Retreatment using a dual mode of low-fluence Q-switched and long-pulse Nd: YAG laser in patients with melasma aggravation after previous therapy

Chun Pil Choi, Seon Mi Yim, Soo-Hong Seo, Hyo Hyun Ahn, Young Chul Kye, Jae Eun Choi

Research output: Contribution to journalArticle

3 Citations (Scopus)


Background: Aggravated melasma after treatment is vulnerable to stimulation, can easily deteriorate, and may be distressing without proper management. Objective: To retrospectively assess the effectiveness and safety of combination therapy using low-fluence Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (QSNY) and long-pulse Nd:YAG laser (LPNY) (dual toning) in patients with rebound melasma. Materials and methods: A total of 30 patients with aggravated melasma after previous therapy who were treated with dual toning were enrolled. A total of 10 sessions were conducted at 1-week intervals, followed by maintenance treatment. The results were evaluated using the modified Melasma Area and Severity Index (mMASI) and the physician's global assessment (PGA) before and 2 months after completing the 10 treatment sessions. Results: The baseline mMASI was 10.48 ± 3.64, which significantly decreased to 3.22 ± 1.45 2 months after completing the 10 treatment sessions (p < 0.001). Twenty-four patients (80%) had PGA grade 4 (76-100% improvement) and 6 patients (20%) had PGA grade 3 (51-75% improvement). Conclusion: Dual toning may be a safe and effective salvage treatment for patients with aggravated melasma after previous treatment. LPNY may stabilize melasma activity to prevent rebound hyperpigmentation via dermal remodeling.

Original languageEnglish
Pages (from-to)129-134
Number of pages6
JournalJournal of Cosmetic and Laser Therapy
Issue number3
Publication statusPublished - 2015 Jan 1



  • Adverse events
  • Long-pulsed Nd:YAG laser
  • Melasma
  • Q-switched Nd:YAG laser
  • Rebound hyperpigmentation

ASJC Scopus subject areas

  • Surgery
  • Dermatology

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