Although the books always say that lipids and cholesterol should be checked in patients with xanthelasmas, I think that I have yet to detect anyone who has markedly abnormal levels. Incorporating the upper lid excision into a blepharoplasty gives a nice result. There are some xanthogranulomatous diseases (e.g. Erdheim-Chester) that are associated with xanthelasmas, and I always keep that in mind in any patient with a xanthelasma. Usually the lesions associated with xanthogranulomatous disease look a little different than the typical xanthelasma.
For a written transcript of this video, please see http://webeye.ophth.uiowa.edu/eyeforum/atlas-video/excision-upper-and-lower-xanthelasma.htm
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