Purpose: Melasma is a facial pigmentary disorder that commonly causes psychosocial distress. Quality of life (QoL) is not routinely assessed in daily practice; therefore, its improvement in relation with the reduction of melasma severity remains unclear, especially among people of color. This study aimed to determine whether clinical improvement after triple combination cream (fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%) correlated with improved QoL. Patients and Methods: Participants with melasma were enrolled in a one-group pretest–posttest study and treated with triple combination cream for 12 weeks. The Melasma Quality of Life Scale (MELASQoL-INA, a validated questionnaire adapted into the Indonesian language) and the modified Melasma Area and Severity Index (mMASI) assessments were carried out at baseline visit and at weeks 4, 8, and 12 to evaluate QoL and clinical severity. Results: Thirty female participants aged 30–60 years, with Fitzpatrick skin type IV or V and without other facial skin conditions, completed the study. The most negatively affected QoL domains were emotional well-being (appearance concerns, embarrassment, and frustration) and social life (desire to interact with other people). Significant improvements were observed in both mMASI (median reduction from 4.45 to 1.80; p < 0.001) and MELASQoL-INA scores (median reduction from 37 to 17; p < 0.001) after 12 weeks of treatment. Although no correlation was observed between mMASI and MELASQoL-INA scores at week 12 (r = 0.029, p = 0.879), a weak positive correlation was found between their respective changes after treatment (r = 0.397, p = 0.03). Conclusion: Clinical improvement in melasma severity following triple combination therapy is modestly associated with improved QoL. However, QoL impairment does not always correspond linearly with disease severity, highlighting the importance of integrating subjective QoL outcomes alongside clinical evaluations in the management of melasma. © 2026 Darmawan et al.