Endolesional ablation of xanthelasma using microfiber optic laser delivery

Abstract

Xanthelasma palpebrarum is the most common type of cutaneous xanthoma and is often a cause of psychological distress and aesthetic dissatisfaction. The extent, depth, or background skin type, intolerance to downtime, or cost, may restrict the treatment options, or contribute to a recurrence rate of up to 60%. 1470 nm microfiber laser is a recent clinical innovation that allows highly targeted delivery of Laser to deeper tissues through fibers as small as 150 µm in diameter, targeting fat and/or water chromophores. We report a retrospective data series on five patients (10 eyelids) treated with intralesional microfiber laser, where other treatment methods were inappropriate, contraindicated, or declined. Single-use tip firing microfibers (150-300 µm), were introduced into lesions under tactile and visible indicator light guidance (1- 2 W; 250-500 Hz, LEED 1-2 Jcm–2, 1470 nm ). Results were followed up with before/after photography. The pain was measured using a prevalidated 1-10 Likert scale. Patients were followed up by remote consultation up to one year post-treatment. Xanthelasma size was (7 mm ± 4 mm, mean ±SD). The average time to complete resolution was 12±2.4 weeks ( All patients were normolipidemic pre-treatment. Sessions needed were 1.2±0.4 (mean ±SD). Maximum discomfort on a 1-10 Likert scale was 3±1/10 (mean ±SD), at eight weeks’ follow-up. No recurrences were reported up to 1 year’s follow-up. No patients had visible scarring. Most importantly, all patients reported minimal downtime and could continue normally with activities of daily life. 1470 nm microfiber laser is a promising method for the management of palpebral xanthelasma: within this case series was safe and effective in experienced hands. Further, larger studies are in hand to assess follow-up long-term outcomes and patient satisfaction.