Journal of Asia Pacific Aesthetic Sciences

ABSTRACT: Management of patients with concomitant melasma and acquired bilateral nevus of Ota-like macules (ABNOM) remains challenging due to the risk of post-laser induction or exacerbation of melasma and the potential development of post-inflammatory hyperpigmentation (PIH). We report a case of a 56-year-old woman with long-standing facial melasma and ABNOM treated with low-fluence 1064 nm Q-switched Nd:YAG (QSNY) laser and high-intensity focused ultrasound (HIFU). A total of 31 QSNY laser sessions were performed at 1–2-month intervals, together with four sessions of HIFU over four years. Marked clinical improvement with progressive pigment lightening was observed throughout the treatment period. The modified Melasma Area and Severity Index (mMASI) score decreased from 11 at baseline to 3, representing a 73% reduction. Near-complete clearance of ABNOM lesions was achieved, accompanied by improvement in skin turgor and laxity. Throughout the treatment course, only mild transient erythema and post-laser hyperpigmentation were observed, both resolving spontaneously without intervention, with no other significant adverse effects reported. This combined approach resulted in sustained improvement in pigmentation and skin quality, suggesting that low-fluence QSNY laser combined with HIFU may be an effective and safe treatment option for patients with concomitant melasma and ABNOM.