Stubborn pigmentation/melasma? (photo)

Hi there! I have stubborn pigmentation from prior sun damage/acne, melasma from pregnancy, and ruddiness/redness from rosacea. I have tried IPLs, clear and brilliant, VI peels at the dermatologist. I use retinol, hydroquinone/arbutin, vitamin C, and sunscreen religiously in my routine. What else would you recommend for someone like me? I'm willing to deal with some intense downtime if the results will actually be impactful. Thank you in advance!