Is This Severe Milia or Cholesterol Deposit Around the Eyes? (photo)

        Yes, you have xanthelasma, and I think that your surgeon is giving you a realistic appraisal of your options.  Find a plastic surgeon with ELITE credentials who performs hundreds of eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Your posted photo shows xanthelasma with large xanthomas of the upper eyelids with smaller ones at the inner corners of the eyes and inner half of the lower eyelids. This is not milia.

The xanthomas are deposits of fat filled foam or xanthoma cells in the superficial dermal layer of the skin often surrounded by scarring and inflammation. About half of the patients with xanthelasma have a metabolic disorder with increased fat in the blood (Hyperlipoproteinemia type IIa - high blood cholesterol and LDL levels). The fat is transported in a protein capsule so the complex is called a lipoprotein. .

The treatment of xanthomas has been surgical removal of the fat deposits with or without overlying skin, laser treatments and chemical peels. The treatment decision tree depends on the size and number of xanthomas and whether they are hard or soft. Hard ones can be uncapped to remove the xanthoma and then the cap of skin is sutured back down. Smaller xanthomas closer to the lower eyelid lashes or upper eyelid creases can be removed with the skin at blepharoplasty. Larger xanthomas needed to be removed in a staged piecemeal fashion.

Your upper eyelid xanthomas looks like it can be mostly removed by blepharoplasty but the lower eyelid ones are not amenable to blepharoplasty. You may be able to uncap one or two of those but the remainder will likely need laser or chemical peel.

You will need your cholesterol and LDL blood levels measured and if high medically/dietary controlled to prevent recurrence.


I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

 

Your photos and description appear consistent with Xanthelasma, or cholesterol deposits in the skin.  This can be treated with a TCA chemical peel, lasers or excision.  A study of TCA chemical peel treatment show a 25% recurrence rate.  Excision could have a lower rate of recurrence, although in your case it may be difficult to remove the entire area without removing to much eyelid skin.