthetic result, but a visible mark or change in skin colour at the treated site is possible. The outcome depends on the depth of the treatment, the size of the lesion and individual healing, with skin discolouration being the most common adverse effect of these procedures.
Xanthelasmata may recur, regardless of the method chosen — this is known for all procedures currently in use. A follow-up allows for the evaluation of the results and agreement on further steps, if required.
Removal cost of xanthelasmas
The price depends on the number, size and depth of the lesions, the chosen method and the scope of the procedure. The eyelid region requires precise work, so the treatment plan is determined individually, following an examination.
Current prices can be found in dermatology price list. After the examination, you will receive a treatment proposal and cost information, including a follow-up plan and any potential additional interventions.
Frequently asked questions about xanthelasma removal
Can xanthelasma be removed with a cream, balm, or naturally?
Creams and balms should not be considered a reliable substitute for an examination and appropriate treatment. It is particularly important not to independently use preparations that irritate the skin in the immediate vicinity of the eye, as the eyelid region is thin and sensitive, and the consequence can be permanent scarring.
Is the procedure painful?
The procedure is performed under local anaesthesia. The injection of the anaesthetic may sting briefly, after which the treated area will feel numb. Mild tenderness and tightness are possible once the effects of the anaesthetic wear off.
Is one procedure enough?
It depends on the scope and depth of the changes. For minor deposits it usually is, whereas for deeper ones an additional procedure is planned. The doctor explains this before starting, so you know in advance what to expect.
Is the treatment only done in winter?
The timing is chosen according to the method and the possibility of sun protection implementation. These procedures are planned during the period of reduced UV radiation, from autumn to early spring, as this reduces the possibility of subsequent pigmentation at the treated site.
Book xanthelasma removal in Belgrade
The Imedic Polyclinic is located at Kneza Miloša 23 street, 2nd floor, Belgrade. Opening hours: Monday–Sunday, 9:00–21:00.
Appointments are made by phone: 064 237 0707. If you contact us from abroad, we are also available via Viber and WhatsApp on the same number.
Author: Dr Ivica Jeremić
Doctor of Medical Sciences (Molecular Medicine and Immunology), subspecialist in rheumatology, dermatology resident.
Updated:
Expert sources
PubMed: A Practical Review of the Management of Xanthelasma palpebrarum
NCBI: Xanthelasma – An Update on Treatment Modalities
American Academy of Ophthalmology EyeWiki: Ocular Injuries Due to Cosmetic Laser
