Xanthelasma treatments, methods comparison.

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What are the chances of scarring after Xanthelasma Treatment?

The chances of scarring after undergoing Xanthelasma treatment depend on the

  • Type of treatment
  • Whether any damage was caused to the dermis during the treatment
  • Infections following the treatment

 

Type of treatments proven to work

The available treatments that are scientifically proven to work are only:

  1. Surgical excision. (Removal using Lasers, Electrocauterisation, Hyfrecator,   Cryotherapy .conventional excision using a scalpel)
  2. Peelings

 

Surgical excisions

Xanthelasma excision using a Scalpel

This is the oldest method of removing Xanthelasma. It consists in using the same procedure used for skin cancer excision. This is a very effective procedure in removing Xanthelasmas within one session. However it is very invasive:

  • Bleeding will inevitably occur during the surgical procedure
  • The use of local anaesthetic is mandatory
  • There are risks of infections
  • The procedure will almost inevitably scar the client
Xanthelasma Excision using Scalpel

Scalpel Excision to be avoided

This is one of the many examples of Xanthelasma excision using the Scalpel.

Visisble Scars are usually left

Visible scar left by Scalpel Xanthelasma excision

This type of procedure is to be avoided due to the high chances of scarring the client. Given all the modern techniques available there is no reason for this type of treatment to be used any longer.

Excision

Scars following excision using a scalpel

 

Laser removal

Lasers are generally instruments capable of ablating soft tissues with a high degree of precision.

Xanthelasma laser removal is currently the most popular treatment and the most expensive at the same time. This treatment is advised to many clients suffering from Xanthelasma, not because Xanthelasma laser removal is the most cost effective or risk-free way to treat this condition but because surgical lasers are widely used in the western world (Europe and north America).

Laser Xanthelasma removal effectiveness is dependent on the surgeon who uses the Laser and less dependent on the Laser itself. The more experienced the surgeon the less the risks of scarring and the higher the success rate of the procedure.

An experienced surgeon is usually capable of removing all the Xanthelasmas within one session and without damaging the dermis, consequently minimising the risks of scarring.

Although this is the most popular treatment, unfortunately this is not the most cost effective and not the treatment that presents the least risks. This is because the success of this procedure is highly dependant on the surgeon’s ability.

The main causes of scars after Xanthelasma removal using a surgical laser are:

  • Laser’s misuse which causes undesired damage to the dermis, generally by trying and remove thick and deep Xanthelasma within one session only. This type of damage is generally caused by human error. No machinery’s fault has been reported as being the cause of scars after Xanthelasma excision using lasers.
  • Subsequent infection of the treated part. The chances of infection after the treatment are very low. However, the areas treated with the laser have to be kept dirt free and should be disinfected regularly until the treated area has healed completely.

The risks associated with the use of lasers for Xanthelasma removal are not limited to potential damage to the dermis and hence scarring. Operating lasers for xanthelasma removal can cause another inherent risk…Surgical lasers could be inadvertently pointed directly into the client’s eye damaging the eyes and in extreme cases even causing permanent loss of vision. Therefore, in order to avoid to inadvertently damage the client’s eyes, it is highly recommended that the client wears eye protectors during laser excision.

 

Xanthelasma excision using conventional electro-cautery units

Although this type of treatment is cheaper than laser excision, generally the risks of scarring the clients are lower. The tip of the the electro-cautery unit is used in fulguration mode. The eyelids and the skin around the eye are particularly sensitive, therefore the equipment has to be set to operate at low power in order not to affect the dermis on such a delicate part of the skin.

Electrocauterisation will allow the operator to ablate the Xanthelasma with a high degree of precision and more effectively than using conventional lasers. This higher degree of precision makes the excision easy to perform and minimises the chances of causing damage to the dermis. Hence, Xanthelasma removal by using an electrocautery unit in fulguration mode is generally easier and safer than using conventional surgical lasers.

Therefore despite the fact that electrocauterisation units are available at a much lower price than surgical lasers, they are a far better option for xanthelasma removal, both in terms of safety and results.

The fulguration mode of many units on the market may not display a spark, however the tip of the device will be ablating the Xanthelasma effectively anyway.

When using electrocauterisation units for Xanthelasma removal usually anaesthetic is required to ease the pain otherwise caused to the client. The pain is caused by the unwanted transferred heat to the surrounding healthy skin.

To sumarise…

By using electrocauterisation units:

  • The procedure is cheaper due to the low cost of the conventional electrocauterisation units.
  • The likelihood of scarring the client is less than using lasers because there is less room for mistakes
  • The use of local anaesthetic may be required.
  • The risks of hurting the eyes are less than using conventional lasers.

 

Excision using the Hyfrecator

The hyfrecator is a specialised electrocauterisation unit operating in Fulguration mode. This is a highly specialised inexpensive surgical unit used extensively by dermatologists. This unit has adjustable power settings and it does produce a visible spark when the tip of the Hyfrecator is close enough to the skin. The level of precision is as high as an electrocauterisation unit.

Therefore, by using the Hyfrecator:

  • The procedure is cheaper than conventional lasers due to the low cost of the Hyfrecator ( in the region of 2000 USD)
  • The likelihood of causing scars are less that with a laser because there is less room for mistakes.
  • The use of local anaesthetic maybe required.

There are less risks to the eyes than using lasers.

 

Cryotherapy (also refferred to as Cryosurgery)

Cryotherapy is a dermatological method of removing warts, birthmarks, saeborrhoeic Keratoses and many other lesions. This is done by quickly deep freezing the area to be treated and can be done by using various substances. The most common substance used is liquid Nitrogen. Treatments using Cryotherapy are very effective in removing skin lesions.  Cryotherapy has also been  used in the treatmnent of Xanthelasmas.

The main advantage of Cryotherapy is that the xanthelasmas can be removed within one session.

However the effects of Cryotherapy are difficult to control.  Therefore although it has being adopted as a Xanthelasma treatment in some Clinics, it is not generally advisable to be used for Xanthelasma removal for two reasons:

  1. Relatively high potential dangers to the eyes (normal eye protectors used to protect the eyes during laser excision cannot protect the eyes against the deep cold of the cryosurgery).
  2. This treatment presents the highest likelihood of causing scars amongst all the options available.

The risks of infection after the procedure are very low.

 

 

Peelings for Xanthelasma removal

Peelings are the preferred option for Xanthelasma removal for three reasons:

  1. Peelings can be performed by the clients themselves as the peelings are safe and easy to apply. This is provided that the peeling is formulated to suit the client skin type.
  2. The right peelings are safe as they do not cause damage to the dermis. The area treated is very unlikely to get infected. As a consequence chances of scarring are remote.
  3. The price for a Xanthelasma removal peel is only a fraction of the cost of any surgical excision alternative.
  4. There is no need for anaesthetic, however people usually experience a burning sensation for up to 5 minutes.
  5. Using the right specialised peel is provides the best chances of removing the xanthelasma without leaving any scars.
  6. Repeated use of specialised peels will  inevitably remove Xanthelasmas.

Disadvantages

The only disadvantage of using specialised peels for xanthelasma removal is that more than one treatment may be required to remove all the xanthelasma.

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