For a 68-year-old patient with controlled systemic lupus erythematosus (SLE), microneedling is generally the safer choice over Moxi (1927 nm thulium laser) for collagen induction and skin rejuvenation. Patients with SLE are at increased risk for photosensitivity and post-inflammatory hyperpigmentation, and there is a potential for disease flare with light- and heat-based procedures such as lasers. According to current dermatology best practices, there are no established guidelines supporting the routine use of laser treatments like Moxi in lupus patients, and these interventions should be approached with caution due to the risk of exacerbating cutaneous or systemic disease[4]. Microneedling, by contrast, is a mechanical, non-thermal procedure that does not rely on light or heat, making it less likely to provoke a lupus flare or photosensitive reaction. While transient erythema and swelling can occur, these effects are typically mild and short-lived. In summary, for a patient with controlled lupus seeking to increase collagen, microneedling is preferred over Moxi due to its lower risk profile in photosensitive and autoimmune conditions. Regardless of the procedure, strict photoprotection remains essential, and any intervention should be performed by an experienced provider familiar with the nuances of treating patients with autoimmune disease.