Journal of Asia Pacific Aesthetic Sciences

ABSTRACT: Melasma is a chronic acquired hypermelanosis that predominantly affects Asian women with Fitzpatrick skin types III–IV. Its multifactorial pathogenesis and high recurrence rate make long-term management challenging, particularly in patients with concurrent facial aging concerns. This study evaluated a layer-targeted multimodal treatment strategy addressing both pigmentation and skin aging. A 46-year-old Asian woman (Fitzpatrick skin type IV) with a history of melasma exceeding 10 years, accompanied by midface laxity and infraorbital eyebags, underwent a sequential treatment protocol. This included 25 sessions of low-fluence 1064-nm and 595-nm Q-switched Nd:YAG (QSNY) laser, 7 sessions of high-intensity focused ultrasound (HIFU), 2 sessions of calcium hydroxyapatite (CaHA), and 4 sessions of pulsed-wave radiofrequency (RF) microneedling. Clinical outcomes were assessed using the modified Melasma Area and Severity Index (mMASI) and the Global Aesthetic Improvement Scale (GAIS). The mMASI score improved from 4.5 at baseline to 0.6 at final follow-up, with visible improvement in skin laxity and infraorbital contour. The final GAIS rating was Grade 1 (very much improved). No adverse events, including post-inflammatory hyperpigmentation, were observed over a 3-year follow-up period. This case suggests that a layer-targeted multimodal approach integrating pigment modulation, structural support, and dermal remodelling may achieve sustained improvement in chronic melasma while concurrently addressing facial aging in patients with darker skin types.