Laser treatment of giant xanthelasma palpebrarum

Xanthelasma palpebrarum is the most common cutaneous xanthoma. It typically presents in middle-aged and older adults, most often around the eyelids. The diagnosis is made clinically. Giant xanthelasmas palpebrarum are xanthelasmas that extensively affect the superior and inferior bilateral eyelids. Many techniques have been put forward for treating these lesions (surgical, laser, and chemical techniques), but we describe our experience in the treatment of giant xanthelasmas by ultrapulsed CO2 laser. Between 2009 and 2012, in the Division of Plastic and Reconstructive Surgery at the University of Palermo, 12 patients with giant xanthelasmas were treated using a CO2 laser. The laser parameters are as follows: frequency 20 Hz, energy 75 mJ, and power 1.5 W. Each laser session lasts 15 min; the treatment consists of three or four sessions that are carried out at intervals of 15 days. Patients were followed up after 2, 6, and 12 months. This technique is rapid and it is accepted very well by patients. The only disadvantage is a long healing time (10-15 days). The ultrapulsed CO2 laser, in experienced hands, is an excellent device that enables the complete removal of giant xanthelasmas with a minimally invasive but very effective technique.