Operative treatment of large periocular xanthelasma

Aesthetic Surgical Treatment of Large Xanthelasma palpebrarum

BACKGROUND

Xanthelasma palpebrarum (XP) is a common eyelid condition. Various treatment modalities exist, each with its own merits and drawbacks. Managing larger lesions poses increased challenges. This study aims to explore the aesthetic surgical management of large xanthelasma palpebrarum.

METHODS

Patients with xanthelasma palpebrarum presenting to our department underwent partial excision of the lesion and debridement of the medullary nucleus under local anesthesia for lesions with a diameter of 6 mm or more. Microsurgical scissors were utilized to remove residual subcutaneous lesions. Postoperatively, tie-over bolster dressings were applied. Patients with lipid and glucose abnormalities received corresponding therapy. Bolster dressings were removed on the third postoperative day, with suture removal seven days later.

RESULTS

All flaps subjected to subcutaneous medullary debridement exhibited complete viability, with minimal localized eyelid depression early postoperatively and inconspicuous scarring three months post-surgery. No instances of lid ectropion were observed. The eyelid maintained a natural appearance, with a low recurrence rate of xanthelasma palpebrarum.

CONCLUSION

Surgical intervention involving partial excision of the lesion and medullary nucleus debridement offers a satisfactory approach for managing large xanthelasma palpebrarum.

LEVEL OF EVIDENCE IV

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Carbon dioxide laser excision as a novel treatment for large xanthelasma palpebrarum: long-term efficacy and safety

AIMS

This study evaluates the long-term efficacy and safety of carbon dioxide (CO₂) laser excision as a novel treatment for large xanthelasma palpebrarum.

METHODS

The study included 295 patients diagnosed with xanthelasma palpebrarum, categorised as 246 patients with grade I, 16 with grade II, 22 patients with grade III and 11 with grade IV lesions. All underwent CO₂ laser excision and were followed up for a 12-month period. Treatment efficacy was assessed through clearance and recurrence rates, evaluated using digital photography and complications were recorded.

RESULTS

The participant group consisted of 66 males and 229 females, with an average age of 41.7±11.6 years. Clearance rates exceeded 99% for grades I-III and were around 95% for grade IV lesions. The recurrence rate was 6.8%, with higher recurrence rates observed in lesions over 2 mm in height compared with those under 2 mm (p<0.001). The main complications over the 12-month follow-up were scarring (4.4%), hyperpigmentation (8.1%) and hypopigmentation (8.5%), with no severe complications reported.

CONCLUSION

CO₂ laser excision emerges as a precise, minimally invasive and effective modality for treating xanthelasma palpebrarum, marking a significant advancement in treatment modalities. Further research is required to reinforce these results and refine treatment protocols.

A scoring-based clinical grading model for xanthelasma palpebrarum: predicting treatment frequency and prognosis

Xanthelasma palpebrarum is one of the most common cutaneous xanthomas in humans. Currently, there are various methods available for treating xanthelasma palpebrarum, but the high treatment frequency and recurrence rate remain significant challenges for patients. Therefore, it is necessary to establish a reasonable and effective clinical grading system to guide the diagnosis and treatment of xanthelasma palpebrarum. We developed a clinical scoring system related to local injection of pingyangmycin for the treatment of xanthelasma palpebrarum, which can be used to predict early prognosis and treatment outcomes in patients. We collected and retrospectively studied 246 outpatient cases of xanthelasma palpebrarum treated with local injection of pingyangmycin in the Department of Plastic Surgery at Shanghai East Hospital from February 2020 to August 2022. Potential independent risk factors for adverse outcomes (recurrence or non-recurrence) were considered in univariate and multivariate logistic regression models. Predictive factors were determined based on the multivariate logistic regression model and Cox model, and a scoring grading system was established. External validation was conducted on an independent cohort of 110 patients. Based on logistic regression analysis, the number, area, and color of lesions were identified as significant predictive indicators (P < 0.05), with respective AUCs of 0.710, 0.799, and 0.755. The Cox model established hazard ratios for four new severity indicators of xanthelasma palpebrarum: hyperlipidemia, number of lesions, lesion area, and lesion grayscale value. Based on these findings, a new clinical grading model was developed, which was validated to be effective in the external cohort. The new scoring-based clinical predictive model can effectively predict the number of pingyangmycin injection treatments and prognosis in patients with xanthelasma palpebrarum. It holds promise for broader application in clinical practice.

