Jason Emer, MD, FAAD, FACS
Fully Ablative Erbium Laser For Severe Acne Scars: What Removing The Top Layer Of Skin Actually Does
How Dr. Jason Emer uses tunable resurfacing laser (TRL) to treat severe rolling and boxcar acne scars by removing the top layer of skin and building new tissue in its place.
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.
Dr. Emer removed the entire top layer of skin with fully ablative erbium laser resurfacing to treat severe rolling and boxcar acne scars that did not respond to surface treatments.
Your plan starts with Dr. Emer.
Schedule ConsultationReserve online. West Hollywood and New York.
From the filmed session
What Dr. Emer did · RE:SKN
Tunable resurfacing laser adjusted for depth, strength and speed across each pass to remove the top layer of skin entirely, allowing new tissue to form in place of severe rolling and boxcar scars. Multiple passes at varying depths to even out scar topography and tighten loose skin.
“This is called TRL contour tunable resurfacing laser TRL. That means we can alter this in different ways for different strengths and different purposes.”
Dr. Emer, in the film
Micro droplet silicone placed prior to resurfacing session to build structural foundation beneath severe scars.
“We've already done our professional and our micro drop of silicone. So, now we're doing the resurfacing part.”
Dr. Emer, in the film
Prescription medications, aggressive post care regimen and preventative skin care during the week-long peel and healing phase.
“You have to be on medications for this. You have to be at home while you're peeling and you have to be on aggressive skin care.”
Dr. Emer, in the film
Biologic support applied during healing to guide correct new skin formation and optimize tissue regeneration.
“That's why stem cells and exoomes and peptides help this.”
Dr. Emer, in the film
Why patients fly in
Dr. Emer adjusts the laser depth, strength and speed with every pass to match the shape and severity of rolling versus boxcar scars, evening out topography rather than applying uniform settings across the face.
“You guys can see each pass has a different purpose, different depth, different speed. So, we even everything out because this type of scar is different shaping in different areas.”
He performs fully ablative resurfacing in patients with darker skin tones when prior treatment history shows tolerance and when the patient prioritizes maximum scar improvement over pigmentation risk, managing any discoloration that occurs.
“This is a little more risky as someone with a darker skin tone because of risk of hyper or hyper hypo pigmentation. However, to really get his improvement, he's not as worried about discoloration, which we can fix no matter what.”
This patient had prior resurfacing, micro droplet silicone and professional skin care before this session. Dr. Emer builds results over time rather than attempting maximum correction in one treatment.
“We should be able to see a really dramatic improvement this time since it's been building upon what we've done before.”
Every patient is on prescription medications during healing, follows aggressive skin care regimens, and stays home during the peel phase. The post care is as important as the laser settings.
“The key is to be very even with the application and going to somebody that really knows how to do this and the post care for it. That's the key.”
THE THINKING BEHIND THE TREATMENT
Follow Dr. Emer’s approach through the stages described in this case.
Back to the video ↗Rolling and boxcar scars that required the strongest resurfacing option available.
This patient has severe rolling and boxcar acne scars, the kind that do not respond to surface treatments. He has already received micro droplet silicone and professional skin care, and this resurfacing session builds on that foundation.
“So in this case, he has very severe rolling and box car scars.”DR. JASON EMER · FROM THE VIDEO
Fully ablative resurfacing is a commitment: prescription medications, a week at home, and aggressive post care.
“And by resurfacing, it's really the only way to get it to tighten and smoothen.”DR. JASON EMER · FROM THE VIDEO
Dr. Emer used fully ablative erbium laser resurfacing, adjusting the depth, strength and speed of each pass to match the shape and severity of the scar. The treatment removes the top layer of skin entirely, and new skin grows back smoother and tighter over the following week.
This patient has a darker skin tone, which carries higher risk of pigmentation changes with ablative resurfacing. He chose to proceed because he wanted the strongest possible improvement and was not as worried about discoloration, which can be treated if it occurs. He has had this treatment before and did well with only a little bit of hyperpigmentation that Dr. Emer was able to treat.
“You have to be on medications for this. You have to be at home while you're peeling and you have to be on aggressive skin care.”DR. JASON EMER · FROM THE VIDEO
Severe acne scars treated with fully ablative erbium laser / Patient story
Rolling and boxcar scars that required the strongest resurfacing option available.
This patient has severe rolling and boxcar acne scars, the kind that do not respond to surface treatments. He has already received micro droplet silicone and professional skin care, and this resurfacing session builds on that foundation.
Dr. Emer used fully ablative erbium laser resurfacing, adjusting the depth, strength and speed of each pass to match the shape and severity of the scar. The treatment removes the top layer of skin entirely, and new skin grows back smoother and tighter over the following week.
