Refining Xanthelasma Palpebrum Treatment: A Scar Minimising Dual Technique Approach

Xanthelasma palpebrum (XP) is the most common cutaneous xanthoma, presenting as bilateral, yellowish periorbital plaques, occurring more commonly in women during the fourth and fifth decades of life. Although benign, XP can be cosmetically distressing to the patient, warranting treatment. There are multiple therapeutic modalities available, such as surgical excision, chemical cauterisation, cryotherapy, laser ablation, and radiofrequency (RF) cautery. Among these, RF cautery is popular for its precision, ease of use, and low cost. However, conventional RF carries a significant risk of post-inflammatory hyperpigmentation (PIH), scarring, and recurrence (especially in darker skin types) due to excessive thermal injury or incomplete removal of the lesion. Here, the authors describe a novel dual-modality technique combining superficial RF cautery with subsequent manual needle extraction of residual lipid deposits. After initial lesion debulking by RF, a 26-gauge needle is used to extract deeper xanthelasma material, similar to milia extraction. This approach minimises collateral thermal damage, reduces PIH and scarring risk, and ensures thorough lesion clearance, thereby lowering recurrence. This method demonstrated faster recovery and superior cosmetic outcomes compared to conventional RF cautery alone. This simple, low-cost modification addresses the major limitations of conventional RF, while providing a safe and cosmetically superior alternative for management of XP and adds a valuable innovation to the dermatologist’s surgical toolkit.