Q: I am in my mid-30s and have recently developed deposits on my upper eyelids called xanthelasma, which are associated with high cholesterol.

I have since tried to control my diet but the deposits on my eyelids remain and are quite unsightly.

A general practitioner told me that even with a low-cholesterol diet, the xanthelasma will not go away. He said I could consult an aesthetic doctor to remove them through lancing, laser or other methods, although the condition may still come back.

What are the pros and cons of the various methods?

A: Xanthelasma are soft yellowish plaques that occur over the eyelids. They are more frequently seen on the upper rather than lower eyelids and usually on the inner half of the upper eyelid.

Over time, they have a tendency to progress and coalesce into larger plaques. Once established, they remain or may even increase in size.

These yellow plaques are made up of cells filled with cholesterol deposits in the dermal layer of skin. About half of those with xanthelasma have an elevated plasma lipid level. Hence, it is recommended that all individuals with xanthelasma undergo tests to determine their lipid profile. Even after the lipid levels have normalised, xanthelasma do not disappear.

These deposits do not cause pain or discomfort nor affect the function of the eyelids. However, droopy eyelids have been known to result from very large deposits.

The many treatment options to remove xanthelasma include CO2 laser ablation, chemical cauterisation, cryotherapy (a procedure which destroys tissue by freezing) and surgical excision. Apart from surgical excision, the other methods have not been effective in completely removing the deposits. These methods may result in scarring and pigmentation changes in the eyelid. Recurrence of the plaques is possible too.

Surgical excision often involves making only a small incision around the lesion. This procedure is usually performed under local anaesthesia. After the plaque is excised, the wound edges are sutured together, often in the natural crease line of the eyelid. These skin crease incisions are well camouflaged within the natural crease lines of the eyelids and often do not pose a significant aesthetic problem. -Dr Ong Wei Chen

This article was first published in Mind Your Body, The Straits Times.