LaseMD Ultra: The Pigment Laser That Doesn’t Target Pigment

What does a 1927nm laser actually target?

Water. Not melanin.

That sounds like a technicality and it is the single most important thing about this device. Most light-based treatments for brown spots work by aiming at pigment itself — melanin absorbs the energy and the spot breaks up. It works, and it carries an obvious problem: if your skin has more background melanin, the laser cannot easily tell the spot from the skin around it.

The 1927nm thulium wavelength is absorbed by water in the tissue instead, penetrating to roughly 200 micrometres. Its penetrance remains shallow, and meaningfully so. It creates thousands of microscopic columns of controlled injury in the epidermis and upper dermis while leaving the tissue between them untouched, and the skin resurfaces from those intact islands.

Because the target is water rather than pigment, the treatment can be used across a much wider range of skin tones than a melanin-targeting device. In a city as diverse as this one, that matters more than any marketing claim about downtime.

What’s the actual evidence?

Better than most aesthetic devices, and I want to be precise about how good.

A 2025 systematic review in Lasers in Medical Science pooled 17 studies covering 448 patients treated with the 1927nm thulium laser. It found consistent improvement in skin texture, pigmentation and scar appearance, with an acceptable safety profile and adverse events that were mild and transient. Typical protocol across the studies: three sessions at monthly intervals.

Now the part a clinic quoting that review would normally skip. The same authors reported considerable variability in treatment parameters between studies, and judged most of the included studies to carry a moderate to high risk of bias. Their conclusion was that future research is needed to standardise protocols and confirm long-term effects.

So: consistent signal, imperfect evidence base. That’s an honest summary of most energy-based devices in aesthetics, and I’d rather hand it to you than pretend the literature is stronger than it is.

There’s also work specific to what I use it for most. Vingan and colleagues, in Lasers in Surgery and Medicine, found that the magnitude and duration of pigment improvement is influenced by summer photodamage — which is why we tend to run these series in autumn and winter.

Can it treat melasma? Yes — and it will probably come back

This is where I part company with how the treatment usually gets sold.

Melasma responds. Kurmuş and colleagues retrospectively reviewed 100 patients treated with a 1927nm thulium laser and found mean MASI scores falling from 11.8 at baseline to 6.7 after one session and 3.4 after two, with no major side effects. That’s a substantial improvement in a condition notorious for resisting treatment.

Then look at what happens afterward. Niwa Massaki and colleagues followed 20 melasma patients long-term. Mean MASI improved from 13.2 to 8.5, and twelve of twenty reported more than half their melasma cleared. But of the fifteen patients successfully followed up, seven had recurred at a mean of about ten months, and two developed post-inflammatory hyperpigmentation.

Fact vs. Fad: Melasma is a chronic, hormonally and UV-driven condition. No laser cures it. What a 1927nm laser can do is clear it substantially for a period measured in months, after which maintenance and rigorous sun protection determine what happens next. Any clinic offering to “get rid of your melasma” is describing a result the long-term follow-up data doesn’t support.

I still treat melasma with this device. I just tell people what they’re buying: a reset, not a cure, and a commitment to sunscreen that will do more for the outcome than the laser did.

Why not just use IPL?

The real distinction is mechanistic. Intense pulsed light is broadband light that works primarily through melanin absorption. It’s genuinely effective — I’m not going to tell you IPL doesn’t work — but that mechanism is exactly why it demands caution in tanned skin and in higher Fitzpatrick phototypes, where the epidermis competes with the target.

A water-targeting wavelength doesn’t have that competition. Different tool, different chromophore, different candidate. If you’ve been told you’re not an IPL candidate because of your skin tone, that assessment doesn’t automatically transfer here.

Why don’t we have a CO2 laser?

Two reasons, and neither is cost.

The first is skin type. CO2 is ablative — it vaporises the surface, which then has to re-epithelialise. A 2025 safety review states the trade-off plainly: ablative lasers carry substantial downtime and risks of post-inflammatory hyperpigmentation and scarring, which makes them unsuitable for many patients, particularly those with darker Fitzpatrick skin types. In practice that means a device I would have to decline to use on a large share of the people who walk into a Philadelphia practice. I’d rather own a laser I can offer to nearly everyone.

The contrast is sharp. Bae and colleagues treated 61 patients with Fitzpatrick types IV–VI who already had post-inflammatory hyperpigmentation using a low-energy 1927nm laser: mean improvement 43%, no side effects observed. The thulium wavelength is used to treat the complication ablative resurfacing is most likely to cause in those same patients.

The second is that full ablative resurfacing has fallen out of favour. I want to be precise here, because this gets overstated. Fractional CO2 — treating columns of tissue and leaving bridges of intact skin between them — is still a standard, effective, evidence-based treatment, and good practices use it well. What has declined is fully ablative full-face resurfacing, where the entire surface is removed. Fractionation gave most of the benefit with a fraction of the risk and recovery, and the field moved.

Fact vs. Fad: “All the results of CO2 with none of the downtime” is attached to nearly every non-ablative device and it isn’t true of any of them. Less downtime is real. Equivalent results are not. At around 200 micrometres of penetration, a 1927nm laser does not reach the tissue where deep static wrinkles and significant atrophic scarring live, and no number of sessions changes that. If that’s your problem, the honest answer is that you need a laser device I don’t own, and I’d rather refer you than sell you three sessions of the wrong thing.

