Efficacy of picosecond Nd:YAG 1064 nm laser in melasma treatment: a real-world retrospective analysis

BACKGROUND: Melasma is a challenging hyperpigmentation disorder, especially prevalent in individuals with darker skin tones. Traditional treatments, like hydroquinone and chemical peels, have limitations due to high recurrence rates and post-inflammatory hyperpigmentation (PIH) risk. Picosecond lasers have emerged as promising alternatives for treating melasma in patients with Fitzpatrick skin types III-IV. This study aims to evaluate the efficacy and safety of the 1064 nm Nd:YAG picosecond laser for melasma in a Vietnamese population. METHODS: This retrospective study analyzed 29 female patients with mild to very severe melasma treated using a 1064 nm Nd:YAG picosecond laser. Each patient received an initial toning procedure followed by a fractional treatment, across three sessions at four-week intervals. Outcome measures included MASI (Melasma Area and Severity Index), MELASQoL (Melasma Quality of Life), VISIA imaging and colorimetric assessments. Follow-up visits were conducted at 4, 8, and 12 weeks after the first treatment. RESULTS: Significant improvements were observed in MASI, MELASQoL, and pigmentation indices (L* and b*). VISIA analysis demonstrated significant reduction in superficial spots and brown spots, along with improvements in skin texture and wrinkles. Mild side effects were reported in 51.7% of patients, primarily erythema, which resolved spontaneously. No cases of PIH were documented. CONCLUSIONS: The 1064 nm Nd:YAG picosecond laser is an effective and safe treatment option for melasma in patients with Fitzpatrick skin types III-IV. Its ability to target melanin while minimizing thermal damage makes it particularly suitable for darker phototypes. Quantitative VISIA analysis supported treatment efficacy and revealed additional skin rejuvenation benefits. Further studies are required to assess long-term outcomes and recurrence rates.