Hi,
For melasma, the mainstay of treatment remains avoiding known aggravating factors and topical lightening creams. Treating the underlying blood vessels which may contribute to improvement in the melasma is considered adjunctive and not primary therapy.
There are no direct unbiased comparison between Sylfirm (microneedling RF) and Excel V (short wavelength laser) in the treatment of melasma but they are likely to be non-inferior based on their effects on blood vessels.
For other laser-responsive superficial pigmentation e.g. solar lentigines, Excel V is likely to be superior as it is able to target the pigmentation specifically to clear them, although other pigment lasers are also available and effective.
Hope this helps!
