Objective To explore the effect of blood-lipid regulation combined with Er:YAG laser therapy on lesion improvement in patients with xanthelasma caused by dyslipidemia. Methods A total of 168 patients with xanthelasma caused by dyslipidemia admitted to Armed Police Beijing Corps Hospital from January 2023 to January 2026 were retrospectively selected as the research subjects. According to different treatment regimens, they were divided into the control group and the observation group, with 84 patients in each group. The control group received Er:YAG laser therapy alone, and the observation group received blood-lipid regulation combined with Er:YAG laser therapy. The clinical efficacy, blood-lipid indicators, lesion improvement and aesthetic satisfaction were compared between the two groups. Results The total effective rate of the observation group (96.43%) was higher than that of the control group (84.52%) (P <0.05). At 3 months after treatment, the levels of TC, TG and LDL-C in the observation group were lower than those in the control group, and the level of HDL-C was higher than that in the control group (P <0.05). At 3 months after treatment, the lesion area reduction rate and lesion regression score of the observation group were higher than those of the control group (P <0.05). At 3 months after treatment, the aesthetic satisfaction score in the observation group was higher than that in the control group (P <0.05). Conclusion For patients with xanthelasma caused by dyslipidemia, blood-lipid regulation combined with Er:YAG laser therapy can effectively correct blood-lipid metabolic disorders, ameliorate lesion condition, and improve aesthetic effect and clinical efficacy.