A Practical Review of the Management of Xanthelasma palpebrarum

Xanthelasma palpebrarum is the most common type of xanthomatous lesion. Various methods for treating Xanthelasma palpebrarum have been reported. We conducted a systematic review to evaluate the efficacy and associated complications of different treatment methods, and we summarized these findings as a practical review designed to be clinically useful, accessible, and impactful.

Methods

The PubMed and Embase databases were searched to identify clinical studies that reported on outcomes and complications of different methods of Xanthelasma treatment. The electronic databases were searched from January 1990 to October 2022. Data on study characteristics, lesion clearance, complications, and recurrences were collected.

Results

Forty-nine articles (including 1329 patients) were reviewed. The studies reported on surgical excision, laser modalities, electrosurgical techniques, chemical peeling, cryotherapy, and intralesional injection. The majority of studies were retrospective (69%) and single-arm (84%). Surgical excision combined with blepharoplasty and skin grafts showed excellent outcomes for large Xanthelasma. CO₂ and erbium yttrium aluminum garnet (Er:YAG) were the most commonly studied lasers and showed more than 75% improvement in over 90% and 80% of patients, respectively. Comparative studies reported better efficacy for CO₂ laser than both Er:YAG laser and 30%-50% trichloroacetic acid. Dyspigmentation was the most encountered complication.

Conclusions

Different methods for the treatment of Xanthelasma palpebrarum have been reported in the literature, with moderate to excellent efficacy and safety profiles depending on the size and location of the lesion. Surgery is more appropriate for larger and deeper lesions, whereas laser and electrosurgical techniques can be used in smaller and more superficial contexts. Only a limited number of comparative studies have been conducted, and novel clinical trials are necessary to further augment appropriate treatment selection.

A Modified Surgical Method Combined with Blepharoplasty Design for Treatment of Xanthelasma Palpebrarum

Purpose

Xanthelasma palpebrarum manifests as a yellowish placoid on the medial aspect of the upper eyelids, often in middle and old age. Aggravated lateral hooding of the eyelid might cause a deformity with conventional surgery, which appears to be more deficient on the medial side with excess hooding of the lateral skin. The authors suggest a novel surgical technique to solve this problem and reconstruct the defect appropriately.

Methods

From July 2017 to December 2018, our method of combining excision with blepharoplasty was performed on 8 patients, consisting of 15 lesions on the upper eyelid and 6 lesions on the lower lid. Lesion removal incorporating blepharoplasty incision was done. After resection, the orbicularis oculi musculocutaneous flap was widely elevated extending through the whole upper eyelid with the lateral flap first along with fat maneuver. The flap was advanced into the defect, with even distribution of tension, after lower flap fixation to the required height of the eyelid fold. Taping was done with a hydrocolloid bandage and kept for 2 weeks.

Results

The wounds were healed primarily, and no cases of recurrence, lagophthalmos, hypertrophic scar, pigmentation, or remarkable deformity were noted. All patients were satisfied, and the functional outcomes were excellent. Two patients had trivial complications specific to our method, that of triple fold and neo-Mongolian fold, which were simply revised later.

Conclusions

This modality overcame the drawbacks of eyelid deformity observed in previous surgical methods, giving excellent results without any critical complications.

Continuous Wave Potassium Titanyl Phosphate Laser Treatment is Safe and Effective for Xanthelasma Palpebrarum

BACKGROUND

Although not an accepted standard treatment, the 532-nm continuous wave potassium titanyl phosphate (CW-KTP) laser might be a powerful device to treat xanthelasma palpebrarum (XP).

OBJECTIVE

To determine the safety and efficacy of CW-KTP laser treatment for XP.

MATERIALS AND METHODS

Between January 2013 and January 2015, 30 consecutive patients with XP were treated with a 532-nm CW-KTP laser (spot size: 0.9 mm, power: 5.0 W, fluence: 36-38 J/cm, pulse width: 46 milliseconds, frequency: 2.0 Hz, passes per session: 3). In a retrospective study design, safety and efficacy data were collected and analyzed.

RESULTS

Overall, 29/30 (97%) of patients had an excellent cosmetical result. Downtime was 1 week with crusted lesions. Although slight hypopigmentation was common, only 1/30 (3%) patients had hypopigmentation that was more than expected. Recurrences (13/30; 43%) were frequent, so that yearly maintenance therapy was warranted. No major side effects were noticed.

