Operative Treatment of Large Periocular Xanthelasma

Purpose: To present our experience in operative treatment of large periocular xanthelasma. Methods: Sixty-three patients with large periocular xanthelasma were operatively treated in our department. Ipsilateral and/or contralateral lid skin grafts harvested by blepharoplasty, alone or in combination with local flaps, were used. Forty patients (64%) had enough skin to graft the defect after primary xanthelasma removal. In 10 patients, additional local flaps were used: modified rhomboid flap in six patients, local advancement flap in two, and bi-lobed flap in two patients. In three patients (5%), a sequential approach was applied since xanthelasma were too large to be completely removed in a single-step excision. No serious complications were shown. Results: Patients were followed from 6 months to 8 years. Five patients (8%) returned with recurrences 3-8 years after primary excision. Conclusions: In lack of the setting for xanthelasma laser treatment, operative approach of a single-step or sequential excision using lid skin graft combined with local flaps proved its value for large periocular xanthelasma.