Introduction
Xanthelasmas are deposits of fat in the skin around the eyelid. Removal is only medically indicated in the case of impaired vision and is therefore considered a cosmetic operation which is not covered by the health insurance and therefore has to be paid for by the patient. Cosmetically disturbing xanthelasma can be removed both surgically and laser therapeutically. The following therapeutic procedures are available:
- The surgical excision
- Electrocautery
- CO2 and Er:YAG laser ablation
- The cryosurgery
- Laser coagulation using argon, dye or KTP laser
- Etching with 50 percent trichloroacetic acid
Operation of Xanthelasma
Surgical removal is favorable if there is a parallel dermatochalasis (drooping eyelid) with large skin surpluses in the upper and lower eyelid area, which can then be removed simultaneously. After the surgical excision, a scar is formed and is often problematic, especially in the case of large xanthelasma. A repeat treatment in case of recurrence of xanthelasma is not possible as often as desired due to the scar during surgical removal.
Since vessels are also injured during the operation, severe redness often occurs after the treatment, which is unacceptable as a side effect for many patients. Xanthelasma often reoccurs after surgical removal. In a 1979 study by Mendelsohn, 40% of patients experienced repeated xanthelasmata after the first operation and 60% after the second operation.
Similar to laser treatment, the surgical measures for removal of xanthelasma depend on the size, number and other factors. It is difficult to name general standard prices. As there are different procedures, the prices also vary depending on the particular procedure (ice, electricity, acid treatment, eyelid lift or treatment with a scalpel). Here, too, the rules of the doctors’ fee schedule apply, which are regularly changed. As a rule, the costs for surgical measures without laser remain in the higher two-digit range.
Laser treatment of xanthelasma
There are different laser procedures for the removal of xanthelasmas like the dye laser, CO2 laser or Er:YAG laser. The choice of the appropriate method depends on the expectations and needs of the patient. Often only a short-term absence from work is intended and patients want minimally invasive methods.
However, an individually suitable therapy should be selected based on the overall findings and the anatomy of the eyelid region. Treatment with the dye laser is only successful in the early stages of very flat xanthelasma and several treatments must be expected. Laser ablation using a CO2 laser or Er:YAG laser always creates a wound area that does not heal until a few days later.
Studies have shown that CO2 laser ablation has been successful in removing xanthelasma without scarring. Only hyper- or hypopigmentation occurred in a few of the patients treated in this way. Also with the Er:YAG laser, good efficacy, low side effects and only few recurrences (recurrence of xanthelasma) are achieved.
The healing of superficial xanthelasma even takes less time than with the CO2 laser. The cost of laser removal of xanthelasma depends on the size and number of these lipid deposits. Furthermore, this treatment is not a medical indication and usually has to be paid for by the patient.
This gives the treating physician or the treating clinics a certain leeway in determining the fees. Therefore, the costs vary enormously from the higher two to medium three-digit range. However, the costs of laser treatment of xanthelasmas are also subject to the German scale of fees for physicians.
Each service is defined there with a point or monetary value. On the basis of a written individual case agreement, however, the basic price from the fee regulation can be multiplied by a new factor. Nevertheless, the basic principle is that “appropriateness” must be observed. Accordingly, the offered prices for a laser treatment of Xanthelasmas can be compared.
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