Objective To study the effect of treatment with intense pulsed light+Q-switched laser on the MASI score and facial aesthetics of patients with melasma. Methods A total of 50 patients with melasma admitted to our hospital from February 2022 to January 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 25 patients in each group. The control group was treated with intense pulsed light, and the observation group was treated with intense pulsed light+Q-switched laser. The severity of melasma (MASI score), facial aesthetics, skin barrier function and adverse reactions were compared between the two groups. Results After treatment, the MASI score of the observation group was (10.14±3.01)scores, which was lower than (13.64±4.04)scores of the control group, and the difference was statistically significant (P <0.05). After treatment, the levels of the skin Melanin Index (MI) and Erythema Index (EI), and the score of skin color in the observation group were all lower than those in the control group, and the differences were statistically significant (P <0.05). There was no significant difference in the skin barrier function between the two groups after treatment (P >0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The application of treatment with intense pulsed light+Q-switched laser for patients with melasma can effectively reduce the severity of facial melasma and enhance the facial aesthetics while ensuring the treatment safety.