What treatments have you found most effective in removing syringomas?

Most often the syringomas I have treated have been multiple small lesions around the eyes. Because it is readily available, safe, of minimal cost, and easy, I like to use pinpoint electrodesiccation. I use a Hyfrecator 2000 electrosurgical unit on the low setting with 2-3 watts. Because electrodesiccation is quite painful, I use buffered lidocaine and epinephrine local anesthetic injected intradermally. Usually, because the eyelids swell substantially and this can obscure the lesions, I use a minimal volume of anesthetic and wait 10-20 minutes prior to treating so I can better visualize the lesions.

I’ve tried most of the standard listed techniques for multiple syringoma removal. My go-to for years now has been to have my team run Lido with epi under the field with a 1-inch needle while I see other patients. I use fine forceps and Castroviejo curved scissors and superficially pinch out each lesion. It’s fast and easy, and 90% of the time heals without scarring due to the pliable and redundant nature of eyelid skin. Rarely I see PIH, but it’s less than what I saw with electrodesiccation, and the recurrence rate is close to zero. Try it! Patients really appreciate the work.

I usually use the erbium YAG laser with a 1 mm spot and gently ablate the lesions until most of the whitish stroma has disappeared.

Agree with Vic on erbium focal treatment. And also with @Dr. First Last’s resurfacing of the whole area intermittently from time to time in people who tend to make a lot of these. 

Light-handed destruction with electrodessication is my go-to treatment, along with repetitive education on the genetic nature and near certainty of additional lesions in the patient’s future (no treatment is the other option, of course).