Can I get PicoSure for melasma if I'm on blood thinners (xarelto)?

Yes, you may have the PicoSure laser procedure if you're on blood thinners.  The laser procedure penetrates the skin without actually 'puncturing or cutting' the skin so there's no bleeding.
Melasma is a challenge to treat but treatable (not curable).  Make sure that in addition to the PicsSure, you're on a skin care regimen to address hyper pigmentation.  I'd also recommend continued chemical peels, and of course, sunscreen, sunscreen, sunscreen!
Good luck,
Dr. Huo

Taking blood thinners while receiving PicoSure will not have an effect on your treatment. There are no contraindications with these type of drugs and use of the PicoSure device. Melamsa can be difficult to treat, and the PicoSure with the Focus Optic has become a device I utilize extensively for the treatment of melasma, typically in combination with topical products and of course a good sunscreen. Make sure you are seeking treatment with a provider who is experienced in both the treatment of melasma and the PicoSure device. Using the correct parameters on the device is essential to getting a good result from this treatment, so make sure you are receiving these treatments from a trusted provider!