Jason Emer, MD, FAAD, FACS

Why Erbium Laser Bleeds During Treatment Deep Remodeling For Acne Scars And Porous Skin

Why Erbium Laser Bleeds During Treatment: Deep Remodeling For Acne Scars And Porous Skin

How Dr. Jason Emer uses the ProFractional erbium laser at high density and depth to remodel acne scars and thickened skin, and why the treatment creates visible holes that heal into smoother texture.

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Dr. Emer's patient from this film, after treatment. Background darkened for the page; the body is not retouched. Individual results vary.

THE DETAIL IS THE DIFFERENCE.See the results ↓

Dr. Jason Emer MD · FAAD · FACS

MD, FAAD, FACS: board-certified dermatologist and cosmetic surgeon
Former Chief Resident in dermatology, Mount Sinai, New York
More than 10,000 patient encounters
Male facial sculpting longer than anyone in the United States
The highest filler volume on the West Coast
West Hollywood and New York

The practice's own photographs

Before. After.

Patients of the practice, from Dr. Emer's published before and after gallery. Each case is one patient. Individual results vary.

Before and after, Acne Scars Treatment, patient 253621 — Acne Scars TreatmentPatient 253621

Before and after, Acne Scars Treatment, patient 240717 — Acne Scars TreatmentPatient 240717

Before and after, Acne Scars Treatment, patient 240718 — Acne Scars TreatmentPatient 240718

Before and after, Acne Scars Treatment, patient 240719 — Acne Scars TreatmentPatient 240719

Before and after, Acne Scars Treatment, patient 240720 — Acne Scars TreatmentPatient 240720

Before and after, Acne Scars Treatment, patient 240721 — Acne Scars TreatmentPatient 240721

See the full before and after gallery

ProFractional erbium laser at high density creates visible bleeding channels that reach below the surface to remodel porous skin, deep acne scars and texture damage that lighter treatments cannot touch.

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From the filmed session

Inside the treatment. With Dr. Emer.

ERBIUM LASER BLEEDS BECAUSE ITS SO DEEP AND REMODELS COLLAGEN WITHIN ACNE SCARS | Dr. Jason Emer

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What Dr. Emer did · RE:SKN

Every procedure. In order.

01

Nerve blocks and topical anesthetic

Injectable nerve blocks placed before the laser session to reduce discomfort during the deepest passes, followed by topical numbing applied to the treatment area.

“we have nerve blocks in there to reduce it”
Dr. Emer, in the film
02

ProFractional erbium laser at high density RE:SKN

High density laser passes creating visible holes in the skin that reach tissue below the surface, deep enough to cause bleeding as the laser remodels thickened, porous skin and deeper scars.

“you can literally see the holes in her skin. But this is really going to remodel, especially since she has more of that like uh porous skin. This is going to really remodel the skin a lot for her. Um at a high density and going deep. That's why there's a little bit of bleeding.”
Dr. Emer, in the film
03

Additional topical numbing into open channels

Topical anesthetic applied directly into the laser-created channels after the initial passes, allowing the numbing medicine to penetrate the open tissue and make the remainder of the session more tolerable.

“look at these holes and how deep they are and the numbing medicine will go in there and help her get a lot more numb”
Dr. Emer, in the film

Why patients fly in

What Dr. Emer does differently.

Depth that causes visible bleeding

Dr. Emer uses the ProFractional erbium laser at a depth that creates visible holes and bleeding during the session, a sign the treatment is reaching tissue below the surface where scars and texture damage sit, not just refreshing the top layer.

“The reason it hurts is it's going really deep. You see, like you can literally see the holes in her skin.”

High density passes for maximum remodeling

The laser is set to high density, creating more channels per treatment area than standard protocols, which means more collagen remodeling and greater texture improvement over the following months.

“This is going to really remodel the skin a lot for her. Um at a high density and going deep.”

Layered numbing strategy for deep work

Nerve blocks are placed before the session, then additional topical numbing is applied into the open channels created by the laser, allowing the anesthetic to reach deeper tissue and make the rest of the treatment more tolerable.

“The reason it works really well to do that is look at these holes and how deep they are and the numbing medicine will go in there and help her get a lot more numb.”

Treatment for thicker, porous skin that resists lighter approaches

This protocol is reserved for patients with thickened, porous skin or deeper surface scars that have not responded to gentler resurfacing, conditions that require remodeling from below the surface.

“when you have these more thicker, porous skin or these deeper scars on the surface, we really need to do a strong laser. So, this is definitely not anything weak.”

THE THINKING BEHIND THE TREATMENT

The story.
The decisions.
The details.

Follow Dr. Emer’s approach through the stages described in this case.

