A meta-analysis evaluates the efficacy and safety of the combination of Q-switched laser (QS) with intense pulsed light (IPL) versus monotherapy in the treatment of melasma, a common skin disorder with hyperpigmented patches on the face. It included 31 studies with 2,801 patients. Combination therapy achieved a significantly greater reduction in MASI score (standardized mean difference: 1.20, 95% CI: -1.36 to -1.05; p < 0.001) and a higher pooled efficacy rate (92.0% vs. 77.4%; hazard ratio: 1.10, 95% CI: 1.03–1.17; p < 0.05). The recurrence rate was lower in the combination group (8.5% vs. 17.8%; hazard ratio: 0.54, 95% CI: 0.32–0.90; p < 0.05). Patient satisfaction did not differ significantly between groups. The incidence of adverse effects was comparable in both groups.