This patient has a darker skin tone, which carries higher risk of pigmentation changes with ablative resurfacing. He chose to proceed because he wanted the strongest possible improvement and was not as worried about discoloration, which can be treated if it occurs. He has had this treatment before and did well with only a little bit of hyperpigmentation that Dr. Emer was able to treat.
The patient in this video has severe rolling and boxcar acne scars, the kind that do not respond to surface treatments. Dr. Emer is using fully ablative erbium laser resurfacing, a treatment that removes the top layer of skin entirely so new skin can grow back smoother and tighter.
This is not the first treatment this patient has had. He has already received micro droplet silicone and professional skin care, and this resurfacing session builds on that foundation. The goal is dramatic improvement, and the approach carries more risk and more commitment than lighter resurfacing.
TRL stands for tunable resurfacing laser. The word tunable means Dr. Emer can adjust the depth, strength and speed of each pass to match the shape and severity of the scar. Rolling scars need different settings than boxcar scars, and different areas of the face need different depths.
This is basically taking off the top layer of skin, which is why when it grows back patients need to be very diligent about the skin care. The laser removes damaged tissue, and the body replaces it with new collagen and new skin. That process takes a week of peeling at home, and the outcome depends on how carefully the post care is followed.
How the treatment is built
Fully ablative resurfacing is a commitment: prescription medications, a week at home, and aggressive post care.
Rolling scars, boxcar scars and uneven texture are mapped so each area receives the correct depth and number of passes.
The tunable resurfacing laser (TRL) is adjusted for depth, strength and speed, and each pass removes damaged tissue so new skin can form.
The skin peels over the following week. Patients must be on prescription medications and follow aggressive skin care protocols during this time.
Stem cells, exosomes, peptides and preventative skin care help the new skin form correctly and stay protected as it matures.
The treatment, explained
Also called tunable resurfacing laser, TRL, erbium laser, ablative laser resurfacing, acne scar resurfacing, laser skin resurfacing.
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 laser work, thousands of scar cases, and techniques that balance maximum improvement with controlled risk.
Dr. Emer built his reputation on outcomes that other practices could not deliver: severe acne scars smoothed, sun damage reversed, and skin that looks renewed rather than erased. He personally performs every laser treatment in his practice, and his protocols for post care and pigmentation management are studied by dermatologists internationally.
Patients come to him when the scars are deep, when other treatments have failed, and when the result has to be worth the commitment.
Shallow scars need less depth. Deep scars need more. The laser adjusts for each area of the face.
Each pass has a different purpose: evening out texture, tightening loose skin, or removing damaged tissue entirely.
The key is to be very even with the application and going to somebody that really knows how to do this and the post care for it.
Asked plainly, answered plainly
Fully ablative means the laser removes the entire top layer of skin, not just the surface. New skin grows back in its place over the following week. This is different from fractional or non-ablative lasers, which leave the top layer intact.
It carries higher risk of hyperpigmentation or hypopigmentation in darker skin. Candidacy depends on scar severity, skin type, prior treatment history and whether you are willing to manage pigmentation changes if they occur. Not every skin tone can do this treatment. Dr. Emer determines candidacy during consultation.
You must stay at home while the skin is peeling, which takes approximately one week. You will be on prescription medications and must follow aggressive skin care protocols during this time. The exact recovery plan is set at consultation based on your skin type and the treatment settings used.
Many patients build results over multiple sessions rather than achieving maximum correction in one treatment. The patient in this video had prior resurfacing, micro droplet silicone and professional skin care before this session. The number of treatments needed depends on scar severity and is discussed at consultation.
Stem cells, exosomes and peptides are applied during healing to guide correct new skin formation. Prescription medications and preventative skin care protect the skin as it heals. The post care protocols are as important as the laser settings and are detailed at consultation.
TRL stands for tunable resurfacing laser, which means the depth, strength and speed can be adjusted with each pass. Dr. Emer changes the settings to match the shape and severity of each scar, evening out topography rather than applying uniform settings across the face.
Risks include hyperpigmentation, hypopigmentation, prolonged redness, infection and scarring. Darker skin tones carry higher risk of pigmentation changes. Dr. Emer manages these risks with detailed pre-treatment assessment, prescription medications and aggressive post care protocols. All risks are discussed at consultation.
Yes. This patient had micro droplet silicone and professional skin care before the resurfacing session. Dr. Emer often layers treatments over time to build results. The treatment plan is determined at consultation based on your scar severity and goals.
A consultation with Dr. Emer covers your skin type, your scar severity, and whether fully ablative resurfacing fits your case.
Schedule ConsultationWest Hollywood and New York City