A Modified Surgical Method Combined with Blepharoplasty Design for Treatment of Xanthelasma Palpebrarum

Abstract

Purpose: Xanthelasma palpebrarum manifests as a yellowish placoid on the medial aspect of the upper eyelids, often in middle and old age. Aggravated lateral hooding of the eyelid might cause a deformity with conventional surgery, which appears to be more deficient on the medial side with excess hooding of the lateral skin. The authors suggest a novel surgical technique to solve this problem and reconstruct the defect appropriately.

Methods: From July 2017 to December 2018, our method of combining excision with blepharoplasty was performed on 8 patients, consisting of 15 lesions on the upper eyelid and 6 lesions on the lower lid. Lesion removal incorporating blepharoplasty incision was done. After resection, the orbicularis oculi musculocutaneous flap was widely elevated extending through the whole upper eyelid with the lateral flap first along with fat maneuver. The flap was advanced into the defect, with even distribution of tension, after lower flap fixation to the required height of the eyelid fold. Taping was done with a hydrocolloid bandage and kept for 2 weeks.

Results: The wounds were healed primarily, and no cases of recurrence, lagophthalmos, hypertrophic scar, pigmentation, or remarkable deformity were noted. All patients were satisfied, and the functional outcomes were excellent. Two patients had trivial complications specific to our method, that of triple fold and neo-Mongolian fold, which were simply revised later.

Conclusions: This modality overcame the drawbacks of eyelid deformity observed in previous surgical methods, giving excellent results without any critical complications.

Figure 1

Simple excision of the medial lesion can induce deformity displaying lack of skin on medial upper eyelid and hooding on the lateral side.

Figure 2

Illustration of surgical technique. (Above) Using only the lateral flap can be enough to cover the defect when the lesion is minimal. (Below) If the following defect is relatively wide, the medial flap could be applied in addition to the lateral flap.

Figure 3

Surgical procedures. (a) Preoperative design. (b) After lesion removal, the orbicularis oculi musculocutaneous flap was widely elevated with fat maneuver. (c) Lateral flap is advanced to the defect distributed by even tension after lower flap with tarsodermal or tarso-dermo-levator fixation. (d) Postoperative photography.

Figure 4

Large defect up to half of the horizontal length can be covered resolving comorbid matters like sunken eyelid, levator function asymmetry, or ptosis by fat reposition and levator manipulation. (a, b) Preoperative photography. (c) Photo at 1 month postoperatively showing neo-Mongolian fold. (d) At 2 months after revision.

Figure 5

(a–c) In patients with existing double eyelid line, fold height is handled without making a new eyelid fold by drawing the most tensive line to previous line, and puffy lax eyelid is corrected by further resection of the skin along the fold line. (d) Postoperative photo at 5 months.