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As a plastic surgeon, I get asked by family doctors to see many
patients with xanthelasmata affecting their eyelids. Consequent on old
medical school teachings about the associations now being re-inforced in
the editorial by Fernandez & Thompson, they have almost invariably had
their serum lipids measured before referral. Four out of five have no
dyslipidaemia and I believe other plastic surgical colleagues would
confirm the same experience. Therefore if the eminent authors of this
editorial are correct in making a link between these cutaneous cholesterol
deposits and cardiac disease, it does not seem to be via elevated blood
lipid levels, or at least the ones we are measuring. Because plastic
surgeons probably see most of these patients, it would not be difficult to
recruit a sizeable cohort from a dozen or so of these specialists and nail
this for once and all.