Effectiveness of a combined approach using PDL and Q-switched 1064 Nd: YAG laser mode for the treatment of melasma lesions in Venezuelan female patients

Zulay Rivera; Víctor Ollarves Ruiz; Ingrid Rivera Pineda; Dennis Alexander Lugo; Isabel Hagel López

doi:10.57662/am.2026.17899

Effectiveness of a combined approach using PDL and Q-switched 1064 Nd: YAG laser mode for the treatment of melasma lesions in Venezuelan female patients

Authors

Zulay Rivera Unidad Medico Estética Láser (UNIMEL), Caracas Venezuela - Escuela JM Vargas, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela https://orcid.org/0000-0002-1278-6691
Víctor Ollarves Ruiz Unidad Medico Estética Láser (UNIMEL), Caracas Venezuela https://orcid.org/0000-0002-6245-0854
Ingrid Rivera Pineda Unidad Medico Estética Láser (UNIMEL), Caracas Venezuela, Escuela JM Vargas, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela,
Dennis Alexander Lugo Unidad Medico Estética Láser (UNIMEL), Caracas Venezuela, Escuela JM Vargas, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela https://orcid.org/0000-0002-1797-7489
Isabel Hagel López Unidad Medico Estética Láser (UNIMEL), Caracas Venezuela, Instituto de Biomedicina “Dr. Jacinto Convit”, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela https://orcid.org/0000-0003-4464-1830

Keywords:

melasma, Pulsed dye laser (PDL), Q-switched Nd:YAG laser, vascular component, laser toning, long-term efficacy

Abstract

Background: Melasma is a chronic hyperpigmentation disorder often presenting with a vascular component. Conventional therapies show variable efficacy and limited durability of results, highlighting the need for optimized treatment strategies.

Objective: To evaluate the effectiveness of combined laser toning (Q-switched 1064 Nd:YAG) and pulsed dye laser (PDL, Candela Vbeam) for the treatment of vascularized melasma lesions.

Methods: A total of 120 female patients aged 34–56 years with vascularized melasma underwent treatment and follow-up at baseline, 3-, 6-, and 12-months using VISIA Complexion Analysis. Standardized images (frontal, right, and left lateral) were obtained to assess percentile scores for brown spots (melasma) and red spots (telangiectatic erythema within melasma). Patients received eight weekly sessions of laser toning. Subgroups included: 26 patients treated with laser toning alone, 54 patients with PDL prior to laser toning, and 40 patients with PDL after laser toning.

Results: Median VISIA percentiles for both brown and red spots significantly increased after treatment (p < 0.005), reflecting a reduction of vascularized melasma lesions. Improvement was most pronounced in patients receiving PDL before laser toning (p < 0.0001). The therapeutic effect of PDL followed by toning persisted for 12 months, whereas patients treated with laser toning alone showed diminished effects by 6 months (p < 0.05).

Conclusions: The combination of PDL followed by Q-switched 1064 Nd:YAG laser toning is a safe and effective treatment for melasma with a vascular component, providing longer-lasting results compared to laser toning alone.

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