Italians Errani and Vinci are the first women's doubles team to win back-to-back Australian titles since Serena and Venus Williams in 2010.
Four-time Grand Slam-winners Errani and Vinci dominated early before French Open champions Makarova and Vesnina, seeded third, applied pressure in the second set.
Errani and Vinci renewed their focus, and tightened their serve, recovering a break before surging ahead late in the third set to confidently close out the match.
With the win, Errani and Vinci lead the WTA Road to Singapore doubles standings and retain their No. 1 ranking.