What procedures do you recommend for patients interested in xanthelasma removal?

I have had success treating xanthelasma with both hyfrecation (particularly for very small lesions) and fully ablative laser (both CO2 and Erb-YAG).

I found excision, when possible, provided the most effective long-term improvement. Other options include fractional erbium or carbon dioxide laser resurfacing.

Since these frequently recur, I generally use erbium ablation though 90% TCA works equally well, but has a greater risk for hypopigmentation especially if they have a darker skin type.