Abstract

Objectives: To assess the safety and efficacy of a combined 755-nm picosecond laser and microneedling-assisted transdermal delivery of tranexamic acid, niacinamide (NANA), GABA, and exosomes for melasma in Asian women, with outcomes including MASI score reduction, melanin index, skin quality parameters, and treatment tolerability. Introduction: Melasma is a chronic relapsing acquired hypermelanosis prevalent in Asian women, driven by melanocyte hyperactivity, oxidative stress, inflammation, vascular dysregulation, and dermal matrix changes, contributing to treatment resistance and recurrence. Multimodal strategies targeting these pathways may improve outcomes. This study evaluates combined 755-nm picosecond laser and microneedling-assisted delivery of tranexamic acid, niacinamide (NANA), GABA, and exosomes, assessing efficacy, pigment indices, skin quality, and safety. Materials / method: Patients received three monthly sessions combining low-fluence 755-nm picosecond laser with microneedling-assisted delivery of depigmenting and regenerative agents. Outcomes were evaluated using mexameter-derived melanin index, MASI scores, Visia skin analysis, photography, and patient-reported satisfaction. Assessments were performed at baseline, before each session, and one month after the final treatment session. Data collection was longitudinal to track progressive changes and post-treatment durability of response in a controlled clinical setting, prospective design. Results: All patients completed the protocol with progressive improvement. Mean melanin index decreased from 310 to 210 (32% reduction), while MASI scores dropped from 9.2 to 4.2 (54% improvement). Photographs demonstrated visible lightening of hyperpigmented patches and more uniform skin tone. Patient satisfaction was high, with 90% reporting moderate to significant improvement. Treatments were well tolerated; transient erythema and mild edema were the only side effects. No post-inflammatory hyperpigmentation or scarring occurred. Conclusion: : Combining 755-nm picosecond laser with microneedling-assisted delivery of tranexamic acid, niacinamide, GABA, and exosomes is a safe and effective multimodal approach for melasma in Asian women. This strategy simultaneously addresses pigment removal, melanogenesis inhibition, inflammation, and dermal regeneration, offering superior outcomes compared with monotherapy. Larger studies are warranted to confirm durability and long-term prevention of recurrence.