Xanthelasma on the eye

Xanthelasma is a soft and painless accumulation of fat, especially cholesterol, on the eyelids.

These yellowish fat deposits do not affect vision.

Xanthoma is a disorder in which small yellow fat nodules (yellow nodules) form under the epidermis.

Xanthelasma is an important representative of xanthomas and appears on the eyelids and can form without any other disease.
Xanthoma and xanthelasma are not necessarily
caused by elevated blood cholesterol.


Causes of xanthelasm

Xanthomas often occur in the elderly and people with elevated blood cholesterol.
Some are very small. Others have a diameter of more than 3 centimeters.
Xanthomas can occur anywhere on the body, but you can see them above all:

  1. eyelids (xanthelasma),
  2. Elbow
  3. Joints
  4. Yearning
  5. Kneel
  6. Hands
  7. feet,
  8. Buttocks.

Xanthelasma can be the sign of a disease in which there are too many fats in the blood.

These diseases include:

  • Some tumors
  • Diabetes
  • Hyperlipidemia (impaired lipid metabolism)
  • Congenital metabolic diseases such as familial hypercholesterolemia
  • Liver disease (cirrhosis)
  • Gall stones
  • Primary biliary cirrhosis
  • Pancreatitis
  • Hypothyroidism.

In pregnancy, the likelihood of forming a xanthelasm increases due to diet and hormonal changes.

Symptoms of xanthelasma

The most common symptoms of xanthelasma are:

  • Nodules under the skin
  • Skin formations:
    • of various forms,
    • yellow to orange,
    • with well-defined contours.

Xanthelasma usually does not cause skin itching and pain.

Diagnosis of xanthelasma

The responsible doctor is the ophthalmologist.
As a rule, xanthelasma is diagnosed by examining a skin growth.

  • As a rule, no biopsy of the tissue is necessary, but can confirm that it is a fat deposit.
  • blood test and other tests may be done to determine a disease responsible for the occurrence of the xanthelasma.

Therapy for the removal of xanthelasma

Patients should control fasting fat levels.
With hyperlipidemia, the risk of cardiovascular disease must be assessed.
The xanthelasma can be left unless the patient wishes to have it removed for aesthetic reasons.

Drugs to lower elevated blood lipid levels have a limited effect on xanthelasma.

There are numerous ways to remove a xanthelasm, including:

  • surgical removal,
  • CO2– or argon laser ablation,
  • chemical cauterization,
  • electrical exciccation,
  • Cryotherapy.
  • Radio frequency.

Ablation with carbon dioxide or argon laser
In laser therapy, a laser beam is directed at the eyelid.
Before treatment, an anesthetic cream is applied to the skin.

Reasons to use this technique are:

  • no damage to the surrounding tissue,
  • faster hemostasis and healing,
  • no seam required,
  • the speed of this procedure is cited as a primary reason.

However, pigment changes and scars may occur.

Chemical cauterization: The use of chlorinated acetic acids has been shown to be effective in removing xanthelasma.
These agents cause a precipitation and coagulation of protein, as well as a melting of fats.
Monochloroacetic acid, dichloroacetic acid and trichloroacetic acid were used with good results and minimal scarring.

Possible complications associated with chemical cauterization include:

  • Irritation
  • burning of the treated eyelid,
  • Ectropion (outward rotation of the eyelid).

 Electrical exciccation (felc and plexer®), cryotherapy and radiofrequency may destroy xanthelasma if it is superficial, but repetition of therapy may be required.

Cryotherapy can cause fibrosis and pigment loss.

Surgery of a xanthelasma

Surgical removal
With a small and linear xanthelasma on the upper eyelids, the doctor usually recommends surgical removal because the scars merge with the surrounding tissue of the eyelid. Less protruding fat deposits could be leveled and removed; then the layer can be sewn.

  • Using a surgical microscope
  • a tab is lifted and carefully removed piece by piece with side-mounted microscissors,
  • Finally, the skin flap is sutured.

With complete removal, prominent scars may remain in the lower eyelid because the tissue is thicker.
With the simple removal of a large xanthelasma, possible consequences are:

  • retraction of the eyelid,
  • Ectropion
  • Need for another complicated reconstructive operation.