CONCLUSION

Continuous wave KTP laser therapy is safe and highly effective for XP, although regular follow-up treatments are often necessary to maintain the achieved cosmetic results.

Treatment of xanthelasma palpebrarum by upper eyelid skin flap incorporating blepharoplasty

BACKGROUND

Wound repair after xanthelasma palpebrarum excision in the upper eyelid is a challenge for the plastic surgeon due to the difficulty obtaining tissue of the appropriate color and texture. The authors present their treatment of xanthelasma palpebrarum by an upper eyelid skin flap incorporating blepharoplasty with satisfactory results for 16 patients.

METHODS

From September 2004 to August 2012, 32 xanthelasma lesions in the upper eyelids of 16 patients were surgically excised, after which an orbicularis oculi muscle myocutaneous flap was formed in blepharoplasty. The flap was used to repair the defect resulting from excision of the lesion. The xanthelasma palpebrarum treatment and blepharoplasty were performed simultaneously.

RESULTS

No flap necrosis complications occurred after the operation. During a 3- to 12-months follow-up period, no lesion recurrence, lagophthalmos, hypertrophic scar, or bulky appearance was noted in any of the 16 patients. Aesthetic results in the upper eyelid were obtained for all the patients.

CONCLUSION

By the reported method, the "waste" skin in blepharoplasty can become "treasure" material for covering the defect resulting from lesion excision. No new donor area is required. The dual effects are excision of the xanthelasma lesion and a satisfactory cosmetic result in the upper eyelid. This procedure could be the preferred option for xanthelasma palpebrarum in the upper eyelid.

Treatment of large xanthelasma palpebrarums with full-thickness skin grafts obtained by blepharoplasty

PURPOSE

The treatment of large xanthelasma palpebrarum cases in patients whose lesions could not be closed primarily is reported. All lesions were repaired with full-thickness skin grafts obtained by blepharoplasty of the same upper eyelid. Patient satisfaction, complications, and recurrence rates were investigated.

METHODS

Sixteen patients were treated between 2007 and 2012. Bilateral upper eyelids were involved in all patients. Twenty-six large xanthelasma palpebrarum lesions were treated using this method. All lesions were located in the medial canthus of the upper eyelid.

RESULTS

The patients were followed up for 6 months to 5 years (mean 3 years). No patients developed complications or required revision surgery. All patients had normally positioned upper eyelids and were satisfied with the aesthetic outcome. Two patients had mild hyperpigmentation at the graft site.

CONCLUSIONS

The results of this study suggest that large xanthelasma palpebrarum defects that are not primarily closed after excision should be repaired with full-thickness skin grafts harvested from the lateral aspect of the same upper eyelid. Moreover, good patient satisfaction can be achieved when blepharoplasty of the upper eyelid is performed concurrently in patients who are middle-aged or older.

Xanthelasma palpebrarum treatment with a 1,450-nm-diode laser

BACKGROUND

Various treatments of xanthelasma palpebrarum have been studied, including surgical excision, treatment with chemicals, and ablative laser therapy, but these methods have some disadvantages. Recently, nonablative laser therapy has been proposed as a treatment for xanthelasma palpebrarum.

OBJECTIVE

To investigate the efficacy and safety of a 1,450-nm-diode laser in the treatment of xanthelasma.

MATERIALS AND METHODS

Sixteen patients were treated using a 1,450-nm-diode laser. Fluences of 12 J/cm(2) , a 6-mm spot size, and a dynamic cooling device setting of 20 to 30 ms were used. One to four treatments 4 to 6 weeks apart were given to each patient. Photographs were taken before each treatment session and 4 to 6 weeks after the last treatment.

RESULTS

Two (12.5%), eight (50%), and four (25%) of the 16 patients were scored as having some (20-40% clearing), moderate (40-60% clearing), and marked (60-80% clearing) improvement, respectively. Focal mild transient hyperpigmentation was noted in five patients. Post-treatment local swelling lasted 3 to 4 days.

CONCLUSION

The 1,450-nm-diode laser treatment is a new, valuable treatment option for xanthelasma palpebrarum, offering relatively mild side effects. Studies including long term follow up and a comparison with alternative treatment modalities are necessary to further assess the clinical utility of this treatment. The authors have indicated no significant interest with commercial supporters.