Is this the same as Fraxel, or Moxi, or Clear + Brilliant?

Partly — and the naming is genuinely confusing, so it’s worth ten seconds of decoding.

“1927nm” is a wavelength, not a brand. Several manufacturers build devices around it, and patients meet them as trade names without being told they’re comparing versions of the same underlying idea. As Dermatology Times laid out when the category expanded: Solta Medical’s Fraxel Dual pairs 1550nm with 1927nm, Solta’s Clear + Brilliant offers 1927nm through its Permea handpiece, Sciton’s Moxi is a 1927nm device, and Lutronic makes the LaseMD Ultra — the one we use, now sold under Cynosure Lutronic after the companies combined.

They are not identical. They differ in maximum power, in how deep and how densely they place the microscopic treatment zones, and in how much the operator can adjust. A gentle “prejuvenation” device and a platform tunable up to genuine resurfacing are different purchases even at the same wavelength.

But if a clinic tells you their laser is fundamentally different technology from the one down the street, ask which wavelength. Often the answer is the same number.

What about precancerous spots?

The LaseMD Ultra is FDA-cleared for dermatological procedures requiring coagulation of soft tissue, treatment of actinic keratosis, and treatment of benign pigmented lesions including solar lentigines. So treating a precancerous spot with it is within its clearance, not an off-label stretch.

Beyond that I’d rather be conservative. There’s a 2026 study following 23 patients through four monthly thulium sessions that reported improvement in both actinic keratosis counts and photoaging scores, but it’s small and has no control arm, and I am not going to tell you that a cosmetic laser prevents skin cancer.

The practical point is narrower and, I think, more useful: a face with significant sun damage often has lesions on it that deserve a physician’s eye before anyone points a laser at them. That’s a reason to have this looked at by a doctor rather than booked as a spa service, and it’s the main argument for where you have it done.

What does the treatment actually involve?

A full-face session takes roughly 30 to 45 minutes including numbing. The handpiece rolls across the skin — most people describe it as warm and prickly rather than painful.

Afterwards you’ll be pink, similar to a strong wind-burn, with a fine sandpaper texture for a few days as the treated micro-columns work their way out. Most patients are comfortable in public within two to four days, though that varies with how aggressively we set the device and with your skin.

Plan on a series of three, spaced about a month apart, then maintenance once or twice a year. One session produces a visible glow; a series is what changes pigment.

One feature worth knowing: the microchannels the laser creates are used to deliver topical actives immediately afterward, while the skin is still permeable. It’s a real mechanism rather than a marketing tool — you’re getting the ingredient further in than it would otherwise go.

Full-face LaseMD Ultra here is performed by a physician, our advanced practice nurse, or a licensed medical aesthetician certified on the device — and whichever of them you select when you book is the person who performs your treatment. Not a colleague, not whoever is free that day. Targeted work on individual scars is usually handled by our aestheticians. And we book these as a series into autumn and winter rather than mid-summer, for the reasons above.

References

Thulium laser (1927 nm) for dermatological conditions: a systematic review. Lasers in Medical Science. 2025. doi:10.1007/s10103-025-04781-5 (17 studies, n=448; most at moderate to high risk of bias)

Kurmuş GI, Tatlıparmak A, Aksoy B, Koç E, Aşiran Serdar Z, Ergin C. Efficacy and safety of 1927 nm fractional thulium fiber laser for the treatment of melasma: a retrospective study of 100 patients. Journal of Cosmetic and Laser Therapy. 2019. doi:10.1080/14764172.2019.1683581 (retrospective)

Niwa Massaki AB, Eimpunth S, Fabi SG, Guiha I, Groff W, Fitzpatrick R. Treatment of melasma with the 1,927-nm fractional thulium fiber laser: a retrospective analysis of 20 cases with long-term follow-up. Lasers in Surgery and Medicine. 2013;45(2):95–101. doi:10.1002/lsm.22100

Bae YC, Rettig S, Weiss E, Bernstein L, Geronemus R. Treatment of post-inflammatory hyperpigmentation in patients with darker skin types using a low energy 1,927 nm non-ablative fractional laser: a retrospective photographic review analysis. Lasers in Surgery and Medicine. 2020;52(1):7–12. doi:10.1002/lsm.23173

Vingan NR, et al. Investigating the efficacy of a fractionated 1927 nm laser for diffuse dyspigmentation and actinic changes. Lasers in Surgery and Medicine. 2023. doi:10.1002/lsm.23653

Safety and tolerability of the 1440- and 1927-nm non-ablative fractional diode laser system for skin resurfacing: a review of current literature. 2025.

Prospective study of efficacy and safety of non-ablative 1927 nm fractional thulium fiber laser in Asian skin photoaging. Frontiers in Surgery. 2023. doi:10.3389/fsurg.2023.1076848

Clinical and histopathological assessment of the field of cancerization in human skin before and after treatment with a 1927-nm thulium fractional laser. Lasers in Surgery and Medicine. 2026. (prospective single-arm observational study, n=23)