Power of Two

In just a short time, Sciton’s power couple—MOXI™, a 1927nm non-ablative fractionated laser, and BroadBand Light (BBL®) HERO™ (High Energy Rapid Output)—has become the go-to combination procedure for skin rejuvenation.

Together, the two devices can address most skin concerns, including discoloration/pigmentation, vascularity, fine lines/wrinkles, and textural issues.

Both power players are available on the new smaller mJOULE™ platform from Sciton®, which is more portable than the JOULE platform. The devices are available together or alone on the mJOULE platform, and the HERO technology can be added to JOULE™, enabling users to customize their platform to their individual needs.

“BBL HERO plus MOXI is a home run for pigment as well as restoring luminosity, radiance, glow, and improvements in superficial skin texture,” says Sherrif F. Ibrahim, MD, PhD, founder of Rochester Dermatologic Surgery, PC and assistant professor of dermatology at the University of Rochester Medical Center in Rochester, NY.

To better understand why they make the perfect couple, it’s important to first appreciate what each of the technologies brings to the table and how they can work synergistically.

More on MOXI

The latest modality to join the Sciton family of offerings, MOXI can treat uneven pigmentation, tone, and texture abnormalities, light photodamage and skin aging, rejuvenation, and/or provide long-term maintenance of more aggressive laser and light procedures, such as Halo™ or Resurfacing Perfected™. It offers a range of delivery options from light at 5mJ and five percent density up to 20mJ and 20 percent density.

MOXI can be used on all body areas, including the face, neck, chest, arms, and hands. The average treatment time is 12-15 minutes for a full face. Improvements can be noticed after a single treatment and tend to be long-lasting.

MOXI has a variety of treatment options which can be customized to each patient. The most commonly used options comprise three levels:

Level 1: Prevent and refresh

5-10mJ, five to 10 percent density

Four to five passes

Level 2: Revitalize and maintain

10-15mJ, 10-15 percent density

Four to five passes

Level 3: Transform and renew

15-20mJ, 15-20 percent density

Six to eight passes

“You can set MOXI at level one for a light treatment—and ideal for dark skin types—or increase up to level three for greater correction,” notes Dr. Ibrahim. “It is a simple, but elegant laser that is easily programable.

“There’s little to no learning curve,” he adds. MOXI offers an intuitive user interface with three modes for simple operation: Quick-Start, Measure, and Manual. “In Measure mode, for example, you can program how many passes over each treatment zone by manually entering the surface area and dialing in a very specific amount of energy and density of coverage. Alternatively, you can jump right in and begin with the Quick-Start levels, or select Manual mode for complete control over settings,” Dr. Ibrahim says.

BBL HERO: Fastest IPL on the Market

Sciton’s BBL is already an industry darling, having quickly gained worldwide popularity after its introduction in 2004, and BBL HERO improves on the original, allowing practitioners to quickly treat the entire body. “It has four times the speed, three times the peak power, and two times the cooling capacity of the original BBL,” says Dr. Ibrahim. “These features establish it as being leaps and bounds beyond any other IPL that exists.”

BBL Hero can address a variety of conditions, including acne breakouts, rosacea, pigmented lesions, photoaging, photodamage, sunspots, vascular lesions, and skin laxity.

BBL HERO revolutionized BBL treatment overnight, he says. “This is the Lamborghini or Ferrari of IPL devices,” Dr. Ibrahim says. “We are seeing corrective changes in browns and reds, an unprecedented smoothing of the skin, and an improvement in texture.”

With BBL HERO, providers can treat the full face and large body areas such as the back, arms, and legs in two to five minutes thanks to its large spot size (15x45mm), high repetition rate, easily exchangeable snap-on Finesse Adapters for hard-to-reach areas or small spots, and change-on-the-fly Smart Filters that enable treatment of various skin conditions with a single handpiece (See sidebar).

These new attributes opened the door for non-facial treatments, Dr. Ibrahim says. “Traditional IPL relies on the stamping method which results in uneven or over- or under-treated areas once you start treating off of the face and are time/labor intensive.”

