Rise of the 1927 nm wavelength

Moxie is slang for having guts or attitude. And it pretty much sums up Sciton’s new fractionated 1927 nm thulium device called Moxi.

U.S. aesthetic surgeons are finding the 1927 nm wavelength is a rising star in facial rejuvenation. It’s a great option for patients who don’t want the more aggressive treatments but are looking for a treatment that will address their photodamage with little to no downtime.

There is growing demand for fractional facial resurfacing, according to recent statistics. The Aesthetic Society reported in its 2019 statistics that micro-ablative resurfacing (fractional resurfacing) experienced the largest increase among selected nonsurgical procedures, rising 71.9% from 2018 to 2019. Member surgeons reported performing 66,275 fractional resurfacing procedures in 2019. There was a 2% uptick in nonablative laser skin resurfacing procedures from 2017 to 2018, according to the latest statistics by the American Society of Plastic Surgeons. Members of that Society reported doing 433,533 Fraxel or similar procedures in 2018.

While the newest 1927 nm laser on the block is Sciton’s Moxi, which is part of the company’s new small mJoule platform, there are other popular 1927 lasers for facial rejuvenation. Among them, the first that was commercially successful in this space, the Fraxel Dual 1550/1927 (Solta Medical). Lutronic Aesthetic has the LaseMD ULTRA, a non-ablative fractionated laser. Solta Medical’s Clear + Brilliant offers the Permea handpiece, a thulium 1927 nm.

More Moxi

I’m gaining experience with the Moxi and think it fills an important niche, giving us a new wavelength that results in minimal downtime. It’s an affordable treatment and is especially good for treating pigment or photodamage.

Compared to the hybrid fractional laser Halo (Sciton), which delivers both ablative and non-ablative wavelengths to the treatment area, Moxi offers less downtime, a better price point and noticeable results. In my experience, it also offers slightly better outcomes for pigment than Halo.

Halo delivers the 1470 nm wavelength for coagulation and the 2940 nm wavelength for ablation. Looking at histology slides, Halo treatment causes fairly aggressive dermal and epidermal injury. With Halo, patients get a great result by day 4, after going through a healing period of a few days when they don’t look their best.

We conducted a small study at Sciton looking at why some prospective patients decided against Halo treatment and found the most common reason was price. Most practices charge from $1500 to $2000 for Halo. Sciton looked at this as a business opportunity to introduce a procedure that was less expensive with less downtime but still efficacious. That’s why the company introduced its 1927 nm laser.

The device features different settings from 5 mJ to 20 mJ. Looking at histology slides for Moxi, there’s less tissue injury than with Halo. Most dermal pigment sits at the epidermal-dermal junction, so even at the low setting of 5 mJ or 10 mJ, you’re going to be able to treat most of the pigment and can go deeper if you want.

Providers can select among three preset levels or a manual mode with the device. Level 1 is at 5 mJ to 10 mJ, which reaches 5% to 10% density with four or five passes. Level 2 is at 10 mJ to 15 mJ at 10% to 15% density with four or five passes. The skin renewal setting is level 3. Its energy setting is 20 J/cm, with 20% coverage and six passes.

I administer the treatment under topical anesthesia. Be sure that you and your patient wear eye protection.

The procedure typically takes between 10 and 20 minutes. In Florida, performing Moxi is within the scope of practice of aestheticians, so my aesthetician will soon be offering it, too.

I had the procedure on my face and was impressed with how little time it takes and how dramatic the results were considering such limited downtime. While patients’ skin might be a little red after level 1 or 2 treatments (nothing they can’t hide with a little makeup), those that have level 3 might have a day of downtime.

While most patients notice results after one treatment, we usually do a series of up to three for optimal outcomes, including reduction in pore size. The price point for Moxi is at about $500 for a series of up to three treatments. The total disposable cost is about $50. And patients get a significant reduction in UV damage without missing a beat.

I use it as a full-face treatment. It’s new, so we’re still playing with some of the parameters and have been using it on the less aggressive side so far.

Providers can buy the mJoule platform with or without BBL.

I’ve used Moxi in combination with Halo but prefer to do it along with BroadBand Light (BBL), which according to Sciton, is the world’s most powerful intense pulsed light (IPL) device. The combination targets more of the pigmented lesion without adding downtime.

This 1927 nm laser is a great option for patients during the COVID-19 post-shutdown period. The last thing people want to do right now is sit in the house to recover after this pandemic. They want to get out. Moxi is one of those options that allows them to do that and will help their skin look refreshed and rejuvenated.

Boca Raton, Fla., plastic surgeon Jason Pozner, M.D., is on the Aesthetic Authority’s editorial advisory board and Sciton’s Medical Board and works closely with the company on new product development.