Journal of Asia Pacific Aesthetic Sciences

ABSTRACT: Melasma and solar lentigines are common acquired facial pigmentary disorders that frequently coexist in clinical practice. The management of mixed pigmentary conditions remains challenging, and evidence for combination laser therapy in such cases is limited, particularly in extended treatment protocols. We report the case of a 52-year-old woman with Fitzpatrick skin type III who presented with coexisting melasma and solar lentigines of five years’ duration. She underwent 20 sessions of exclusive laser therapy over 2.5 years using low-fluence 1064-nm Q-switched Nd:YAG (QSNY) laser and 660-nm ruby laser–like technology. Progressive and sustained clinical improvement was observed throughout the treatment course, with visible changes noted after 10 sessions. The modified Melasma Area and Severity Index (mMASI) score demonstrated a 75% reduction, decreasing from 21.30 at baseline to 5.30 after 20 sessions. The treatments were well tolerated, with only transient post-treatment erythema resolving within 1–2 days. This case suggests that extended combination laser therapy using low-fluence 1064-nm QSNY and 660-nm ruby laser-like technology may be an effective and well-tolerated option for patients with coexisting melasma and solar lentigines when carefully planned and closely monitored.