What is the best treatment for xanthelasma removal?

Dr. Parvin Shafa | May 20, 2026

Xanthelasma is a yellowish plaque that typically forms around the eyes. It consists of cholesterol deposits under the skin. Removal of xanthelasma is done only for cosmetic purposes.

I am Dr. Parvin Shafa, founder of OC MedDerm in Irvine, CA. With over 25 years of experience in dermatology and skin surgery, I have treated thousands of cosmetic and surgical skin conditions, including xanthelasma removal around the eyes. At OC MedDerm, I have removed an average of 10 to 15 xanthelasma per month for the past decades.

With over 25 years of experience practicing dermatology and performing skin surgery, I have had the opportunity to treat xanthelasma using various recommended treatment options. I have closely followed the downtime of each procedure, risk of complications, chance of scarring, recurrence after removal, and overall patient satisfaction with the final results.

In my opinion, the best way to remove xanthelasma is surgical excision, even for small xanthelasma plaques. This procedure is very delicate and requires an experienced, detail-oriented skin or eye surgeon.

Quick overview of how xanthelasma is removed surgically:

The unwanted yellowish xanthelasma plaque is marked, and the area is numbed. An incision is then made at the border of the plaque, including excess loose skin due to aging. Then the plaque with excess skin is carefully removed from the underlying tissue. A thorough cleanup of any hidden or barely visible cholesterol deposits is performed before closing the wound. This step is important to help ensure the complete removal of deposits that have formed or may contribute to future yellowish plaque formation.

The wound is then closed with sutures placed under the skin to help minimize the risk of visible scarring. Surgical removal of xanthelasma is performed pain-free in the office. Aftercare is usually minimal. Sutures are removed after one week. 

In future blogs, I will explain the procedure in more detail.

Why TCA is not a good treatment option for xanthelasma removal:

TCA (trichloroacetic acid) works by chemically destroying xanthelasma tissue. It is easy to perform, quick, and less costly. However, because the depth of xanthelasma is uneven and the penetration depth of TCA cannot be precisely controlled, the plaque is often only partially destroyed.

TCA can also affect healthy surrounding skin, causing prolonged irritation and chemical burns. Multiple treatments are usually needed. The risk of scarring is significantly higher compared to surgery.

In future blogs, I will discuss more about the pros and cons and why TCA is not an ideal option for xanthelasma removal.

Why a CO₂ laser is not a good option for xanthelasma removal

A CO₂ laser is a fractional laser that sends a focused beam of infrared light to the skin and removes (vaporizes) layers of skin tissue. However, the depth of xanthelasma is uneven and cannot be fully seen during the procedure. Because of this, I may only be able to remove one or two layers, while deeper cholesterol deposits often need additional treatments.

The treatment also creates heat injury to the skin, and healing usually takes longer compared to surgical removal.

A CO₂ laser for xanthelasma removal is an option for very large or diffuse lesions where excision would create excessive tension and eyelid retraction. 

I recommend a CO₂ laser as an alternative to surgery for any patient who is absolutely not interested in surgery or prefers a less invasive approach. 

Follow my future blogs to learn more about why the CO₂ laser is not the best choice for xanthelasma removal.

Why not an erbium: YAG laser?

The erbium: YAG laser has similar pros and cons to the CO₂ laser, but it is slightly gentler. Xanthelasma removal still requires multiple laser passes to destroy the plaque. This creates a wound similar to the CO₂ laser treatment.

Healing is delayed, and the scar is often the same size or slighter smallr as the original plaque.

Why not electrocautery/radiofrequency?

With electrocautery or radiofrequency, I can control the depth of skin and plaque destruction more precisely. However, I do not recommend these treatments for the following reasons:

• The heat and deeper destruction of the plaque create a deep burn, leading to irritation and inflammation of the surrounding tissues.
• This type of wound heals slowly and has a risk of infection.
• After healing, it will leave a scar equal in size or slightly smaller than the original plaque.
• I do not want to replace a xanthelasma plaque with an equally unwanted scar, which is not an acceptable outcome for me.

In my future blogs, I will further explain why electrocautery and radiofrequency are not good options for xanthelasma removal.

At OC MedDerm, we offer a complimentary consultation to evaluate your xanthelasma and discuss the best treatment options for you. Call us at (949) 551-1113 to schedule your no-obligation consultation.

You can also learn more about xanthelasma treatment and our practice by visiting OC MedDerm’s Xanthelasma Removal Page.