GLASS LAB · Medical Aesthetics Evidence Index 303 cells · 19,226 papers · 5,969 top-tier evidence

Pigment · Melasma (mixed / dermal)

Picosecond laser pigment evidence for Melasma (mixed / dermal)

A 68.5 / 100 Supported 8 RCT/meta · 4 clinical/observational · 0 case · 15 total
Strong evidence · positive conclusion

This procedure group has the highest level of PubMed evidence for this indication, and the papers broadly support its effectiveness.

Grade combines the quantity and quality of the research, while direction is a separate signal showing how the papers assess effectiveness.

Includes meta-analysis/SR Median year 2022 Last 5 years 67% Positive results 87% Negative results 2 Korea/Asia 5

Known in Korea as

피코슈어피코웨이피코토닝피코플러스피코슈어 프로피코 색소레이저

Procedure and brand names vary, but the evidence above applies to the same procedure mechanism.

Key papers

tier1 Efficacy of Alexandrite picosecond laser therapy with and without dermal polyrevitalisation (NCTF® 135 HA) in patients with melasma: A Randomised Controlled Trial. La Clinica terapeutica · 2026 · PMID 42047123

Abstract summary (English) OBJECTIVES: This randomised controlled trial aimed to compare the efficacy of Alexandrite picosecond laser therapy combined with dermal polyrevitalisation (NCTF® 135 HA) with laser therapy alone for reducing the severity of melasma. The outcomes were assessed using 3D imaging and the Dermatology Life Quality Index (DLQI). The secondary objectives were to evaluate the safety and tolerability of the combined...

Comparative Study, Journal Article, Randomized Controlled Trial

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tier1 Assessing the Safety and Efficacy of Picosecond Alexandrite Lasers in the Management of Melasma: A Systematic Review and Meta-Analysis of Randomised Control Trials. The Australasian journal of dermatology · 2026 · PMID 41589005

Abstract summary (English) Melasma is a chronic hyperpigmentation disorder that disproportionately affects women and individuals with darker skin types, leading to a significant psychosocial burden. This meta-analysis aims to evaluate the safety and efficacy of the 755-nm picosecond alexandrite laser (PSAL) compared with conventional therapies in the management of melasma. PubMed, Ovid Medline, Embase, Cochrane Library, and Google Scholar...

Journal Article, Systematic Review, Meta-Analysis, Review

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tier1 755-nm picosecond laser plus topical 20% azelaic acid compared to topical 20% azelaic acid alone for the treatment of melasma: a randomized, split-face and controlled trial. Lasers in medical science · 2024 · PMID 38656631

Abstract summary (English) PURPOSE: Melasma remains a refractory skin condition that needs to be actively explored. Azelaic acid has been used for decades as a topical agent to improve melasma through multiple mechanisms, however, there is a lack of research on its combination with laser therapy. This study evaluated the effectiveness of isolated treatment with topical 20% azelaic acid and its combination with 755-nm picosecond laser in...

Journal Article, Randomized Controlled Trial, Comparative Study

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tier1 Comparison of Picosecond and Nanosecond Nd:YAG 1064-nm Lasers in the Treatment of Melasma: A Split-Face Randomized Clinical Trial. Plastic and reconstructive surgery · 2022 · PMID 36729879

Abstract summary (English) BACKGROUND: Melasma is a refractory pigmentary disorder. The picosecond Nd:YAG 1064-nm laser (PSNY) has promise as a better treatment for melasma with few side effects and favorable therapeutic efficacy. The authors evaluated the efficacy and safety of PSNY and the nanosecond Q-switched Nd:YAG 1064-nm laser (QSNY) in patients with melasma.

Randomized Controlled Trial, Journal Article

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tier1 Combination of a 755-nm picosecond laser and hydroquinone 2% cream versus hydroquinone 2% cream alone for the treatment of melasma: A randomized, split-face, and controlled trial. Lasers in surgery and medicine · 2022 · PMID 36345697

Abstract summary (English) BACKGROUND: While combined laser and topical treatments are currently a common approach to melasma treatment, data on the efficacy and safety of this combined therapy remain scarce, with studies showing varied results. OBJECTIVE: To compare the efficacy and safety of hydroquinone (HQ) cream alone versus HQ cream combined with 755-nm picosecond (PS) laser in the treatment of melasma. METHOD: Twenty subjects...

Randomized Controlled Trial, Case Reports, Journal Article

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tier1 Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials. Frontiers in medicine · 2021 · PMID 34660626

Abstract summary (English) Background: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence. Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA). Methods: The PubMed, Embase, and Cochrane Library databases were searched till...

Systematic Review, Journal Article

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tier1 A Prospective, Split-Face, Randomized Study Comparing a 755-nm Picosecond Laser With and Without Diffractive Lens Array in the Treatment of Melasma in Asians. Lasers in surgery and medicine · 2020 · PMID 32865858

Abstract summary (English) BACKGROUND AND OBJECTIVES: Treatment of melasma with lasers remains a challenge due to its limited clinical efficacy in addition to high rates of recurrence and side effects. Recently, picosecond lasers have shown favorable results in treatment of benign pigmented lesions. To compare the efficacy and safety of using a 755-nm picosecond laser for the treatment of melasma in a split-face manner, having one side...

Journal Article, Randomized Controlled Trial

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tier1 Effects of a fractional picosecond 1,064 nm laser for the treatment of dermal and mixed type melasma. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology · 2017 · PMID 29020467

Abstract summary (English) BACKGROUND: Picosecond laser is a novel modality for pigmented skin disorders with extremely short pulse duration. Little is known about the effects of the picosecond laser in melasma. OBJECTIVE: This study aimed to investigate the efficacy of fractional picosecond 1,064 nm laser in melasma treatment.

Journal Article, Randomized Controlled Trial

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tier2 Comparison of the Efficacy of 1064- and 730-nm Picosecond Lasers for Acquired Dermal Melanocytosis. Journal of cosmetic dermatology · 2025 · PMID 40087990

Abstract summary (English) BACKGROUND: Acquired dermal melanocytosis (ADM) is a pigmentary lesion caused by melanocytes in the dermis. These conditions are refractory, and a consensus on treatment remains elusive. AIMS: To compare the efficacy of 730- and 1064-nm picosecond lasers in the treatment of ADM and to supplement the comparison with a literature review.

Journal Article, Comparative Study

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tier2 Modulation of Melanocyte in Melasma Patients After Picosecond Laser Treatment. Journal of cosmetic dermatology · 2024 · PMID 39282999

Abstract summary (English) BACKGROUND: Melasma is a therapeutically challenging hyperpigmented skin condition. Currently, there is a lack of in vivo observation regarding changes in melanin and dendritic melanocytes after laser treatment. OBJECTIVE: To investigate alterations in melanin and melanocytes in melasma before and after laser treatment using optical coherence tomography (OCT).

Journal Article, Observational Study

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Suggested interpretation

Strong evidence base

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