Background <p>Xanthelasma removal often results in cosmetic deformities following surgery, highlighting the importance of repairing postoperative defects.</p> Objective <p>This study presents an innovative surgical approach using lax upper eyelid skin for the repair of postoperative xanthelasma defects, with the goal of optimizing repair outcomes and enhancing both functional and aesthetic results.</p> Methods <p>A repair strategy combining the use of thin local skin flaps with skin grafts was designed to optimize the use of lax upper eyelid skin. Seventeen patients were enrolled, including 12 females and 5 males, aged 26–62 years (mean age: 45). The tumor sizes ranged from 0.5×1&#xa0;cm to 1.5×3.5&#xa0;cm. Pre- and postoperative upper eyelid morphology, along with patient acceptance and satisfaction, was evaluated and documented.</p> Results <p>The follow-up period ranged from 6 months to 2 years. No vascular complications were observed, and the flaps and grafts survived with primary wound healing. The appearance of the skin was excellent, with texture and color closely resembling that of the surrounding tissue. Minimal or improved changes in upper eyelid morphology were noted, and patients were highly satisfied with the repair outcomes.</p> Conclusion <p>This study presents an innovative and effective repair approach utilizing lax upper eyelid skin for the repair of postoperative xanthelasma defects. The postoperative appearance was not bulky, and no significant functional or aesthetic changes were observed, leading to satisfactory repair results.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>