Low fluence ruby laser safely clears stubborn mixed melasma

A retrospective study published on July 20, 2026, shows that a low-fluence fractional 694-nm Q-switched ruby laser combined with AI imaging safely treats stubborn, mixed-type melasma in Fitzpatrick skin types III through V, offering clinicians a reliable protocol for difficult, darker skin cases without triggering post-inflammatory hyperpigmentation.

The study tracked 16 Asian women with a mean age of 49, treated between May 2022 and May 2023, who had persistent melasma for over 10 years. Patients underwent four to five sessions at three- to eight-week intervals using fluences of 0.77 to 0.9 J/cm². By reducing the number of passes, the protocol lowered the cumulative thermal burden. An AI-assisted imaging system served as a digital biopsy, detecting subclinical pigment shifts. Over a six-month follow-up, the darkest Type V pigmentation on the right face decreased significantly, shifting toward lighter Type III/IV superficial patterns, with zero cases of rebound or hypopigmentation.

For your practice, this low-fluence approach paired with advanced imaging suggests you can confidently address long-term melasma in skin of color, using objective texture analysis to prove subtle early improvements to patients before visual clearance is obvious.

Source: Dermatology Times, https://www.dermatologytimes.com/view/ai-assisted-imaging-tracks-success-of-low-fluence-qsrl-laser-for-melasma