Background: Low-fluence 1,064 nm Q-switched Nd:YAG laser therapy has been widely used for the treatment of melasma. Objectives: Although new Q-switched Nd:YAG lasers which are capable of performing in the photoacoustic twin pulse(PTP) mode have been recently developed for high-efficiency laser toning, little information exists about the efficacy and safety of PTP mode laser toning. Methods: Twenty-two Korean women were treated with a total of five times low-fluence PTP mode Nd:Yag laser treatments (Pastelle®, Won Technology Co., Ltd., Daejeon, South Korea) at 2 week intervals. Responses to treatments including the Melasma Area and Severity Index (MASI) scoring, colorimeter measurement, and the investigator`s and patient`s overall assessments were evaluated at the last follow-up visit. Adverse events were also recorded at each visit. Results: Investigator`s and patient`s overall assessment showed that ‘significantly improved’ was indicated by thirteen (59.09%) and nineteen of 22 patients (86.36%), respectively. MASI scores were significantly reduced by 20%. The lightness, measured by using a colorimeter, was significantly increased by 1.3 point. Notable adverse events were not observed. Conclusion: After 5 sessions of laser therapy alone, about 60% of the subjects showed significant improvement. Repeated laser toning treatment using the PTP mode is a safe and effective way to treat facial melasma.