A new study published in the Annals of Dermatology hypothesized that a picosecond laser would show better efficacy with minimal adverse events in the treatment of melasma and post-inflammatory hyperpigmentation (PIH), that are difficult to treat with conventional QS lasers. Here, two patients with melasma and one patient with PIH were treated with a Picosecond Alexandrite 755-nm Laser. All these patients were Korean with skin type IV and no longer responding to QS laser treatments. It was observed that laser treatment was well tolerated in all the patients; adverse events such as PIH were not reported during 8 weeks of follow up. After the multiple treatment sessions, one patient reported fair improvement while two patients reported good improvement. Additionally, ex vivo skin model irradiated with a Picosecond Alexandrite 755-nm Laser also exhibited decreased epidermal keratinocyte necrosis compared to the 532-nm QS Neodymium-Doped Yttrium Aluminium Garnet Laser, yet decreased melanin content. Thus, it was concluded that the Picosecond 755-nm Alexandrite Laser may be useful for effective treatment of intractable melasma and PIH with fewer adverse events in dark Asian skin.