3 Questions with Eric Bernstein

BioPhotonics spoke with Eric Bernstein, M.D., the medical center director at the Main Line Center for Laser Surgery in Ardmore, Pennsylvania, about a recent study on laser treatment of acne scarring published by the American Society for Laser Medicine and Surgery. Results from the study — encompassing the treatment of 13 subjects with an erbium-doped fiber laser — show promise in laser treatment of acne scarring.

What are some typical treatments for acne scarring, and what have their limitations been?

The mainstays for treating acne scarring have been the fractionated lasers, particularly the CO₂ and Erbium:YAG (Er:YAG), and Erbium:glass (Er:glass) lasers, radio frequency (RF) microneedling, and fractionated picosecond-domain lasers. For all their effectiveness in treating photoaging and wrinkles, my experience has been that the fractionated CO₂ lasers have been less effective at improving acne scarring. One of the drawbacks I have seen when using traditional fractionated lasers has been limited efficacy and an increased incidence of pigmentary problems in darker-complected patients. In these patients, RF microneedling and the fractionated picosecond-domain lasers solve the problem of hyperpigmentation, but efficacy is significantly less in my opinion than with fractionated ablative or semi-ablative lasers. So, my new go-to device for acne scarring and photoaging is a 2910-nm fractionated Er:glass fiber laser. This fiber laser is completely new for treating photoaging and acne scarring.

What is it about the 2910-nm, 5000-Hz pulses that makes them particularly effective in reconfiguring collagen?

I’ve been performing histologic and clinical studies on laser-treated skin since the original ultrashort-pulse CO₂ laser in the 1990s, where I looked at more than 100 patients, examining immediate and six-week to three-month post-treatment biopsies. What we noticed about the new Er:glass fiber laser, and published in Lasers in Surgery and Medicine, was that even with very little histologic evidence of thermal injury, patients demonstrated erythema post-treatment, indicating a dermal effect of the laser treatment, and there was histologic evidence of inflammation for one to two weeks following very mild and moderate treatment settings of the laser, respectively, as published in Lasers in Surgery and Medicine. I’ve been able to treat all skin types with this laser, and typically start with two treatments at one- to two-month intervals. I think one of the keys is that the zone of thermally altered dermal collagen left behind is just right — not as thick as after CO₂ laser treatment, but not too thin to prevent a strong remodeling response and hemostasis. The laser is extremely versatile due to its very rapid (~5000 Hz) repetition rate, enabling stacked ablative and coagulative pulses. We often deliver more than 2500 mini pulses in less than a second. This versatility enables this laser to do things no other device has, in my opinion.

What are the next steps in your research? I believe you indicated the study group would be expanded.

I’m the chief medical officer for Acclaro Medical, the company that created the fractionated Er:glass fiber laser, and we’ve assembled a medical advisory board of serious clinician-scientists in the field of laser surgery. New research is focused on laser coring as an evolving treatment to improve acne scarring and the signs of photoaging. What’s novel about laser coring with this fiber laser is the ability to leave a “just right” zone of thermal damage behind to stimulate healing and dermal remodeling, and to create a range of core sizes in a spiral pattern due to the extremely rapid pulse-duration of this laser. Having a laser that can deliver up to 5000 pulses/s enables versatility heretofore not seen in a dermatologic laser device. I’m excited to see what new developments our medical advisory board comes up with for this type of device.