Abstract: Melasma is a skin condition characterized by symmetrical hyperpigmentation over the malar region, primarily affecting women with darker skin types. Its pathogenesis is multifactorial, involving ultraviolet (UV) exposure, hormonal influences, and genetic predisposition. Effective management remains challenging due to the condition’s chronic nature. Low-fluence Q-switched Nd:YAG laser (LFQSNY) has shown promising results, particularly when combined with oral tranexamic acid (TA). This case report evaluates the effects of combination therapy using 1064 nm LFQSNY and oral TA in a 49-year-old woman with a 10-year history of melasma and a strong family history of the condition. The treatment led to significant improvement, with her modified Melasma Area and Severity Index (mMASI) score decreasing from 13.8 to 5.8. These findings suggest that the combination of LFQSNY and oral TA may be an effective treatment option for managing chronic melasma and warrants further investigation.