A new operative method for treatment of xanthelasma or xanthoma palpebrarum: microsurgical inverted peeling.

A new operative technique for treatment of xanthelasma or xanthoma palpebrarum was introduced. The merits of this technique are (1) no skin excision with the tumor, (2) making the flap from the skin covering the tumor, (3) no need for donor site, (4) no significant cosmetic problem, and (5) reoperation performed by same procedure. Our new technique is performed under local anesthesia. The skin and tumor are raised together just above the orbicularis oculi muscle like a flap. The tumor is peeled piece by piece from the flap using micro-scissors under a surgical microscope. After tumor enucleation is performed, the skin flap without the tumor is sutured back directly. Our new technique was performed for seven cases of xanthelasma. The recurrence of the tumor was seen only in two cases, which were complicated with hypercholesterolemia. No recurrence was observed after a secondary operation and with the use of anti-hypercholesterolemic drugs. Large xanthelasma can be treated by our new surgical technique without extra skin excision with the best possible cosmetic results.