Post ATF Laser for Melasma

[medgrl31]

I had ATF, I think it was called, on my face 3 days ago for melasma above bilateral eyebrow, upperlip, bridge of nose, chin, and various patches on cheeks.  He told me that following the procedure the spots would get darker before "sloughing" off.  Boy did they!  I just thought they were emberassing before having the laser done!  I paid for three sessions and he said it should be 4 weeks inbetween each session.  Then I read that melasma should be examined under a Wood lamp to see if it is dermal or epidermal and that this type of laser could actually make one of these types worse.  He did not examine my skin under a Woods lamp.  Also I did use Tri-Lumina with poor results.  

1.  How long before these spots will slough off?  What has been your expierence in that?
2.  How many treatments with this laser does it take on average and how long should you wait inbetween each session?
3.  What is the best treatment to get rid of it from the face in your opinion?
4.  Can this be related to an auto-immune/connective tissue disease?
5.  Should my face have been examined under a Wood lamp prior to doing the procedure?

Thank you in advance for your answers!

[Howard Rosenberg, MD]

This problem is more a dermatologic issue than a plastic surgery problem. I have had some success with treatment with Obaji skin care products (retina A and hydroquinone) followed by TCA peel.  I am unfamiliar with the laser treatment you mentioned.