Objective To explore the effect of ultra-picosecond laser combined with intense pulsed light (IPL) on skin lesion severity in patients with melasma. Methods A total of 210 patients with melasma admitted to Baotou Wushu Huamei Medical Aesthetics Hospital from August 2024 to August 2025 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 105 patients in each group. The control group was treated with IPL, and the observation group was treated with ultra-picosecond laser combined with IPL. The treatment effect, skin lesion severity, inffammatory factor indicators and adverse reaction rate were compared between the two groups. Results The total effective rate of the observation group (98.10%) was higher than that of the control group (90.48%) (P<0.05). The scores of skin lesion area and color in the observation group after treatment were lower than those in the control group (P<0.05). The levels of all inffammatory factor indicators in the observation group after treatment were lower than those in the control group (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion For melasma, the combination of ultra-picosecond laser and IPL therapy is effective, which can effectively repair skin lesions, reduce inffammatory response, and does not increase the risk of adverse reactions.