Jason Emer, MD, FAAD, FACS
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.
Dr. Jason Emer MD · FAAD · FACS
The practice's own photographs
Patients of the practice, from Dr. Emer's published before and after gallery. Each case is one patient. Individual results vary.
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
What Dr. Emer did · RE:SKN
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
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
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
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.”
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.”
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.”
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
Follow Dr. Emer’s approach through the stages described in this case.
Back to the video ↗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
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
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.
“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
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
“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
Deep laser treatment for skin that needs to be rebuilt / Patient story
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.
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.
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.
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.
How the treatment is built
Planned around the depth needed to remodel scar tissue and thickened skin, not just refresh the surface.
Injectable nerve blocks and topical anesthetic are applied before the laser begins to reduce discomfort during the deepest passes.
The ProFractional erbium laser creates visible holes in the skin at high density, reaching tissue below the surface where scars and texture damage sit.
Topical numbing is applied into the channels created by the laser, making the rest of the session more tolerable.
The visible holes close as new collagen forms, and the texture continues improving for months as the skin rebuilds.
The treatment, explained
Also called fractional erbium resurfacing, high density laser resurfacing, deep laser remodeling, erbium laser for acne scars, ablative fractional laser, laser skin remodeling.
Signature procedures
Peptides / biologic optimization
Peptide and biologic protocols for recovery, body composition and longevity, with epigenetic testing. RECODEX™ peptides are available to purchase through the practice after consultation.
Why Dr. Emer
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.
Deep pitted scars and texture irregularities that sit below the surface and have not improved with lighter treatments.
Skin with enlarged pores, rough texture, or thickening from sun damage or aging.
Lines and folds that require collagen remodeling below the surface to smooth.
Texture changes, pigment irregularities, and skin quality degradation from chronic sun exposure.
Asked plainly, answered plainly
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.
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.
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.
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.
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.
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.
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.
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.
A consultation with Dr. Emer covers your skin condition, your goals, and whether deep laser remodeling fits your plan.
Schedule ConsultationWest Hollywood and New York City