Excision of upper and lower xanthelasma
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:37
Posted Feb 10, 2017
This is Richard Allen at the University of Iowa. This video demonstrates excision of bilateral upper and lower eyelid xanthelasmas. In this case, the excision of the upper lid xanthelasmas will be incorporated into an upper lid blepharoplasty. An incision is made along the blepharoplasty markings to incorporate the upper eyelid xanthelasma. This results in excision of a fair amount of skin medially. The incision is made with the Colorado needle. Dissection is then carried out below the layer of the xanthelasma medially. Superiorly, remaining xanthelasma is excised at the edges of the incision. This is performed in the exact same manner on both sides. Hemostasis is obtained with the unipolar cautery. Attention is then directed to the lower eyelid xanthelasmas. A 15 blade is used to make an incision around the xanthelasma. The skin excision in this area should be conservative to prevent postoperative ectropion. Dissection is then carried out just under the xanthelasma. The deposition of the material is in the subcutaneous plane and should not extend into the orbicuaris. Thus, the orbicularis muscle should be preserved in order to prevent any postoperative lower lid malposition. The lower lid incisions are then closed with interrupted 6–0 Prolene suture. Attention is then directed to the upper lid incisions which are closed with a combination of running and interrupted 6–0 Prolene sutures. Overall, I think that this is a safe procedure to perform in the excision of xanthelasmas. The excision of skin tends to be somewhat aggressive medially in the upper eyelid. Overall, the patients usually tolerate this relatively well. As with all patients with xanthelasmas, there is a risk of recurrence.
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