Objective: A Comparison of the Efficacy of Selective Photothermal Therapy and Dual-Mode 1064 nm Nd:YAG Laser Therapy (Combining Selective Photothermal and Photoacoustic Effects) for the Treatment of Melasma Methods: We selected 86 patients with melasma treated at our hospital between February 2024 and February 2026. Using a random number table, the patients were divided into an observation group (treated with dual-mode laser therapy) and a control group (treated with selective photothermal laser therapy alone), with 43 patients in each group; a 1064 nm Nd:YAG laser was used in both groups. We compared the overall treatment efficacy rate, TEWL values, VISIA absolute scores, and melasma area severity index between the two groups. Results: Compared with the control group, the observation group showed a higher overall response rate, as well as decreases in MASI scores, TEWL values, VISIA absolute scores, EI values, MI values, and recurrence rates (P<0.05).Conclusion: The dual-mode 1064 nm Nd:YAG laser, which combines selective photothermal and photoacoustic effects, demonstrates significant therapeutic efficacy and a low recurrence rate. It can improve skin pigmentation and erythema while promoting the restoration of skin barrier function.