Objective To explore the efficacy of picosecond laser combined with Sibai Quban ointment in the treatment of melasma of qi stagnation and blood stasis type. Methods A total of 160 patients with melasma of qi stagnation and blood stasis type admitted to Nanjing Medical University Friendship Plastic Surgery Hospital from January 2019 to December 2022 were selected as the research subjects. According to the random number table method, they were divided into group A and group B, with 80 patients in each group. Group A was treated with picosecond laser, and group B was treated with picosecond laser combined with Sibai Quban ointment. The melasma severity, clinical efficacy, aesthetic effect and satisfaction were compared between the two groups. Results After treatment, the MASI score of group B was lower than that of group A (P<0.05). The total effective rate in the group B (91.25%) was higher than that in group A (78.75%) (P <0.05). After treatment, the MI, EI and melasma area of group B were lower than those of group A, while the satisfaction rate was higher than that of group A (P <0.05). Conclusion Picosecond laser combined with Sibai Quban ointment has a definite efficacy in the treatment of melasma of qi stagnation and blood stasis type. It helps to improve clinical symptoms, reduce the disease severity, and achieve high patient satisfaction.