Objective To analyze the clinical efficacy of picosecond laser combined with facial acupuncture therapy in the treatment of melasma and its influence on patient satisfaction. Methods A total of 80 patients with melasma admitted to the Department of Aesthetic Traditional Chinese Medicine of our hospital from January 2021 to October 2023 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 40 patients in each group. The control group was treated with picosecond laser, and the observation group was treated with picosecond laser combined with facial acupuncture therapy. The MASI score, clinical efficacy and satisfaction were compared between the two groups. Results The MASI scores of the observation group at 6 months and 1 year after treatment were lower than those of the control group, and the differences were statistically significant (P <0.05). The total effective rate of treatment in the observation group (97.50%) was higher than that in the control group (72.50%), and the difference was statistically significant (P <0.05). The satisfaction rate of the observation group (97.50%) was higher than that of the control group (75.00%), and the difference was statistically significant (P <0.05). Conclusion For patients with melasma, the treatment of picosecond laser combined with facial acupuncture therapy can further enhance the therapeutic effect, improve clinical symptoms, and increase satisfaction, which is worthy of clinical application.