For sessions 3 and beyond, treatment intervals depend on the following body location:

Transcription

1 Laser Hair Reduction and Pseudofolliculitis Gemini Nd:YAG 1064 nm Hair Growth Cycle: Hair grows in three different cycles. Anagen, Catagen, and Telogen. The only time the hair has a nutrient (blood) supply is in the Anagen, active growth state. Subsequently, the ONLY cycle in which you can effectively kill a hair follicle is in the Anagen state (which is true f ALL hair reduction modalities). Frequency of Treatments Hair grows at different rates depending on body location. When treating your patient f hair reduction, body location plays a key role when deciding frequency of treatment. The patient s (2 nd ) visit should be 4-6 weeks from their initial treatment. F sessions 3 and beyond, treatment intervals depend on the following body location: Head and Neck weeks Underarms, Bikini, Tso (front and back) weeks Extremities (Arms and Legs) weeks If patient notices new hair growth after 2-3 weeks post-treatment (i.e. the hair is in the Anagen state), they may return ASAP f a follow up session. A minimum of 6-8 treatments may be needed. Part No , Rev. D 31/07/2009 Page 6.1

2 Laser Hair Reduction and Pseudofolliculitis Gemini Nd:YAG 1064 nm These treatment parameters should be used on Fitzpatrick skin types I - VI. 1. Determine the patient s skin type and select the settings f the test spots from the parameters on page As a reminder, these settings should be adjusted accding to the col, texture, and density of the hair. Black, coarse, very dense beard hair requires lower fluences. Darker skin types require longer pulse durations. 3. Remove any make-up lotions and cleanly shave the area to be tested. Apply clear, colless ultrasound clear, colless (no alcohol Lidocaine) Aloe Vera gel and test spot the treatment area with the highest density hair growth. Always use contact cooling. 4. Starting with Test Spot 1, perfm test spots, hold handpiece perpendicular to tissue. Deliver 3-4 test spots in either a square pattern line (Figure 1), with the laser set f 1 pulse per (PPS) (HZ). Remember: deliver one pulse, and quickly move to the next position. When treating, overlap the pulse by 10% and treat in a basket weave pattern (two passes in opposite directions is the basket weave pattern). Treat until you have a discomft level of 3-5 depending on topical use. Look f perifollicular erythema and edema in skin types I-III. Number of passes depends on the afementioned responses. 5. Recd the initial reaction on the test spot notes. Tell the patient you are determining the highest level of energy that their skin can tolerate without adverse reaction. point should be based on Pain Scale value of 3-4 with topical anesthetic applied, of 5-6 with no topical applied. Sensation should feel like plucking waxing. See Mankoski Pain Scale next page. 6. Test spots on patients with skin types V and VI should be observed after a day waiting period pri to the actual treatment. Other skin types may not have to wait as long. Page 6.2 Part No , Rev. D 31/07/2009

3 Laser Hair Reduction and Pseudofolliculitis Gemini Nd:YAG 1064 nm 7. Upon return, using medium pressure on the handpiece, treat the patient at the highest fluence tested that created the desired discomft level, and did not cause an adverse reaction (crusting, blistering pigment change). 8. Do not test spot over a bony area treat within the peribital ridge treat eyebrows. Retract pull the skin away from the peribital ridge bony prominence to treat. If it is necessary to treat over a bony area, reduce fluence by 10%. 9. Utilize tongue, wet gauze pad, white clear (colless) mouth guard to protect teeth. 10. Avoid any permanent tattoo and cosmetic tattoo (eye liner, lip liner, cheek blush). 11. F Skin types V VI only, if clinical end points are not achieved, you may use settings f one lighter skin type. Mankoski Pain Scale Figure 1. Test Spot and Treatment Ranges point should be based on Pain Scale value of 3-4 with topical anesthetic applied, 5-6 with no topical applied. Sensation should feel like plucking waxing. 0 Pain Free 6 Can t be igned f any length of time 1 Very min annoyance-occasional min twinges 7 Makes it difficult to concentrate 2 Min annoyance-occasional strong twinges 8 Nausea and dizziness set in as facts of pain 3 Annoying enough to be distracting 9 Unable to speak. Crying out moaning 4 Can be igned if you really concentrate uncontrollably near delirium 5 Can t be igned f me than 30 minutes 10 Unconscious. Pain makes you pass out. Copyright 1995, 1997 Andrea Mankoski. All rights reserved. Right to copy with attribution freely granted. Part No , Rev. D 31/07/2009 Page 6.3

