What is Xanthelasma?
Xanthelasma is a benign formation of cholesterol fat that appears around the eyes and is not usually a health concern. Cholesterol levels of the patient should be checked first as many people that develop Xanthelasma have high cholesterol, however this is not always the case. It is currently debated as why certain people develop Xanthelasma versus others and the results are still inconclusive. For people who do not have this condition, the main prevention known so far is keeping a healthy lifestyle and most of all keeping cholesterol levels down.
The main problem is that people feel it is un-aesthetic and they become uncomfortable with the condition. Many practitioners recommend not to have it removed as it is benign and it can reappear after removal, however many patients will insist on having it removed.
How can it be removed? The removal may not be straight forward because fat formation can grow deep into the skin and removal can involve excision. There are two traditional methods known to remove the Xanthelasma:
- Chemical Peels
The patient should be warned that even after removal the Xanthelasma this could reappear at a later date.
This is the best option to treat all type of Xanthelasma because it presents the least risks and complete removal is always achieved.
The peels will cause the Xanthelasma to be removed by using targeted chemical ablation and can be done at home and with no special preparation. The Xanthelasma is painted with the specialized peel taking care to avoid contact with the eyes. When the peel is applied, the skin turns white for half an hour, it will then pink up and then start to crust. Once the solution is applied the patient should remain still until the specialized peel has dried up. At that point there there will not be danger to the eyes.
After the treatment, it is important not to touch the Xanthelasma and leave it be for as long as possible. No make up should be used and the use of any creams should be avoided as well. A week later the crust will have hardened and it will peel off by itself. The crust will contain some skin as well as the whole or part of the Xanthelasma. Even if the Xanthelasma is too thick to be removed within one session,a subsequent session will be likely to result in complete removal.
Despite the fact that the preferred option to remove Xanthelasma is the use of appropriately formulated cosmetic peels, there are still cases when patients choose to undergo surgical removal.
This can be done in three ways:
- Traditional Excision using a normal scalpel and stitches. This is very effective but requires local anaesthetic and leaves scars including higher risks of infection and bruising.
This technique is the oldest and still in use, however unfortunately it will cause visible scarring to the patient around the eyes. The surgeons that still use this technique normally argue that the scars will look like the wrinkles around the eyes. However in some cases the scarring is very evident and can only covered up by using make up.
- Laser Removal. No bruising, usually leaves no scars and has low risk of infection. This also has no risk of bleeding during the procedure or the recovery period. Local anaesthetic is required and eye protection should be worn by the patient during the procedure. The main advantage is that due to the laser precision no scarring is usually left after healing and this is currently the preferred option for dermatologists who are trained to use a professional surgical laser. The manufacturer’s user manual of the laser is the best way to locate the optimal settings for this type of excision. But as a rule of thumb the equipment should be set so that the laser will remove the outer part of the skin very slowly and it will not penetrate too dip into the skin. Local anaesthetic should be applied to the areas to be treated and the equipment should be operated by slowly burning the Xanthelasma until complete removal. Once again special care must be taken so that the laser will not dig too deep into the healthy tissues as this could cause scarring. With this technique, extreme care should be taken not to touch the eyes, therefore it is highly recommendable to have the patient wear appropriate eye protection.
- Removal using the Clarker. No bruising, usually leaves no scars and has low risk of infection. No risks of bleeding during the excision nor during the recovery period. Neither local nor topical anaesthetic are required.
Advantages versus surgical laser
- It is a portable device, therefore the procedure can be also be performed outside the clinic.
- No Xanthelasma recurrence on the areas treated with the Clarker
- No medication required, except for eye-drops containing Benzalkonium
- In the vast majority of cases there is no need for any type of anaesthetic.
- Extremely low risks of scarring. No cases of scarring reported to date.
- Thanks to the Clarker in large clinics, Xanthelasma removal is now a simple and safer procedure performed by clinicians and health care assistants.
- Although there is no need to apply local anaesthetic to the patient, in remote cases when the patient is particularly sensitive, topical anaesthetic can be applied not compromising the outcome of the procedure. The Clarker can also be used to anaesthetise the Xanthelasma to be removed by using circular anaesthesia.
- The risks associated to the eyes and the possible scarring of the patient are minimised drastically.
- Remote risks of bleeding. No case of bleeding reported to date.
- Xanthelasma are removed within one session.
- The procedure can be carried out without having the patient to use eye protection, however it is always recommendable to use extra precautions and not to allow the tip of the Clarker to touch the eye by mistake.
After the Xanthelasma removal session with the Clarker, the area will appear as if a make-up pencil has been used to cover the Xanthelasma.
How to remove Xanthelasma with the Clarker
Today, thanks to the Clarker’s state-of-the-art technology, Xanthelasma removal has become extremely simple to carry out and the procedure presents minimal risks.
As stated earlier, when Xanthelasma Removal is performed with the Clarker there is no need for any type of anaesthetic, however it is better to test the patient sensitivity first. Apply the Clarker to the eye lid once (away from the Xanthelasma) to see how the patient responds; the patient should experience a mild pain. The patient should not experience any pain when the Clarker is applied on the Xanthelasma, however in case the patient feels discomfort due to hypersensitivity apply topical anaesthetic or/and circular anaesthetic with the Clarker. Anaesthetic for this type of procedure with the Clarker is rarely required.
The Clarker should be set at minimum power. Then the tip of the device has to be applied on the Xanthelasma until complete removal is achieved. A smoke extractor can be used to get rid of the fumes generated during the treatment and for complete removal, it may be necessary to apply the Clarker on the Xanthelasma a number of times before removal is achieved. Gently remove the carbon deposits with cotton slightly soaked with non-alcohol based antiseptic. The areas treated will be pain free soon after the procedure without any bruising. However make up must not be worn until the healing is complete.
After the procedure, the patient should wash the face as usual, drying with a cotton cloth being careful to gently pat and not to rub the treated area. The patient should not apply any kind of medication, except for eye-drops containing Benzalkonium for the sole purpose of disinfecting the treated area once a day.
The patients can resume their normal activities immediately after the session. The results are excellent and no scars have been caused to date. The procedure is normally completely painless and extremely simple to perform. There has not been any reported complications to date.
One of the issues related with Xanthelasma removal after conventional surgery or laser, is the risk of recurrence. However through the years it has been noticed that the areas treated with Clarker have not presented any recurrence. The recurrence may be around the eyes, but not on the areas previously treated with the Clarker.
Therefore any new patient with Xanthelasma can safely be informed that the procedure is permanent and there is no risk of recurrence on the areas treated with the Clarker.
Hence, it is also advisable to treat the areas where new Xanthelasma are likely to appear as a preventative measure from future recurrence.
After complete healing, the part treated with the Clarker will be slightly clearer than the surrounding tissue. This slight colour difference will disappear in about a year, then it will not be possible to notice the area has ever undergone any treatment at all.