Solar Lentigines Treatment Guidelines - Medsystems

LIMELIGHT
Facial Telangiectasia,
Diffuse Redness and
Solar Lentigines
Treatment Guidelines
For use with the LimeLight Pulsed Light Handpiece with a wavelength range of 520 to 1100 nm.
Appropriate operator safety eyewear for this device, provided by Cutera, senses the light pulse and
blocks out incoming light. A small amount of light at the beginning of the pulse will be visible.
This eyewear is not for use with the 1064 nm laser handpiece.
The patient should be given the solid, light blocking eyewear also provided by Cutera. Observers of
the procedure may wear the green tinted eyewear provided by Cutera.
© November 2006, D0481 Rev. C
Cutera • 3240 Bayshore Boulevard • Brisbane • California • 94005
PH: 415.657.5500 • www.cutera.com

LimeLight Treatment Guidelines
The following guidelines are based on physician feedback from treatments with the LimeLight Pulsed Light
Handpiece on patients with Fitzpatrick skin types I–IV. Treatment of patients with skin type V and VI using the
LimeLight Pulsed Light Handpiece is not recommended. Additional treatment information is discussed in the
Clinical Presentations CD included with the system.
The LimeLight should only be operated by qualified practitioners who have received appropriate training and have
thoroughly read the operator manual. Protective eyewear must be worn by all people in the treatment room.
Consult the Operator Manual for additional information, including contraindications and possible adverse effects.
PRE-OPERATIVE CONSIDERATIONS:
• Conduct a patient consultation complete with medical history prior to treatment.
• Patients should not be treated if they have had significant sun exposure, or artificial (light based or sprayon)
tanning, in the 4 weeks prior to treatment.
• Clean the skin, including removal of all make-up and other skin care products. Any creams or products left
on the skin can interact with the light and increase the risk of unwanted side effects.
• Shave any hair in the area to be treated.
• Pre-operative photographs should be taken with consistent technique (patient positioning, camera settings,
and room lighting) prior to the initial treatment for general reference. Printed pre-operative photos can also
be used to compare and duplicate the same patient position when taking follow-up photos.
• Pigmented lesions should be evaluated for potential skin cancer warning signs prior to treatment. If these
are present, the lesion should not be treated unless diagnosed as benign.
• These treatments can be tolerated without anesthesia. Topical anesthesia can be used if desired. It must be
completely removed prior to treatment. CAUTION: Toxicity may result with overuse of topical anesthesia.
Consult the manufacturer's labeling.
• When treating near the mouth, rolled-up gauze can be placed between the lips and teeth to protect the teeth
from discomfort.
• Although this device has not been optimized for hair removal, patients should be advised that hair removal
may occur as a result of these treatments.
• Do not treat over areas with tattoos.
• Extreme caution should be used when treating near the eye, taking care to avoid ocular damage from the
light. Patient eye protection appropriate for the given treatment should be used. The light should always be
pointed away from the eye and only applied to the skin outside of the orbital rim. Skin at the edge of the
orbital rim can be treated by pulling it away from the eye while simultaneously holding the goggles in
place, so treatment is kept outside of the orbital rim.
© November 2006, D0481 Rev. C LimeLight Treatment Guidelines
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LIMELIGHT TREATMENT PARAMETERS:
Treatment of a test area should be performed and observed for the desired response and signs of unwanted side effects.
Settings for full treatment should be based on test area results. A waiting period of 20 to 30 minutes is recommended
for most patients when treating lentigines. Darker skin types may require 24 to 48 hours to develop.
SKIN
TYPE
CONDITION PROGRAM FLUENCE
(Face)
I-II Fine Telangiectasia and
Diffuse Redness on
patients with light skin
I-III Telangiectasia, Diffuse
Redness and Solar
Lentigines
IV and III
with actinic
bronzing*
Telangiectasia, Diffuse
Redness and Solar
Lentigines
A 12 – 18 J/cm 2
B 12 – 26 J/cm 2
C 12 -22 J/cm 2
FLUENCE
(Neck, Chest & Body)
Treatment in these areas
usually requires 2-4 J/cm 2
less than on the face for
similar conditions.
This device is not intended
for the treatment of leg
veins.
* Actinic bronzing is chronic “tan-like” pigmentation damage resulting from long-term sun exposure. This is
different from recent sun exposure, which should not be treated.
Specific parameters are provided as a guide only. Select parameters depending on color and density of lentigines,
hair density, vascularity, and actinic bronzing. Observe light-tissue interaction and clinical endpoints to determine
appropriate settings. Patients with skin type IV should be treated with caution. Treatment of patients with skin types
V and VI is not recommended.
• Treatment is not recommended for areas of recent sun exposure or tanning.
• The LimeLight has three program modes (A, B, and C) which control the wavelength distribution, pulse
duration, and epidermal cooling:
o Program A is the most aggressive program [shortest wavelength distribution and shortest pulse
durations] and is intended for patients with light skin and fine vascular targets if Program B does
not give the desired response. This mode can also be used for low-contrast lentigines on patients
with light skin.
o Program B is the most commonly used program and is intended for patients with vascular and/or
pigmented targets.
o Program C is the least aggressive program [longest wavelength distribution and longest pulse
durations] and is intended for patients with darker skin.
• Sun Mode increases the treatment window temperature from the standard setting, 5° or 10° C, to 20° C.
Recommended use of Sun Mode:
o Telangiectasia or combination of telangiectasia and lentigines:
� Sun Mode off (standard cooling)
� Thin layer of gel
o Lentigines only:
� Sun Mode on
� No gel
� Allows reduced fluence for effective treatment
• Prior to treating each patient, the program, the fluence, and the repetition rate settings must be determined.
If in doubt about which Program to use, it is safest to use the longer wavelength program of the two choices
(i.e. B over A and C over B).
• The program should always be entered first, as each time the program is changed, the system will recall the
fluence and repetition rate last used with that particular program.
© November 2006, D0481 Rev. C LimeLight Treatment Guidelines Page 3 of 4

