Is this Xanthelasma? Can this be removed? (Photos)

Question

About 2 months ago I noticed this on my eyelid. Fearing it’s Xanthelasma and I have a cholesterol problem! When I stretch my eyes a bit it looks like there’s a cluster of smaller bumps as part of it. Above that area is a small white hard bump that I thought was a milia. I seem to have several of these milia come up lately, but now doubting what it is. Would like to have these removed as they are unpleasant on my face

Raffy Karamanoukian, MD, FACS · Answer

We treat these xanthelesma issues commonly in my plastic surgery office. I would suggest only doing this with an experienced eyelid surgeon in order to position the incisions in the right plane and axis.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

David K. Isaacs, MD, FACS · Answer

It’s possible that these could be xanthelasma, but the only way to know for sure is with an in-office evaluation, and sometimes a small biopsy is done to confirm the diagnosis. If it does turn out to be xanthelasma, it’s important to follow up with your internist to check cholesterol and overall lipid health and begin any needed treatment, such as starting medication.

This area has very thin skin and limited extra tissue, so removal needs to be done carefully to avoid issues like webbing or distortion of the eyelid. As a surgeon who specializes in eyelid reconstruction, I usually like to perform a precise surgical flap combined with CO2 laser.

An in-person exam will determine the diagnosis and the safest and most natural-looking treatment plan.

C. Blake Perry, MD · Answer

The lesion is a xanthelasma. Typically these lesions are NOT associated with system cholesterol levels. There is a rare genetic disorder that people can get that have extremely high cholesterol levels and numerous xanthelasma. Only sure way to remove these lesions is surgical excision. Some providers do a laser treatment but it is often ineffective.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Based on your description, it sounds like you may have a combination of xanthelasma and milia. Xanthelasma typically presents as soft, yellowish deposits along the inner eyelids, while milia are tiny keratin-filled cysts that can appear individually or in small groups. Both are benign, but cosmetic removal is common for aesthetic reasons. Treatment options include: for milia, gentle extraction by a dermatologist with a sterile needle or curette; for xanthelasma, options include laser ablation (CO2 laser), chemical cauterization, or surgical excision. I hope this helps!

Allison Yee, MD, FACS · Answer

From the photos, it looks like xanthelasma, which is a subcutaneous deposition of cholesterol . First, you should address your cholesterol levels with your primary care doctor. Unfortunately, the lesions will not go away if your cholesterol lowers. This requires surgical excision. Someone skilled in excising lesions around the eyes can do the procedure with minimal scarring.

Ira H. Rex III, MD · Answer

Yes, it looks like xanthelasma.  It is good to check with your medical doctor to make sure you are cholesterol is not high or other things going on.  To handle the lesion itself, it can be destroyed by a number of methods including chemical or laser, or it can be cut out usually with a very nice result.

Nelson Lee Novick, MD · Answer

At least from the photos provided, these bumps do appear to be xanthelasmas. I have been treating xanthelasmas for decades, using low intensity electrocautery to flatten and shrink them. Following numbing with a local anesthetic, this procedure in experienced hands, should take no more than two to three minutes to complete. Please note: strict lipid control is important for diminishing the chance of new lesions appearing. You would be wise to consult with an experienced, board certified cosmetic dermatologist.

S. Daniel Huang, MD · Answer

This does look like cholesterol deposits. I have had success with serial fractionated CO2 laser treatments for this condition. Because of the location, preparation with globe shields and timely application of the topical anesthetics so it does not seep into the eyes takes up the majority of the time for the treatment. There is post procedure laser skin care until the skin resurfaces in 5-7 days. Usually 2 sessions (at least 6 months apart) result is satisfactory. Best wishes.