Not anymore. The BBL HERO handpiece is constantly in motion, says dermatologist Joel L. Cohen, MD, Director of AboutSkin Research in Greenwood Village and Lone Tree, CO. Dr. Cohen is a board-certified dermatologist who is fellowship-trained in lasers, aesthetics, and Mohs surgery. He runs a very active clinical research unit and publishes a tremendous amount in these fields.

“You have complete control over settings, joules, pulse width, cooling, but also most importantly, how quickly the system pulses as you move the handpiece,” he adds, noting that it’s important to go more slowly around the eyebrows, hairline, and sideburns.

“Instead of trying to line-up the squares or rectangles, you are actually gliding quickly along the skin...which avoids the whole lining things up and also allows you to treat larger areas in less time,” Dr. Cohen says. “For some treatments where efficiency and time are of issue, especially with multiple large areas, BBL HERO makes a huge impact. Instead of doing neck and chest one day and then the face and hands the next, we can now do it all together in a single 30-minute session with BBL HERO. And you can recognize your clinical endpoint more quickly, as the whole process is quicker.”

Patients with more significant sun damage will still temporarily have their pigment darken as part of the normal response. “Those with some milder pigment, and often, redness, may see an increase of redness along with the darkening of any pigment appearing like cayenne pepper as the clinical endpoint,” Dr. Cohen says. “These manifestations of chromophore (target) absorption will resolve over the next few days as the skin responds and recovers from the treatment to reveal the newly revitalized, healthy skin.

"BBL HERO is exciting because you can do a few things that up the game in terms of effective therapy and treatment of photodamage, pigment, and redness. You should be able to avoid the dreaded 'patterning of squares and rectangles' on the skin from traditional pulsed light devices, and the treatments are much much quicker, and more efficient," Dr. Cohen says.

"Going hand-in-hand with pigment and sun damage is textural change, and we can help improve skin quality in terms of collagen by heating it up with multiple passes of BBL HERO over often a series of treatment sessions (and can even add-in SkinTyte which is part of the same system). It is also incredibly helpful to treat folks that have that old 'IPL pattern' to the skin."

BBL HERO Plus MOXI: Perfect Together

And just when you thought things couldn’t get any better…along came mJOULE with the combination, Dr. Ibrahim says. When BBL HERO and MOXI are used together, the results far exceed either one alone. “One plus one equals 10 in this case,” he says.

Patients are shown before (left) and after one treatment.

“When treating patients with BBL HERO plus MOXI, we start with 400 to 600 pulses of BBL HERO to cover the face, followed by an immediate transition to MOXI,” Dr. Ibrahim says. MOXI safely addresses deeper pigments than BBL, including for melasma, he explains.

“We can do one treatment at a higher setting, which will cause a little more swelling and peeling with about two days of downtime or we can do multiple treatments on the lower end with less swelling and peeling,” Dr. Ibrahim says.

The sky’s the limit with this combination, he adds. “Some patients request multiple treatments with no downtime, while others would like more of a corrective intervention and then lighter treatments down the road.”

And because 1927nm is highly absorbed by water, these treatments are safe on all skin types, Dr. Ibrahim notes.

“This is not a combination for advanced photodamage including etched-in lines or acne scars, but it’s a match made in heaven for pigment and luminosity, radiance, and glow. It has become our go-to combination overnight.”

The award-winning results speak for themselves. Dr. Ibrahim took home the Maverick award at the 2021 Vegas Cosmetic Surgery & Aesthetic Dermatology (VCS) meeting for his talk on MOXI plus BBL HERO. He shared data on 12 female patients aged 18 or older with Fitzpatrick skin types ranging from I-IV who had moderate sun damage, aging skin with visible areas of fine lines, dyspigmentation, and/or erythema of the face. Of these, 11 patients received a single combination treatment of BBL HERO and MOXI and one patient underwent two treatments.

“Improvements in pigment and texture were seen in all patients,” he concluded. “These treatments with BBL HERO in combination with MOXI are safe and effective in the treatment of mild to moderate dyspigmentation and photoaging."

Learn more about MOXI and BBL HERO and how they can help grow your practice at mJoulebySciton.com