Background Melasma is a common pigmentary skin disorder. Q-switched Nd:YAG laser therapy is commonly used, but its efficacy is limited. PhotoAcoustic Technology Pulse (PTP) mode is a newer technology that may enhance treatment outcomes.Objectives To explore the comparative efficacy and safety of the Q-switched Nd:YAG laser with PTP mode versus the traditional single-pulse mode in the treatment of melasma.Methods A retrospective study was conducted on 129 patients with chloasma in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from November 2016 to December 2018. The control group received the treatment with traditional mode. The study group was treated using PTP mode. The efficacy was evaluated using the Melasma Area and Severity Index (MASI) scores and patient satisfaction assessments.Results The effective rate was 47.69% in the control group and 59.38% in the study group. There was a statistically significant improvement in MASI scores in both groups compared to baseline (p