Because of the success of fractional photothermolysis in treating many dermal skin conditions, we thought that our patient's extensive xanthelasma could be treated with this technology. Treatments were performed using a 1550-nm-wavelength, erbium-doped laser (Fraxel SR 1500; Reliant Technologies Inc, Mountainview, California). The treatment area was cleansed with a mild soap (Cetaphil Gentle Skin Cleanser; Galderma Laboratories, LP, Fort Worth, Texas) before the procedure. A topical triple anesthetic composed of benzocaine, 10%, lidocaine, 6%, and tetracaine, 4% (BLT; New England Compounding Center, Framingham, Massachusetts) was applied under occlusion to the treatment area of the cheeks, temples, upper eyelids, and inner canthi for 1 hour before treatment. A water-soluble tint certified by the US Food and Drug Administration (OptiGuide Blue; Reliant Technologies Inc) was applied to the treatment area (first 3 sessions) to allow the laser's optical tracking system (Intelligent Optical Tracking System; Reliant Technologies Inc) to adjust the treatment pattern with respect to handpiece velocity. An ointment (LipoThene Inc, Pacific Grove, California) was applied over the water-soluble tint so that the laser handpiece could glide smoothly over the treatment area.