Comparison of 1064‐nm Picosecond and Q‐Switched Neodymium‐Doped Yttrium Aluminum Garnet Lasers for Melasma in Asian Women: A Randomized Double‐Blind Split‐Face Trial

Background Melasma is a chronic, relapsing facial hyperpigmentation that remains challenging to treat in medium‐to‐dark phototypes. Aims To compare the efficacy, safety, tolerability, and recurrence of 1064‐nm picosecond neodymium‐doped yttrium aluminum garnet laser treatment versus 1064‐nm Q‐switched neodymium‐doped yttrium aluminum garnet laser treatment in Asian women with melasma. Methods In this prospective, randomized, double‐blind, split‐face trial, 16 Asian women with Fitzpatrick skin types III–IV received three treatment sessions at 4‐week intervals. Laser allocation was randomized by hemi‐face, and outcome assessors were blinded. The primary endpoint was the hemi‐modified Melasma Area and Severity Index (hemi‐mMASI), assessed at baseline and at 1, 2, 3, and 6 months after the final treatment session. Secondary outcomes included the Global Aesthetic Improvement Scale (GAIS), recurrence, and pain intensity measured using a visual analog scale. Results Both 1064‐nm picosecond Nd:YAG and 1064‐nm Q‐switched Nd:YAG laser treatments were associated with significant reductions in hemi‐mMASI over time. No statistically significant between‐treatment differences in hemi‐mMASI or GAIS were detected during follow‐up. Pain scores after the first treatment session were significantly lower on the picosecond‐treated side. Recurrence rates at 6 months did not differ significantly between treatments. Conclusions In Asian women with Fitzpatrick skin types III–IV, both 1064‐nm picosecond Nd:YAG and 1064‐nm Q‐switched Nd:YAG laser treatments were associated with clinical improvement in melasma. No statistically significant between‐treatment differences in hemi‐mMASI or GAIS were detected in this small split‐face trial, whereas picosecond treatment was associated with lower pain scores after the first treatment session. Trial Registration Chinese Clinical Trial Registry registration number: ChiCTR2000030886