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Background and Objectives: Xanthelasma palpebrarum is a xanthoma arising on the eyelids. When the lesion is large, surgical removal may cause distortion, and total laser ablation or chemoablation can cause scarring and delayed healing. Here, we introduced an adequate method to treat a large xanthelasma palpebrarum lesion. Materials and Methods: Patients were treated with either CO2 oder Er:YAG laser with a beam size of 1.5-2 mm (interbeam distance: 1-2 mm). Three independent plastic surgeons assessed the degree of improvement, scarring, and pigmentation. Results: A total of 13 patients were treated using the pinhole method (7 women and 6 men). The mean patient age was 50.1 ± 8.72 years. The mean follow-up period was 8.3 months. The mean number of treatments was 3 times. The mean grade of improvement was 3.54. Nonetheless, there were 3 cases of hypopigmentation that occurred with a larger lesion size and darker skin color. Conclusion: Large xanthelasmas were treated successfully using the pinhole method. The pinhole method appears to be effective for treating large xanthelasma palpebrarum lesions while avoiding scarring or distortion. [ABSTRACT FROM AUTHOR]