Xanthelasma is a cholesterol deposit in the dermis, usually in the eyelids. Sometimes this is associated with a higher level of cholesterol in the blood, sometimes it is not. These deposits are benign and do not respond to diet.
The lesions can be surgically removed under local anaesthesia, but in big xanthelasmata there may be insufficient skin to close the defect without disfiguring the eyelids. A skin fold may arise next to the scar.
With the CO2 laser the xanthelasma can be removed layer by layer down to the muscle. The underlying tissue contracts, leaving a significantly smaller defect than the original size of the xanthelasma.
A crust is formed over one to two days. It separates after ten days to two weeks. The pink colour of the scar will take several months to disappear.
Scar formation in eyelids is usually uneventful in fair skinned people. The risk of discoloration or excessive scar formation is higher in dark coloured skin. The thicker skin of the cheeks needs more time to heal, with a higher probability of unsightly scars. The risk of abnormal scar formation can never be excluded completely.