Cholesterol spots

Cholesterol spots affect a small proportion of the population. They are deep yellow in color and form a distinct contrast with the surrounding skin, creating a highly visible deformity. It is often distressing to individuals and they may suffer from diminished self-confidence and withdraw from professional and/or social engagements.

How Does It Manifest?

Cholesterol spots tend to form on the inner side of the upper and lower eyelids first. It may progressively enlarge and extend outward to involve the middle and outer portions of the eyelid. Cholesterol spots are deep yellow in colour and form a distinct contrast with the surrounding skin, creating a highly visible deformity. In the upper eyelid, the cholesterol spot tends to lie above the double eyelid crease, further adding to its visibility.

How does it arise?

It is thought that the thin skin in the eyelid region predisposes to the formation of cholesterol crystals. White blood cells are attracted to and engulf these cholesterol deposits and then coalesce together, forming a continuous deposit of cholesterol, which becomes visible to the eye. Individuals often have elevated blood cholesterol, although xanthelasma may sometimes occur in those with normal cholesterol levels as well.

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treatment - Xanthelasma excision

Xanthelasma excision is simple surgery that may be performed as an ambulatory under local anesthesia. Very small patches of xanthelasma may sometimes be amenable to laser ablation alone.

Individuals whose cholesterol has been well-controlled are good candidates to have xanthelasma excision surgery. The probability of postoperative recurrence is reduced when blood cholesterol levels remain optimally controlled.

Surgery aims to completely remove the xanthelasma to reduce the chance of future recurrence, and to minimize postoperative scarring, as this is a highly visible area of the human anatomy.

Individuals are advised to have their blood cholesterol tested and optimally controlled prior to surgery. They are also advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.

Preoperative assessment is performed to ensure that there is sufficient eyelid skin laxity to perform wound closure following the xanthelasma excision. Local anaesthesia is infused into the wound. The incision(s) are made depending on the location, the distribution, and the size of the xanthelasma. The eyelid orbicularis muscle is usually preserved. The wound is then closed meticulously to deliver the best possible postoperative scar and aesthetic outcome.

In rare cases of extensive xanthelasma, skin grafts may be required for complete closure of the wound following excision. Xanthelasma excision is a delicate procedure requiring precise technical execution.

Very minimal swelling is expected after the surgery, which will mostly resolve by the 5th postoperative day. Stitch removal is usually performed on the 5th postoperative day. Most individuals are able to return to work on the day following the surgery. their usual activities immediately following the procedure.

Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. An optional electromagnetic field device may be used for the first 5 days to accelerate wound healing and reduce swelling.

Strenuous activity should be avoided for the first two weeks to minimize bruising. Meticulous scar care is important in the immediate postoperative period to ensure optimal scarring and to achieve ideal postoperative results. individuals are able to return to work on the day following the surgery. their usual activities immediately following the procedure.