Excision of upper and lower xanthelasma #2
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:33
Posted Feb 10, 2017
This is Richard Allen at University of Iowa. This video demonstrates excision of significant bilateral upper and lower lid xanthelasmas. I believe it's easiest to incorporate this excision into a blepharoplasty marking on the upper eyelids. The blepharoplasty marking has been made to incorporate the lesions and the needle tip cautery is used to incise the markings. A flap of skin and orbicularis is then removed. The xanthelasmas usually reside within the dermis of the skin. Patients need to be reminded that the xanthelasmas could recur even after excision. Also, these patients should have their lipids and cholesterol checked. For the lower lids, I think there is a chance of causing an ectropion. Westcott scissors are used to excise the lesions sparing as much skin as possible. Again, the excision should be placed just under the dermis. Orbicularis muscle can be included. If there is significant tension on the wound after excision, wide undermining can be performed. I haven't found it necessary to place skin grafts in this area. The incisions can then be closed with interrupted 6–0 Prolene suture. Medially, the excision is significant on the upper lids. The lower lids can be closed with the same interrupted suture. The upper lids should be inspected to ensure adequate closure of the eyes after excision. Again, I have not found it necessary to place skin grafts in this area. At the conclusion of the case, the patient will use antibiotic ointment 3 times a day. The patient will follow-up in approximately 1 week for suture removal. These incisions usually heal very well long-term.
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