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Overview & Why It Matters

Diffuse dyspigmentation and actinic change are high-volume concerns in aesthetic medicine. The fractionated, non-ablative 1927 nm thulium laser (MOXI™) is engineered to target epidermal water at ~200 µm penetration, making it ideal for photo-induced pigment and texture without removing the epidermis. This prospective clinical report evaluated two MOXI sessions, one month apart, in Fitzpatrick I–IV patients and quantified outcomes with objective imaging (VISIA) and blinded clinician scoring (PGAS). Results showed significant pigment improvement at 1 month with some rebound by 3 months—informing realistic patient counseling and maintenance planning. [oai_citation:0‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)

Methods (Plain Language)

• Design: IRB-approved, prospective, single-center study (May–June 2022); clinical follow-ups at ~1 and ~3 months. [oai_citation:1‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Cohort: 27 women (mean age 47 ± 11.5; Fitzpatrick I–IV); 96% completed 1-mo and 89% completed 3-mo follow-up. [oai_citation:2‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Treatments: Two full-face MOXI sessions (1927 nm), 4 weeks apart; standardized parameters: 15 mJ, ~15% density, six passes (≈2.5%/pass). [oai_citation:3‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Outcomes: VISIA “feature coefficients” for spots/UV spots/brown spots; PGAS by five plastic surgeons; non-parametric stats with significance at p ≤ 0.05. [oai_citation:4‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)

Results & Data Highlights

• Primary Effect: Overall pigment improved ~9% at 1 mo (p<0.0001); improvement remained significant at 3 mo (~3%; p=0.005). [oai_citation:5‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• By Pigment Type (1 mo): Spots −7% (p=0.006), UV spots −16% (p<0.0001), brown spots −7% (p<0.0001). Brown spots still improved at 3 mo (p=0.05). [oai_citation:6‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Laterality: Greater baseline pigment on the left face; both sides improved at 1 mo (left −9.9%, right −7.5%). Right-side gains remained significant at 3 mo (p=0.02). [oai_citation:7‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Clinician Ratings: Mean PGAS ≈ 3.4 at 1 mo and 3.7 at 3 mo (both p<0.0001), corresponding to ~50% improvement ranges. [oai_citation:8‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Treatment Time / Energy: Sessions ~6–10 min; total energy per treatment ~500–812 mJ; no significant energy shift across sessions. [oai_citation:9‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)

Bottom line: measurable improvement peaks around 1 month after two standardized MOXI treatments, with partial regression by 3 months—suggesting maintenance care and UV discipline are key to prolonging results. [oai_citation:10‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)

Clinical Interpretation

The study supports MOXI as an effective, epidermal-targeted option for photo-pigment and early actinic change with low downtime. The left-right asymmetry (higher baseline and stronger rebound on the left) tracks with UV exposure patterns and underscores why seasonal counseling and photoprotection matter. For practices, the data justify clear expectations: fast early wins, maintenance needed—especially through high-UV months. [oai_citation:11‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)

Training Implications: Turning Evidence into Protocols

• Parameter Discipline: Start with conservative density/energy in mixed skin types (I–IV) and scale by response to minimize PIH risk. [oai_citation:12‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Endpoint Literacy: Recognize normal erythema/edema vs. overshoot; set stopping rules before comfort thresholds are exceeded. [oai_citation:13‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Seasonal Strategy: Pre-book maintenance around high-UV periods; insist on SPF and pigment-modulating skincare to reduce rebound. [oai_citation:14‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)
• Consult Scripting: Prime patients that two sessions give visible change at 4–8 weeks, with touch-ups for longevity. [oai_citation:15‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)

These points map directly to John’s device-agnostic checklists and 1927 nm ladders taught in the live and online courses.

Safety Profile

No serious adverse events occurred. Typical, transient effects included erythema/edema resolving within ~24 h and expected micro-crusting (5–10 days)—with no PIH, hypopigmentation, or scarring reported under the standardized protocol. Pre-screening, proper eyewear, and consistent technique remain essential. [oai_citation:16‡2023-MOXI1-4NRV.pdf](file-service://file-JPY5TRocMUK5fgiavca9n3)

Laser Course Options

Citation & Links

Vingan NR, Panton JA, Barillas J, Lazzarini A, Hoopman J, Kenkel JM, Culver A.
Investigating the efficacy of a fractionated 1927 nm laser for diffuse dyspigmentation and actinic changes.
Lasers in Surgery and Medicine. 2023.
View on ResearchGate.

📄 Download the full study (PDF on JohnHoopman.com)