The removal of the xanthelasma is an aesthetic operation.
The cost of removing the xanthelasma depends on the size and clinic in which the procedure is performed.
The minimum cost is 150 euros, but it can also be up to 500 euros.

Can a xanthelasma recur?

Sometimes a xanthelasma returns after treatment.
This relapse can also occur if the level of cholesterol in the blood is normal.
The only possible option is further treatment for xanthelasma removal.

If you decide to have xanthelasma surgically removed, how many treatments are required?
Regardless of the size and thickness of the xanthelasm, a single treatment is usually sufficient to remove the fat deposits.

In certain cases of deep-seated or very spread xanthelasm, treatment may be divided into two sessions. At the first session, the main part of the xanthelasma is removed.
Typically, the deep-seated residues of the xanthelasma are not treated in the first session to avoid possible damage to the dermis.

A month later, the deep-lying remains of the xanthelasma have shifted to the upper layers of the epidermis.
It is therefore easy to remove all remnants of the xanthelasma during a second session, leaving the dermis unchanged and thus reducing the risk of scarring to a minimum.

What is the difference between depigmentation and scarring?

Depigmentation (hypopigmentation) occurs every time wound heals.
This is due to lack of melanin in the skin after a wound has healed.
The new skin composition is very similar to the normal one.
The newer skin is colored pink due to melanin deficiency.

After sun exposure, depigmentation increases.
The main difference between a scar and depigmentation of the skin is that you can see the scar even after years and its consistency differs from that of normal skin.
Depigmentation of the skin passes after 3-4 months.

Does depigmentation of the skin occur after removal of the xanthelasm?

Hypo- and hyperpigmentation of the treated skin are possible complications during the procedure to remove xanthelasma, especially in the case of laser therapy.
As a rule, depigmentation is a normal process, it occurs every time the skin has healed after surgical removal of a xanthelasma.

In case of hyperpigmentation (dark skin spots),
the application of a custom peel is the least invasive treatment and can also help with scars due to surgical removal.
As after any other injury, it takes 3-4 months for the new skin to adjust to the surrounding tissue.
Sun exposure without sun protection should be avoided in order to prevent the risk of an even darker spot forming.

Natural remedies and treatments for xanthelasma

Diet and nutrition
For the treatment of xanthelasm, the diet must be changed, because it is the cause.

The diets I can recommend because they have shown excellent results in my patients are:

  1. Blood type diet – Is against the removal of xanthelasma because it can be unnecessary and harmful. If the fat has accumulated under the skin, it means that it remains outside the arteries and thus no infarction and stroke
    According to this nutritional theory, depending on the blood group, there are recommended foods and those that are not recommended.
    Cereals are the main culprits for a xanthelasma or lipoma, regardless of blood type.
    Cereals are converted into triglycerides and cholesterol in the body.
    For example: pasta, bread, rice, biscuits, rusks, spelt, barley, etc.
  2. The vegan diet / raw food of natural healers and hygienists consists of a plant-based diet, preferably raw food.
    fasting cure is a very effective and quick alternative to the treatment of xanthelasma and xanthomas.
    Food of animal origin is not allowed: meat, eggs, fish, milk and dairy products.
    Legumes and potatoes are recommended, along with fruits, vegetables (preferably green leafy vegetables), seeds, almonds and nuts.
    Cereals are part of the vegan diet, but I advise against them, especially if they contain gluten.

recommended by conventional medicine 
low-fat diet can lower blood lipid levels and prevent recurrences.

Apple cider vinegar can help metabolize excessive fats in the body.

Garlic can help remove the upper layer of xanthelasma, but the fat storage underneath remains.
The garlic can burn the skin and cause a slight swelling, but this is only a temporary effect.

Dandelion is known for its liver detoxifying properties, which can prevent the formation of xanthelasma.
Dandelion can be taken in several forms:

  • prepare an infusion of leaves and roots and drink before meals;
  • drink a glass of fresh juice on an empty stomach;
  • treat the eyelids with packs.

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