Med Laser  
Treatment of melasma using a combination of CO2 laser and Q-switched ruby laser
Jeong Do Park, Se Young Kim, Hyun Gyo Jeong, Syeo Young Wee
Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea
Correspondence to: Syeo Young Wee
Received: May 11, 2022; Accepted: June 28, 2022; Published online: August 3, 2022.
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Background and Objectives
The CO2 laser is a tissue-selective laser that removes superficial lesions by vaporization and ablation. The Q-switched ruby laser (QSRL) is a pigment-selective laser that induces the disruption of melanosomes. This study aimed to evaluate the effects of a combination treatment of the CO2 laser and QSRL on melasma.
Materials and Methods
Fifteen patients with melasma were initially treated with a CO2 laser, followed by multiple QSRL toning. Photographs were taken on the first visit, on completion of the prescribed regimen, and 6 months after the treatment. The melasma area and severity index (MASI) and melasma severity scale (MSS) were evaluated through clinical photographs. Patients subjectively evaluated their improvement on a 5-point scale.
There was a significant change in both mean MASI and MSS scores after the combination treatment with the CO2 laser and QSRL. The MASI score decreased from 5.82 ± 2.6393 to 2.607 ± 1.6973 (p = 0.001). The MSS score significantly decreased from 2.67 ± 0.488 to 1.20 ± 0.561 (p < 0.001). There were no statistically significant differences in the MASI (p = 0.891) and MSS scores (p = 0.046) between post-procedure and 6-month follow-up.
The combination of a CO2 laser and QSRL appears to be effective in the treatment of melasma.
Keywords: Melasma; Lasers

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