The effective treatment of melasma is challenging as it demands a multifaceted approach including strict sun protection, bleaching creams, chemical peels, and laser therapy. The 1064 nm Nd:YAG laser with a 650-microsecond pulse duration is considered a safe option for all skin types.

A study examined 10 patients, treated with the 1064 nm Nd:YAG laser with 650-microsecond pulse duration, every 2-4 weeks, for melasma.

The observations were as follows-

• With conservative treatment protocol, melasma lightened after 3 weeks post-treatment, with numerous treatment sessions needed to obtain satisfactory resolution of melasma, by all the subjects.
• Up to 25% improvement after two treatments was reported by a majority of the participants, and an even more remarkable improvement after the 3rd treatment session.
• Any associated pain or discomfort was not reported by any of the participants.

It was thus inferred that this laser modality benefits users with essentially no pain or downtime, lower risk of rebound, and treatment safety in all skin types with melasma. 

Thus, melasma can be effectively treated with the 1064 nm Nd:YAG laser with a 650-microsecond pulse duration.

Source: Greywal T, Ortiz A. Treating melasma with the 1064 nm Nd:YAG laser with a 650-microsecond pulse duration: A clinical evaluation. J CosmetDermatol. 2021 Nov 11. doi: 10.1111/jocd.14558. Epub ahead of print. PMID: 34762366.