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Surgical correction of Xanthelasma Palpebrarum is a specialized part of oculoplastic surgery focused on removing cholesterol deposits from the eyelids. This procedure is not just cosmetic—it restores both the health and appearance of the eyelid area. Surgeons treat xanthelasma as a local sign of a possible underlying metabolic problem, requiring careful and precise treatment.
The procedure aims to fully remove the yellowish plaques that usually appear near the inner corner of the eye. Unlike surface treatments, surgery removes the entire deposit from deeper skin layers. This approach leads to better results and lowers the chance of the plaques coming back quickly.
The best approach to xanthelasma surgery combines removing the plaques with improving the look of the eyelid. Many patients also have extra eyelid skin, so surgeons often remove both the plaques and the excess skin in one procedure for a more natural, youthful appearance.
This combined approach lets the surgeon remove the xanthelasma and tighten the eyelid skin at the same time. By including the plaque in the eyelid lift, both the deposit and extra skin are taken out in one step. This method shortens recovery and hides scars in the natural folds of the eyelid.
The simple elliptical excision is the usual method for small to medium xanthelasma on the eyelids. The surgeon makes a football-shaped cut around the plaque, following the natural lines of the eyelid to help the scar heal well and stay less noticeable.
This method uses the eyelid’s natural stretch to close the wound directly. It works best for small, separate plaques. The main benefit is a simple closure and a thin scar that usually fades and blends into the eyelid’s natural folds over time.
For larger or more spread-out xanthelasma, surgeons use a modified eyelid lift. This is especially helpful for patients with loose eyelid skin. The surgeon extends the usual incision to include the plaque, removing it along with the extra skin.
This technique is advantageous because it camouflages the removal site within the standard aesthetic lines of an eyelid lift. It allows for the removal of larger amounts of tissue without creating tension on the eyelid margin. It also addresses the heavy, tired look associated with aging eyes, providing a functional and cosmetic benefit.
For very large or recurring xanthelasma, or when the skin is too tight to close the wound directly, surgeons use advanced reconstruction. They may move nearby skin to cover the area, arranging it so the eyelid keeps its normal shape.
If there isn’t enough nearby skin, the surgeon may take a small piece of skin from the other upper eyelid or from behind the ear. These advanced methods are used only in the most difficult cases to prevent the eyelid from pulling down and to keep the eye safe and working well.
Modern xanthelasma surgery is guided by the idea of oculoplastic harmony. This means removing the plaque should never harm the eye’s shape or function. Surgeons must carefully balance removing the deposit with protecting the eyelid’s movement and tear drainage.
Keeping the eyelid’s natural shape is very important. The aim is to avoid any obvious signs of surgery or unevenness between the eyes. Surgeons plan the removal so the inner corner and almond shape of the eye stay the same. The goal is a healthy eyelid that looks natural with the rest of the face.
Knowing what makes up the plaque is key to removing it well. Xanthelasma is made of foam cells—macrophages filled with fat—that sit in the upper and deeper layers of the skin. These plaques feel soft, look yellow, and can grow larger over time.
Since these deposits go deep into the skin, surface treatments often leave some behind. Surgery is preferred because it lets the surgeon see and remove the whole plaque. This complete removal is the best way to clear the area of visible fat buildup.
While the surgery addresses the local manifestation, the procedure’s definition extends to understanding the systemic context. Xanthelasma is often a cutaneous marker for underlying dyslipidemia, such as high LDL cholesterol or low HDL levels. However, it can also occur in patients with standard lipid profiles.
Surgeons view the procedure as part of a broader health intervention. The removal of the plaque improves the patient’s appearance, but it also serves as a trigger for metabolic investigation. The definition of success encompasses both the surgical clearance of the eyelid and the patient’s engagement with their systemic cardiovascular health.
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Xanthelasma is characterized explicitly by soft, yellowish, flat plaques that are typically located near the inner corner of the eyelids. Unlike styes, which are painful infections, or milia, which are complex white cysts, xanthelasma are painless accumulations of cholesterol under the skin.
While non-surgical options like chemical peels, cryotherapy, and lasers exist, surgical excision is often considered the gold standard for deep or extensive lesions. Surgery allows complete removal of the lipid deposit and provides a definitive solution with a generally lower recurrence rate in the treated area.
No, surgical correction of xanthelasma only removes the local deposits on the eyelids; it does not treat the underlying systemic cause. Patients are strongly advised to manage their lipid levels through diet, exercise, and medication to prevent the formation of new plaques.
Xanthelasma is a harmless growth and is not cancerous. Still, any changes in a skin spot should be checked by a doctor. The main concerns with xanthelasma are how it looks and its link to heart risk factors.
The inner corner of the eye has special blood and lymph vessels that make it more likely for cholesterol to leak and build up there. The skin in this area is also thin, so the yellow deposits show up more clearly than in thicker skin.
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