Objective To explore the effect of facial dermal rolling needle combined with tranexamic acid treatment on melasma severity and quality of life in patients with melasma. Methods A total of 80 patients with melasma admitted to Liuzhou Meijia Medical Cosmetology Clinic from December 2022 to December 2023 were selected as the research subjects. According to the random number table method, they were divided into the control group and the study group, with 40 patients in each group. The control group was treated with tranexamic acid, and the study group was treated with facial dermal rolling needle combined with tranexamic acid. The clinical efficacy, melasma severity, quality of life and treatment satisfaction were compared between the two groups. Results The total effective rate of clinical treatment in the study group (97.50%) was higher than that in the control group (82.50%) (P <0.05). After treatment, the Melasma Area and Severity Index (MASI) score and Dermatology Life Quality Index (DLQI) score in the study group were lower than those in the control group (P <0.05). The treatment satisfaction in the study group (97.50%) was higher than that in the control group (82.50%) (P <0.05). Conclusion The application of facial dermal rolling needle combined with tranexamic acid injection introduction therapy for patients with melasma has an ideal effect. It can reduce the melasma severity, improve the quality of life and treatment satisfaction of patients, and is recommended for clinical application.