Objective To explore the effect of photorejuvenation combined with platelet-rich plasma (PRP) on skin pigmentation improvement in patients with melasma. Methods A total of 200 patients with melasma admitted to the Department of Medical Aesthetics, Suzhou BenQ Hospital from January 2024 to May 2025 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 100 patients in each group. The control group was treated with photorejuvenation, and the observation group was treated with PRP on the basis of the control group. The Melasma Area and Severity Index (MASI) score, skin texture improvement, skin pigmentation improvement and satisfaction were compared between the two groups. Results The MASI score of the observation group after treatment was lower than that of the control group (P<0.05). The improvement of skin texture in the observation group after treatment was better than that in the control group (P<0.05). The total effective rate of pigmentation improvement in the observation group (86.00%) was better than that in the control group (70.00%) (P<0.05). The satisfaction rate of the observation group (88.00%) was higher than that of the control group (74.00%) (P<0.05). Conclusion Combined therapy of PRP and photorejuvenation can effectively reduce MASI score, relieve skin pigmentation and optimize skin texture of melasma patients, so as to improve the overall cosmetic effect and patient satisfaction.