Journal of Asia Pacific Aesthetic Sciences

Abstract: Melasma is a chronic hyperpigmentation disorder with complex pathogenesis, making it difficult to treat effectively with a single modality. Conventional therapies often show limited efficacy and frequent recurrences, highlighting the need for multi-targeted treatment strategies. This case describes a 41-year-old woman with Fitzpatrick skin type III and a seven-year history of malar melasma with telangiectatic erythema, who was successfully treated with a multimodal combination therapy. Over a four-month period, she received five sessions of low-fluence Q-switched Nd:YAG laser (LFQSNYL) with pulsed dye laser (PDL), two sessions of high-intensity focused ultrasound (HIFU), and three sessions of polynucleotide (PN) injections. Treatment efficacy was assessed using the modified Melasma Area and Severity Index (mMASI) in conjunction with patient-reported satisfaction. The patient’s mMASI score decreased from 13.2 to 3.3, with visible improvement in both pigmentation and vascular erythema. The patient reported high satisfaction with the results, and no recurrence was noted at three-month follow-up. This case highlights the synergistic benefit of addressing melanin deposition, vascular proliferation, and photoaging simultaneously through combination therapy. By targeting multiple pathogenic pathways, this approach may provide more effective and sustained outcomes. While promising, further clinical studies with larger sample sizes and long-term follow-up are required to validate efficacy and optimize treatment protocols.