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Treating xanthelasma palpebrarum may prove difficult because of its delicate location on the eyelid. Various forms of nonablative laser techniques have been examined, and Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser therapy has shown promising preliminary results.To determine the efficacy of Q-switched Nd:YAG laser treatment for xanthelasma removal.Thirty-seven consecutive patients with 76 lesions received two treatment sessions with a Q-switched Nd:YAG laser without local anesthesia (6 J/cm2 [1,064 nm] or 2 J/cm2 [532 nm], 4-mm spot size, 2–3 passes). Photographs were taken before each treatment session and 4 weeks after the second treatment. Two independent examiners rated clearance in four groups (none [<25% cleared], moderate [25–50%], good [51–75%], and excellent [>75%]).Only two-thirds of the patients completed the entire course of the study; disappointing early results were the main reason for dropping out. The majority of treated lesions (70% or 75%, depending on the examiner) showed no clearance. Plasma low-density lipoprotein cholesterol levels displayed some influence on treatment results but not enough to facilitate stratification of patients.Q-switched Nd:YAG (532 nm and 1,064 nm) laser treatment of xanthelasma cannot be recommended.