Objective: To explore the therapeutic effect of Q-switched 1064nm Nd: YAG laser combined with fruit acid in melasma. Methods: 160 patients with melasma were admitted from February to September 2024 in this study, and the participants will be grouped according to different treatment plans, each of 80. Patients received only fruit acid as a control group; and patients received Q-switched 1064nm Nd: YAG laser combined with fruit acid as a research group, the therapeutic effects between the two groups were compared. Results: the total effective rate of treatment in the research group was higher than the control group(P<0.05); After treatment, the scores of skin lesion related indicators in both groups of patients decreased significantly compared to before treatment, and the advantage of reduction in the research group was more prominent than the control group(P<0.05); After treatment, the scores of MELA-SQOL in both groups of patients decreased significantly compared to before treatment; and the advantage of reduction in the research group was more prominent than the control group(P<0.05); There was no difference in the incidence of adverse reactions between the two groups (P>0.05), and they resolved spontaneously after treatment, the treatment satisfaction in the research group was higher than the control group(P<0.05). Conclusion: Q-switched 1064nm Nd: YAG laser combined with fruit acid can effectively improve pigmentation, improve therapeutic effect, and patients treatment satisfaction, with higher safety and positive significance for improving the quality of life of patients.