Excision of Upper and Lower Xanthelasma with Blepharoplasty

This is Richard Allen at the University of Iowa. This video demonstrates excision of significant bilateral upper and lower lid xanthelasmas. I believe it is 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. These 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.

The same procedure is performed on the opposite side, again excising a flap of skin and orbicularis muscle. A skin-only blepharoplasty could be performed, but make sure to excise deep enough to include the xanthelasma.

Westcott scissors are then used to excise the lesions on the lower lids, sparing as much skin as possible. Again, the excision should be placed just under the dermis for the lower lids. Orbicularis muscle can be included. However, I think there is a chance of ectropion if you are too aggressive in your excision in this area. If there is significant tension on the wound after excision, wide undermining can be performed.

I have not found it necessary to place skin grafts in the 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 three times a day. The patient will follow up in approximately one week for suture removal. These incisions usually heal very well long-term.