From ASLMS 2025: New Laser Platforms Expand Options for Vascular Rosacea

Pictured: Eric Bernstein, MD, at the podium at ASLMS 2025. 

Advanced vascular lasers are transforming the treatment of rosacea by targeting its root cause (chronic vascular dilation) rather than just managing inflammation.

At the 2025 American Society for Laser Medicine and Surgery (ASLMS) Annual Meeting in Orlando, Eric Bernstein, MD, Director of the Main Line Center for Laser Surgery in Ardmore, PA, highlighted the growing capabilities of vascular lasers in managing rosacea and other vascular lesions. Dr. Bernstein, a recognized authority in laser dermatology, reemphasized to the audience the need to shift from treating superficial symptoms of rosacea to addressing underlying vascular pathology.

Rethinking Rosacea Triggers and Protection

"Patients often think it's triggers like hot, cold, exercise, wine and other triggers that cause rosacea, but it’s 100% the sun. Triggers do cause the vessels we acquire from the sun to dilate, causing temporary flares," Dr. Bernstein said. "But the truth is, it's ambient UV—even through car windows, or under umbrellas—that's the real problem. Patients often are much worse on the driver’s side if they drive a lot, or the passenger’s side if they don’t.”

Here Dr. Bernstein advocated for enhanced photoprotection, including daily sunscreen use, clear (so you can see at night) UV-filtering window film, and brown-tinted lenses sunglass lenses to block short wavelength visible light, to block out shorter wavelengths of sunlight more effectively. These measures, he said, provide critical adjuncts to laser treatment by minimizing ongoing angiogenesis of these unwanted blood vessels. He says, “People often ask me if we need these vessels-we weren’t born with them, so we don’t need them.

New Platforms, Better Precision

Dr. Bernstein talked about two specific vascular-specific lasers during his session: a solid-state KTP laser, the DermaV, and a brand new pulsed dye laser (PDL) platform, the VBeam Pro. These technologies, he explained, offer expanded spot sizes, improved beam profiles, the ability to deliver higher fluences with larger spot sizes, and upgraded cooling systems, key enhancements for large-area or sensitive-site treatments.

"When I’m treating both diffuse redness and linear vessels, I increase the pulse-duration for larger vessels,” he explained. For linear telangiectasias, he said he uses a 40 ms pulse-duration, and for diffuse erythema and keratosis pilaris rubra, he starts at 1.5 to 6 ms, adjusting the fluence as needed, all during the same treatment session. The solid-state KTP laser, he noted, includes the ability to deliver sub-pulses. “Selecting sub-pulse modes is analogous to increasing the fluence, enabling the use of larger beam diameters without increasing the fluence and decreasing the spot size,” he said.

Spray cryogen cooling, which he praised for its safety at high fluences, adds an extra layer of epidermal protection, which he noted is valuable when treating the neck or chest, and is available with post-cooling on both devices he discussed.

Beyond IPL: Precision Over Presets

Dr. Bernstein critiqued the broad use of intense pulsed light (IPL) systems for treating rosacea.

“IPL is quite effective for removing freckles because melanin absorbs quite broadly, but it's not the best tool for treating diffuse redness or telangiectasias,” he said. “You need the precision of a single wavelength due to the relatively narrow absorption spectrum of hemoglobin.”

He pointed instead to the VBeam Pro, which offers both 595 nm and 1064 nm wavelengths, large spot sizes (up to 15 mm), enabling highly-effective and rapid treatment of rosacea, most often without purpura.

Clinical Endpoints and Expert Judgment

Dr. Bernstein urged attendees to avoid defaulting to manufacturer presets and instead calibrate settings based on patient response.

“Ignore the company presets,” he said. “We are clinicians and we talk to each other about our settings. Start low, observe endpoints, and increase the fluence with a new laser while observing for desirable endpoints.”

He cited real-time feedback like vessel blanching or transient purpura as critical indicators of efficacy and safety, noting that many patients with rosacea have no acneiform component at all.

“Laser treatment is the only modality that optimally addresses the root cause of rosacea, the unwanted vessels we acquire from the sun,” he emphasized, adding that as newer platforms offer broader customization, the opportunity to tailor treatments for the type and severity of rosacea, in various skin types, will, and has, improved tremendously from earlier-generation lasers. -by Eric Raible

Source: Bernstein EF. Presented at: American Academy for Laser Medicine and Surgery (ASLMS) Annual Meeting; April 24-26, 2025; Orlando