Journal of Asia Pacific Aesthetic Sciences

Abstract: Melasma is characterized by dark-brown patches on the face, and its treatment remains challenging due to its complex pathogenesis. This case report aims to evaluate the efficacy of a combination treatment using multiple targeted approaches, including 1064 nm Low Fluence Q-Switched Nd:YAG laser (LFQSNYL), 595 nm Pulsed Dye Laser (PDL), High-Intensity Focused Ultrasound (HIFU), and Polynucleotides (PN). A 41-year-old woman with Fitzpatrick skin type III and no known medical conditions presented to our clinic with pigmentation on both cheeks that had been present for seven years. Upon examination, she exhibited marked telangiectatic erythema within symmetric, reticulated hyperpigmented patches with irregular borders on both cheeks. Based on the clinical presentation, she was diagnosed with melasma. The patient received a total of five sessions of 1064 nm LFQSNYL combined with 595 nm PDL, two sessions of HIFU, and three sessions of PN treatment. The total treatment duration was four months, with intervals between each treatment modality ranging from one to three months. One month after the fifth treatment session, her modified Melasma Area and Severity Index (mMASI) score decreased from 13.2 to 3.3. The patient expressed high satisfaction with the overall outcome. In conclusion, the combination of LFQSNYL, PDL, HIFU, and PN may offer a promising approach to treating melasma, particularly in cases with telangiectasia. To fully establish the efficacy of this combination treatment, further clinical trials involving larger sample sizes, long-term follow-up, and optimization of treatment protocols are necessary.