Excision of Xanthelasmata - clamp, shave, and suture

Study of molecule variations in human xanthelasma skin based on confocal micro-raman spectroscopy

Confocal micro-Raman spectroscopy was used to distinguish human xanthelasma skin (HXS) from the human normal skin (HNS). Results showed that intensive Raman peaks at 1,269, 1,336, 1,448, and 1,656 cm(-1) increased obviously. Both 1,269 and 1,656 cm(-1) peaks showed that the proteins in HXS were mostly in the anti-parallel ß sheet conformation. While the intensities of bands at 1,032, 1,087, 1,300, and 1,448 cm(-1) belonged to lipids were enhanced in HXS spectrum compared to those in HNS spectrum. There were main intercellular lipids alkyl chains with minor proteins contribution at 1,087 cm(-1) and phenylalanine at 1,032 cm(-1) . To quantitative analysis of the difference, the ratio of I852/I829 was calculated, which was 1:1.04 ± 0.04 and 1:1.11 ± 0.02 for HNS and HXS (p < 0.01), respectively. The data indicated that some tyrosine residues, which form a hydrogen bond with H2 O prior to aggregation, were captured by strong hydrogen-bond acceptors in the aggregate. The decreased ratio of I852/I829 indicated more hydrophobic in HXS than HNS. Principal component analysis showed a one-to-one relationship between human xanthelasma skin and the corresponding Raman spectra. It could be given useful help for the diagnostication of xanthelasma.

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.