Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The surgical procedure is characterized by microsurgical precision. The surgeon uses magnification loupes or a surgical microscope to visualize the borders of the xanthelasma and the delicate eyelid structures. This enhanced visualization is crucial for removing the entire deposit without damaging healthy tissue.
The excision is performed using delicate instrumentation tailored for ophthalmic surgery. This includes micro-forceps, Westcott scissors, and radiofrequency cutting tips. The goal is to dissect the plaque from the underlying muscle with minimal trauma, preserving the vascular supply to the skin flaps.
Most xanthelasma excisions are performed under local anesthesia with or without oral sedation. The surgeon injects a mixture of lidocaine and epinephrine directly into the eyelid skin. This provides complete numbness and constricts blood vessels to minimize bleeding.
For anxious patients or extensive cases involving all four eyelids, intravenous sedation (twilight sleep) may be administered by an anesthesiologist. This ensures the patient remains relaxed and still during the delicate dissection near the eye. Patient comfort is prioritized throughout the experience.
The design of the incision is an artistic as well as a surgical decision. For upper eyelid lesions, the incision is typically placed within the supratarsal crease, the natural fold of the eyelid. This hides the future scar effectively when the eyes are open.
For lesions near the medial canthus (inner corner), the incision may be designed as a “V-Y” advancement or a broken line to prevent the formation of a webbed scar. The surgeon carefully marks the skin before anesthesia to ensure symmetry and optimal vector alignment.
The surgeon incises the skin along the markings and carefully dissects the xanthelasma plaque. The dissection is carried down to the level of the orbicularis muscle. In many cases, the plaque involves only the skin, but if it infiltrates the muscle, a portion of the muscle fibers may also be removed.
Great care is taken to remove the entire depth of the yellow deposit. Leaving residual foam cells increases the risk of recurrence. Once the lesion is removed, the surgeon inspects the wound bed to ensure it is free of lipid material.
The eyelid is highly vascular, so controlling bleeding is essential. The surgeon uses bipolar cautery, a precise tool that delivers energy only between two tweezer tips, to seal small blood vessels. This prevents thermal damage to the surrounding skin and hair follicles.
Meticulous hemostasis prevents post-operative hematomas, which can compromise wound healing and lead to infection. A dry surgical field also allows for more precise closure of the skin edges.
Closing the wound requires a tension-free technique to prevent eyelid distortion. The surgeon uses excellent sutures, typically 6-0 or 7-0, which are thinner than a human hair. These may be absorbable or non-absorbable depending on the surgeon’s preference.
The edges of the skin are brought together with eversion, meaning they are slightly turned out. This promotes optimal healing and a flat scar. If the defect is too large for simple closure, local flaps are rotated into the defect to provide coverage without tension.
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In some advanced procedures, the surgeon may use a fractional CO2 or Er: YAG laser immediately after closure to treat the incision edges. This “laser painting” helps to blend the transition between the treated area and the surrounding skin.
The laser stimulates collagen production and promotes smoother healing. It can also be used to treat any tiny, superficial satellite lesions that were not amenable to excision, ensuring a comprehensive clearance of the area.
After the procedure, the patient is monitored for a short period to ensure stability. Cold compresses are applied immediately to the eyes to reduce swelling and bruising. The head is kept elevated to promote venous drainage.
The surgical team checks for any signs of immediate complications, such as retrobulbar hemorrhage (though scarce in superficial surgery). Once the patient is alert and the wounds are stable, they are discharged with detailed care instructions.
Typically, no heavy bandages are placed over the eyes. The incision line is covered with an antibiotic ointment, which acts as a protective barrier. In some cases, tiny sterile strips (Steri-Strips) are used to support the incision.
Patients are instructed to keep the wound clean and moist with the prescribed ointment. They must avoid rubbing their eyes or getting the area wet for the first 24-48 hours. Keeping the wound moist accelerates re-epithelialization and reduces scarring.
Swelling (edema) and bruising (ecchymosis) are expected parts of the recovery. The eyelid skin is thin and prone to swelling. The bruising may extend to the lower lids due to gravity (“black eye” appearance).
This typically peaks at 48 hours and resolves over the next 1-2 weeks. Patients are advised to use ice packs frequently for the first 2-3 days and to sleep with their head elevated on pillows to minimize fluid accumulation.
Recovery involves avoiding activities that increase blood pressure in the head. Bending over, heavy lifting, and straining are prohibited for the first week. These actions can cause the small blood vessels to pop, leading to bleeding under the skin.
Patients can usually return to sedentary work within 2-3 days, but social downtime may be longer due to the visible bruising. Contact lenses are avoided for 1-2 weeks to prevent pulling on the eyelid during insertion.
It is unlikely your eyes will be swollen completely shut, but significant swelling is normal. The morning after surgery is usually the peak of swelling. Using ice packs and sleeping upright helps keep the swelling manageable so that you can see.
Eyelid skin heals very quickly. Stitches are typically removed 5 to 7 days after surgery. Leaving them in for too long can result in “track marks” or visible scarring, so timely removal is essential.
If you had local anesthesia only, you might be technically allowed, but it is not recommended due to blurry vision from the ointment. If you had sedation, you are strictly prohibited from driving and must have a ride.
The surgery itself is painless due to the anesthesia. Post-operative pain is usually mild and easily managed with over-the-counter acetaminophen (Tylenol) and cold compresses. Potent narcotics are rarely needed.
You must not apply makeup to the incision or the immediate area until the stitches are out and the wound is fully closed, usually about 10 days. Applying makeup too early can cause infection or permanent tattooing of the scar.
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