• The fluence setting should be selected to provide the desired treatment without effecting the pigmentation
of background skin.
• Use lower fluences for darker targets, both pigmented and vascular, or over bony areas.
• The potential for overtreatment is greatest with skin type IV and patients with the pigmentary effects of
long-term tanning (actinic bronzing). Begin with low settings for the initial test treatment.
• Fluence settings should not be based on settings used with other pulsed light devices.
RECOMMENDED TECHNIQUE:
• When telangiectasia are present, with or without solar lentigines, apply a thin layer of clear (no color)
ultrasound gel and use standard cooling (5° or 10° C).
• When only solar lentigines are present, use Sun Mode and no gel. This allows use of reduced fluences.
• Place the entire light-emitting window in contact with the area to be treated.
• Activate the light pulse.
• Place the window over the next treatment area and treat in the same manner.
• If treating an area with closely spaced lentigines, place treatment pulses adjacent to one another so that
there is no more than 1 mm overlap between pulses.
• The desired response for lentigines is some darkening of the treated lentigines, and possibly mild erythema.
If a large portion of the treated area darkens or develops significant erythema, the fluence should be
reduced. This effect is often delayed.
• The desired response for telangiectasia treatments immediately is constriction or darkening of the vessel. If
results are not seen at the lower settings, the fluence may be gradually increased as new areas are treated
while watching for the desired endpoint as well as epidermal damage. Treatment may also affect pigment,
which may have a delayed reaction.
• Always observe the epidermis during the treatment, watching for signs of damage (epidermal separation or
gray coloration). If damage is seen, stop the treatment, cool the skin, and reduce the fluence before
continuing.
• Do not “double pulse” or retreat an area within a single visit.
• Ensure that the window remains clean during the treatment. This is especially important when treating over
areas with hair.
POST-OPERATIVE CARE:
• Ice, chilled gel, or hydro-gel pads may be applied post-treatment as needed for patient comfort. The
treatment window can also be used as an effective post-cooling device.
• Treated lentigines usually darken after treatment, and crusting begins to form within a few days. This
crusting usually resolves in 1 to 3 weeks. It should be allowed to naturally flake off for best results.
• The recommended treatment interval is 4 weeks or longer, depending on the rate of clearance.
• Localized erythema may also be present and typically resolves within 24 to 48 hours. If prolonged
erythema occurs, future treatments should be performed at a lower fluence.
• If a wound develops an antibiotic ointment may be recommended.
• Patients should avoid artificial tanning, or sun exposure without sun protection, between treatments.
© November 2006, D0481 Rev. C LimeLight Treatment Guidelines
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