Novel and Simple Punch Treatment for Xanthelasma Palpebrarum: A Preliminary Case Series

BACKGROUND: Xanthelasma palpebrarum (XP) is a common cutaneous condition of the eyelid, which compromises eyelid aesthetics. Non-surgical treatments are often limited by multiple sessions and high cost. Surgical treatment, although effective, is constrained by the limited availability of eyelid skin and the risk of ectropion. A simple, safe, and effective therapeutic technique is essential for managing XP. AIMS: This study aimed to present a new dermatologic treatment for XP and assess its effectiveness. METHODS: A novel technique, punch-assisted xanthelasma nucleus excision (PAXNE), was applied in four cases of mild-to-moderate XP (Grades I and II) under local anesthesia. Clinical photographs of the patients at the preoperative and postoperative follow-up for 1 month were recorded. Treatment outcomes were assessed at a 1-month follow-up using a 5-Likert scale for periorbital aesthetics and patient satisfaction. Additionally, two independent physicians evaluated treatment efficacy based on lesion clearance (0-4 Scale). RESULTS: Postoperative scarring was inconspicuous, and aesthetic outcomes were satisfactory at the 1-month follow-up. After 1-month follow-up, the average 5-Likert scale score for periorbital aesthetics was 3.25, and the average patient satisfaction score was 3.75. The objective treatment efficacy score reached 4.0 for all cases, indicating over 75% clearance of the lesions. No postoperative complications, such as eyelid ectropion, were found in the preliminary series. CONCLUSIONS: PAXNE is a promising, minimally invasive approach showing excellent short-term aesthetic results, but it needs more investigation in larger cohorts with long-term follow-up.