New operative technique for treatment of xanthelasma palpebrarum: laser-inverted resurfacing: preliminary report.

Xanthelasma palpebrarum lesions are benign but present cosmetic problems to the patient. Their surgical removal has also presented problems to the surgeon. A new laser operative technique for xanthelasma palpebrarum is introduced to avoid the risk for scarring and pigmentary changes after vaporization of eyelid tissue to remove benign lesions, for example, xanthelasma. The authors propose pulsed erbium yttrium aluminum garnet (Er:YAG) vaporization of the lipomatous tissue off the inner surface of the eyelid after incision and eversion of the incised tissue to expose the xanthelasma. The Er:YAG is the laser of choice because of its high absorption in water and thus its self-limiting depth of penetration coupled with extremely precise tissue ablation. Two illustrative case reports are presented, with no recurrence seen in a maximum of 1 year of follow-up. This technique offers the following advantages: no excision of tumor tissue is required (bearing in mind the high rate of recurrence of this lesion) and this wavelength allows good control of tissue removal and accurate recognition of the end point.