The management of xanthelasma can be challenging, as evidenced by our own experiences as well as that of other physicians. Appreciating the difficulties is important, so as to inform the patient of the risks of recurrences after surgical excision and to plan the surgical procedure to prevent ocular complications such as ectropion. The patient with xanthelasma who desires a blepharoplasty is an especially interesting topic. A conservative approach, at times using staged excisions, as discussed in this article, will help achieve the desired result and assure patient satisfaction.