Dermatology and oculoplastic · London
Xanthelasma removal - London
Consultant-led removal of soft yellow cholesterol plaques on the eyelids using TCA peel, CO2 laser, radiofrequency or surgical excision. Assessment, lipid workup and a written pathway before you commit.
What xanthelasma is
Soft yellow cholesterol plaques on the eyelids
Xanthelasma palpebrarum are soft, yellowish, cholesterol-rich plaques that appear on the eyelid skin, most often on the medial (inner) portion of the upper lid. They are benign and do not affect vision, but many patients find them cosmetically troubling because they are prominent and difficult to disguise with makeup.
They can also be a marker of underlying dyslipidaemia. Roughly half of patients, particularly those under 40 or with multiple lesions, have raised total cholesterol, raised LDL, low HDL or a family history of premature cardiovascular disease. A lipid check is not optional; it is part of proper care.
Assessment
Before we treat, we work you up
A consultant dermatologist or oculoplastic surgeon examines the plaques, confirms the diagnosis clinically and rules out other eyelid lesions. Baseline blood tests include a fasting or non-fasting lipid profile (total cholesterol, LDL, HDL, triglycerides), HbA1c and thyroid function. If dyslipidaemia is found we treat it in parallel with your GP, because leaving lipids unmanaged is the single biggest driver of recurrence.
Treatment options
Five ways to remove a plaque
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Trichloroacetic acid (TCA) peel 50–100%
Targeted spot application to the plaque. Quick, low cost and repeatable. May need two or three sessions. Small risk of hypopigmentation, particularly in skin of colour.
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CO2 laser
Precise vaporisation of the plaque under magnification. Immediate visible clearance, minimal scarring, controlled depth. Good for defined lesions on the upper medial eyelid.
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Radiofrequency ablation (Ellman)
Similar results to CO2 laser using high-frequency current. Fine control, minimal thermal spread and quick healing. Suits small to medium plaques.
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Surgical excision
Preferred for large, thick or extensive plaques. Performed by an oculoplastic surgeon with careful eyelid closure. Leaves a fine scar along the lid crease.
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Cryotherapy
Less commonly used. Effective but carries a higher risk of skin lightening and eyelid margin injury. Rarely first choice in modern private practice.
Lipid management
Treating the cause, not just the plaque
If your lipid profile is raised, statin therapy is considered on cardiovascular risk grounds per NICE thresholds (QRISK3 above 10 per cent, familial hypercholesterolaemia, established vascular disease). Diet, weight, alcohol and exercise all matter. Statins are not prescribed to shrink xanthelasma, but lipid control modestly reduces recurrence after removal and lowers your long-term heart attack and stroke risk, which is the more important outcome.
Procedure and recovery
Day-case, local anaesthetic, home the same hour
Treatment is delivered in the clinic under topical anaesthetic drops or local infiltration. Each session takes 10 to 30 minutes depending on plaque size and number. Small dressings are applied. Larger or extensive lesions may need two or three sessions spaced four to six weeks apart.
Expect redness, mild swelling and a fine scab for 5 to 14 days. Makeup can usually be worn after seven days. Contact lenses go back in at three to five days. Sun protection during healing is essential to reduce pigmentation change, and you should avoid picking the scab.
Risks
What can go wrong, honestly
The main risks are hypopigmentation (skin lightening), especially with TCA in darker skin types; post-inflammatory hyperpigmentation; small visible scars, usually fine and settling over months; and recurrence in 20 to 40 per cent of patients within five years, particularly when lipids remain uncontrolled. Serious complications (eyelid margin injury, ectropion after surgical excision) are rare in consultant hands.
Cost
Indicative London pricing
| Item | Indicative range |
|---|---|
| Initial consultant assessment | £150–£280 |
| TCA peel (per session) | £250–£450 |
| CO2 laser or radiofrequency (per session) | £450–£950 |
| Surgical excision (oculoplastic) | £850–£1,600 |
| Lipid profile and thyroid blood tests | £90–£180 |
Most patients need one to three sessions. Xanthelasma removal is treated as cosmetic by UK insurers and is self-pay.
Where in London
Clinics and consultants
Well-regarded London providers include Cadogan Clinic, Cranley Clinic, London Dermatology Centre, HCA Wellington Dermatology and Oculoplastic, Chelsea and Westminster Private, and Skin Care Clinic. For surgical excision we prefer BOPSS-listed oculoplastic surgeons. We match you to a consultant whose caseload matches your plaque size, skin type and preference.
Frequently asked
Xanthelasma: what patients ask
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Do I need my cholesterol checked?
Yes. Around half of patients with xanthelasma have raised cholesterol or another lipid abnormality, especially those under 40 or with multiple plaques. A lipid profile, HbA1c and thyroid function are standard before treatment and matter more for your cardiovascular risk than the plaque itself.
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Is removal a permanent cure?
The treated plaque is cleared, but xanthelasma can recur in around 20 to 40 per cent of patients within five years, particularly when lipids remain uncontrolled. Treating the underlying dyslipidaemia reduces the recurrence rate.
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Will insurance cover it?
No. Xanthelasma removal is considered cosmetic by all major UK insurers (Bupa, AXA, Vitality, Aviva, WPA, Cigna). You pay self-pay. Lipid management on the NHS via your GP is separate and free.
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Will there be a visible scar?
When performed by an experienced consultant, scarring is usually minimal. TCA and laser leave the skin slightly pink for a few weeks. Surgical excision leaves a fine line hidden in the natural eyelid crease. Hypopigmentation is the main cosmetic risk with TCA.
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How likely is recurrence?
Recurrence is common: roughly 20 to 40 per cent within five years across all methods. Surgical excision has the lowest short-term recurrence, TCA the highest. Lifelong lipid control lowers the odds.
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Do I need to take a statin?
A statin is prescribed on cardiovascular risk grounds, not to shrink xanthelasma. If your QRISK3 score and lipid profile meet NICE thresholds, a statin is worth considering. It also modestly reduces recurrence after removal.
Ready to clear a plaque? Speak to a consultant.
Tell us your skin type, how long the plaques have been there and any lipid history. We come back within one working day with a matched consultant and a firm quote.