Back to the video ↗

01Before
The starting point
The kind of texture that does not improve with gentler treatments.
She arrived with porous skin and deeper surface scarring, the kind that sits below the top layer and does not respond to light resurfacing. Dr. Emer used the ProFractional erbium laser at high density, creating visible holes in the skin that bled during the session because the laser was reaching tissue below the surface.
“This is proactal. The reason it hurts is it's going really deep. You see, like you can literally see the holes in her skin. But this is really going to remodel, especially since she has more of that like uh porous skin.”DR. JASON EMER · FROM THE VIDEO
02The plan
What Dr. Emer decided to do
Planned around the depth needed to remodel scar tissue and thickened skin, not just refresh the surface.
“So for those of you who don't know this type of this actually specifically really take slow deep breaths.”DR. JASON EMER · FROM THE VIDEO
03The session
In the room, in order
Nerve blocks and topical numbing were applied before the laser began, and additional numbing was layered into the open channels created by the laser so the rest of the session was more tolerable. The depth is what makes the treatment work: the holes are channels where collagen will rebuild over the following weeks, smoothing the texture from the inside out.
- Nerve blocks and topical numbing
- High density laser passes
- Additional numbing into open channels
- Healing and collagen remodeling
“You guys see? Look, when you have these more thicker, porous skin or these deeper scars on the surface, we really need to do a strong laser. So, this is definitely not anything weak.”DR. JASON EMER · FROM THE VIDEO
04The result
What changed
The skin will be raw and open immediately after the session, and healing takes days to weeks depending on the density and depth used. The visible holes close as new collagen forms, and the texture continues improving for months.
Results are individual and depend on the severity of scarring, skin type, and how the tissue responds to remodeling. A consultation covers what is realistic for your skin and whether this level of treatment is necessary.
“You guys see? Look. You can see how much the laser is going to improve because you can see all the little holes. These are going to remodel her skin very deep.”DR. JASON EMER · FROM THE VIDEO
05What comes next
Recovery and what to expect
“The reason it works really well to do that is look at these holes and how deep they are and the numbing medicine will go in there and help her get a lot more numb.”DR. JASON EMER · FROM THE VIDEO

Read the complete story +

The patient story

Why this laser goes deeper than most

The patient in this video has porous skin and deeper surface scarring, the kind that does not respond to gentler treatments. Dr. Emer is using the ProFractional erbium laser at high density, which creates visible holes in the skin and sometimes causes bleeding during the session.

That depth is the point. The laser is remodeling tissue below the surface, not just resurfacing the top layer. The holes you see in the video are channels where collagen will rebuild over the following weeks, smoothing the texture from the inside out.

What happens during the session

Nerve blocks and topical numbing are applied before the laser begins, but the depth of the treatment means some discomfort is common. Dr. Emer works through the most sensitive areas first, then applies additional numbing into the open channels created by the laser so the rest of the session is more tolerable.

The bleeding and visible holes are signs the laser is reaching the depth needed to remodel scar tissue. This is not a surface treatment, and it is not designed to be comfortable. It is designed to work.

Who this treatment fits

ProFractional erbium at this depth is for patients with acne scars, thickened or porous skin, deep wrinkles, or sun damage that has not improved with lighter approaches. It can be used on most skin tones, but candidacy depends on the condition being treated and how much remodeling is needed.

This is not a first step. It is a tool for cases where the skin needs to be rebuilt, not just refreshed.

What to expect after

The skin will be raw and open immediately after the session, and healing takes days to weeks depending on the density and depth used. The visible holes close as new collagen forms, and the texture continues improving for months.

Results are individual and depend on the severity of scarring, skin type, and how the tissue responds to remodeling. A consultation covers what is realistic for your skin and whether this level of treatment is necessary.

The treatment, explained

What is ProFractional erbium laser?

Also called fractional erbium resurfacing, high density laser resurfacing, deep laser remodeling, erbium laser for acne scars, ablative fractional laser, laser skin remodeling.

What it is: ProFractional erbium laser resurfacing is a fractional ablative laser treatment that creates thousands of microscopic channels in the skin, removing columns of tissue and triggering collagen remodeling in the deeper layers. At high density settings, the laser reaches below the surface to treat acne scars, porous skin, deep wrinkles and sun damage that lighter resurfacing cannot improve. The visible holes and bleeding during the session indicate the laser is working at the depth needed to rebuild texture from the inside out.
How it works: The ProFractional erbium laser delivers focused energy in a fractional pattern, vaporizing columns of skin tissue while leaving surrounding areas intact to speed healing. The depth and density are adjusted based on the condition being treated: deeper passes for acne scars and thickened skin, lighter passes for surface texture and pigment. Nerve blocks and topical anesthetic are applied before the session, and additional numbing is layered into the open channels created by the laser to reduce discomfort. The channels close over days to weeks as new collagen forms, and the texture continues improving for months as the skin remodels.
Who it is for: Candidates include patients with acne scars that have not responded to other treatments, porous or thickened skin from sun damage or aging, deep wrinkles that require collagen remodeling, and texture irregularities that sit below the surface. The treatment can be used on most skin tones, though candidacy depends on the condition being treated and how the skin responds to remodeling. A consultation with Dr. Emer determines whether high density erbium laser is appropriate for your skin and goals.
Recovery: The skin will be raw and open immediately after the session, with visible holes and bleeding that resolve as the channels close. Healing takes days to weeks depending on the depth and density used, with redness, swelling and peeling common during the first week. The texture continues improving for months as collagen rebuilds. Recovery protocols, downtime expectations and post-treatment care are reviewed during consultation.
When results show: The visible holes created by the laser close as new collagen forms, smoothing the texture from the inside out. Initial improvement is visible once the skin heals, and the texture continues refining for three to six months as collagen remodeling progresses. Results depend on the depth and density of the treatment, the condition being treated, and the skin's ability to rebuild. Some patients require multiple sessions spaced months apart for optimal improvement.

