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Escalation to Combined Therapy (Mesotherapy + Picosecond Laser) In cases of: Mixed or dermal melasma Recurrent melasma after previous treatments Large pigment area, thick patches or resistant to topicals/peels We integrate: Picosecond laser (e.g., 1,064 nm or 755 nm) one session every 46 weeks (typically 35 sessions) Mesotherapy sessions interspaced between laser sessions or post-laser for healing support