Surgical management of xanthelasma palpebrarum: Reducing angular defect through extended excision technique

Objectives Xanthelasma palpebrarum (XP) is a common type of cutaneous xanthoma, typically presenting as yellowish papules or plaques around the eyes. Often associated with dyslipidemia, XP may indicate underlying conditions such as non-alcoholic fatty liver disease and hypothyroidism. Various surgical techniques are employed to remove XP, but simple excision can lead to angular deformities, particularly in cases involving the upper eyelid crease. This study aimed to quantify angular deformities resulting from XP excision and propose a surgical method to minimize these defects. Material and Methods Conducted between March 2023 and December 2023, the study included 30 patients diagnosed with a Grade I XP. Patients were divided into two groups: Group A underwent simple lesional excision, while Group B had excisions extended to the lateral canthus. Selection and description of participants were based on specific criteria: Aged over 18 years, having Grade I XP touching the upper lid crease, and no previous treatments. Exclusion criteria included active pregnancy, skin infections, bleeding disorders, keloid history, recurrent herpes, preference for non-surgical treatment, Grade II-IV XP, and inability to follow-up for at least 6 months. The study included 30 patients (26 females and four males) with an age range of 26–54 years. Pre-operative evaluations included detailed eye examinations and biochemical tests. Surgeries were performed under local anesthesia, using 6-0 polypropylene sutures, with a 7–10-day post-operative follow-up for suture removal. Group B’s excisions were tapered to match the lesion’s width. Angular defects were measured postoperatively. Results All patients achieved complete lesion clearance with no recurrence after 6 months. Group A showed an average angular deformity of 143.9°, while Group B had minimal to no deformity. Complications were higher in Group B, but angular deformities were significantly reduced. Conclusion Extending the excision to the lateral canthus effectively minimizes angular deformities in XP surgeries. Proper surgical technique and comprehensive pre-operative assessments, including pinch tests, are crucial to avoid complications and recurrences.