Signature procedures

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Peptides / biologic optimization

RECODEX^™

Peptide and biologic protocols for recovery, body composition and longevity, with epigenetic testing. RECODEX^™ peptides are available to purchase through the practice after consultation.

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From Dr. Emer's Instagram

The work, as he shows it.

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Why Dr. Emer

Laser work is a craft. He set the standard.

Two decades of results, a global patient base, and techniques other dermatologists travel to learn.

Dr. Emer built his reputation on outcomes that read as natural and last. He pioneered laser and scar revision approaches that are now taught internationally, and he personally performs every procedure in his practice.

Patients come to him when the skin needs to be rebuilt: acne scars that have not responded to other treatments, texture damage from sun or aging, and cases where lighter resurfacing has failed.

MD, FAAD, FACS: board-certified dermatologist and cosmetic surgeon
Former Chief Resident in dermatology, Mount Sinai, New York
More than 10,000 patient encounters
Male facial sculpting longer than anyone in the United States
The highest filler volume on the West Coast
West Hollywood and New York

About Dr. Emer Schedule Consultation

EMER METHOD^™×RECODEX^™

Acne scars

Deep pitted scars and texture irregularities that sit below the surface and have not improved with lighter treatments.

Porous or thickened skin

Skin with enlarged pores, rough texture, or thickening from sun damage or aging.

Deep wrinkles

Lines and folds that require collagen remodeling below the surface to smooth.

Sun damage

Texture changes, pigment irregularities, and skin quality degradation from chronic sun exposure.

Asked plainly, answered plainly

What patients ask before they book.

Why does the laser bleed during the session?+

The laser is going deep enough to reach tissue below the surface where scars and texture damage sit. The bleeding is a sign the treatment is working at the depth needed to remodel, not just refresh the top layer. The visible holes and bleeding resolve as the channels close and new collagen forms.

Does the treatment hurt?+

Nerve blocks and topical numbing are used, but the depth of the treatment means some discomfort is common. Dr. Emer applies additional numbing into the open channels created by the laser so the rest of the session is more tolerable. The goal is to get through the deepest passes as quickly as possible while keeping the patient comfortable.

What is the downtime after high density erbium laser?+

The skin will be raw and open immediately after the session, and healing takes days to weeks depending on the density and depth used. Redness, swelling and peeling are common during the first week. The texture continues improving for months as collagen rebuilds. Downtime and recovery protocols are reviewed during consultation.

Can this laser be used on all skin tones?+

The ProFractional erbium laser can be used on most skin tones, but candidacy depends on the condition being treated and how the skin responds to remodeling. A consultation with Dr. Emer covers what is safe and realistic for your skin type and goals.

What conditions does high density erbium laser treat?+

This protocol is for skin that needs to be rebuilt, not just refreshed: deep acne scars that have not responded to other treatments, porous or thickened skin from sun damage or aging, deep wrinkles that require collagen remodeling, and texture irregularities that sit below the surface. It is not a light resurfacing treatment.

How many sessions are needed?+

Some patients see significant improvement after one session, while others require multiple treatments spaced months apart for optimal results. The number of sessions depends on the depth and severity of the scarring or texture damage, the skin's ability to remodel, and the goals discussed during consultation.

What is the difference between this and lighter laser treatments?+

High density ProFractional erbium laser goes deeper and creates more channels per treatment area than standard resurfacing protocols, which means more collagen remodeling and greater texture improvement. The visible bleeding and longer downtime are trade-offs for results that lighter treatments cannot achieve. Dr. Emer reserves this protocol for patients whose skin needs to be rebuilt from below the surface.

When will I see results?+

Initial improvement is visible once the skin heals, typically within weeks. The texture continues refining for three to six months as collagen remodeling progresses. Results depend on the depth and density of the treatment, the condition being treated, and the skin's ability to rebuild.

Discuss your plan

A consultation reviews your anatomy, goals and history, and maps which options apply to you.

Schedule Consultation

West Hollywood and New York City