4 Laser Hair Reduction and Pseudofolliculitis Gemini Nd:YAG 1064 nm Caution: The following treatment parameters are those repted by physicians using IRIDEX products either in published literature (Clinical References Chapter 16) repted directly to IRIDEX. These treatment parameters are only relevant to Fitzpatrick Skin Types I-VI. It is the physician s professional responsibility to determine individualized safe treatment parameters to be used on a case by case basis. These procedures should only be perfmed by physicians who have completed a specialized medical preceptship clinical in-service. When treating black, coarse hair using the 10 mm VersaStat use the following settings: and Ranges Test Spot # 1 Test Spot # 2 Test Spot # 3 I 65 ms 50 J/cm 2 * 65 ms 55 J/cm 2 * 65 ms 60 J/cm 2 * II 50 ms 40 J/cm 2 * 60 ms 45 J/cm 2 * 65 ms 50 J/cm 2 * III 50 ms 35 J/cm 2 * 55 ms 40 J/cm 2 * 60 ms 45 J/cm 2 * IV 50 ms 30 J/cm 2 * 55 ms 35 J/cm 2 * 60 ms 40 J/cm 2 * V 50 ms 26 J/cm 2 * 55 ms 30 J/cm 2 * 60 ms 35 J/cm 2 * VI 55 ms 20 J/cm 2 * 60 ms 26 J/cm 2 * 65 ms 30 J/cm 2 * Skin Type Note: The 10 mm VersaStat uses photon-recycling and delivers approximately 1.5 times the fluence shown on the Gemini control panel. Parameters indicated in the tables above should be displayed on the control panel. When treating medium to fine and lighter hair using the, 4.6 mm 5 mm spot size, use the following settings to achieve higher fluences: and Ranges Test Spot # 1 Test Spot # 2 Test Spot # 3 I 50 ms 160 J/cm 2 * 60 ms 170 J/cm 2 * 60 ms 180 J/cm 2 * II 40 ms 130 J/cm 2 * 50 ms 140 J/cm 2 * 50 ms 150 J/cm 2 * III 40 ms 100 J/cm 2 * 40 ms 110 J/cm 2 * 40 ms 120 J/cm 2 * IV 45 ms 75 J/cm 2 * 45 ms 85 J/cm 2 * 45 ms 95 J/cm 2 * V 50 ms 55 J/cm 2 * 50 ms 65 J/cm 2 * 50 ms 75 J/cm 2 * VI 60 ms 40 J/cm 2 * 60 ms 45 J/cm 2 * 65 ms 50 J/cm 2 * Skin Type *Perifollicular edema and Mankoski Pain Scale 3-4 with topical anesthetic applied Mankoski Pain Scale 5-6 with no topical anesthetic applied. Page 6.4 Part No , Rev. D 31/07/2009

5 Vascular Lesions Gemini Nd:YAG 1064 nm Caution: The following treatment parameters are those repted by physicians using IRIDEX products either in published literature (Clinical References Chapter 16) repted directly to IRIDEX. These treatment parameters are only relevant to Fitzpatrick Skin Types I-VI. It is the physician s professional responsibility to determine individualized safe treatment parameters to be used on a case by case basis. These procedures should only be perfmed by physicians who have completed a specialized medical preceptship clinical in-service. 1. Adjust the spot size until it is 25 50% wider than vessel size. 2. Do not overlap when treating. Treat until you observe a col change in a vessel. You can treat until you observe a sluggish refill no refill. Do not perfm consecutive passes over a vessel but move to the next vessel and return to the iginal vessel if additional passes are needed. You should never observe a white gray col to the skin vessel. 3. Use a longer f darker skin types. 4. Adjust the s per Second f treatment efficiency and safety. 5. Increase fluence by 10% increments from base setting to achieve the desired end point. 6. Begin treatments with the lowest setting. Observe tissue reaction on a small area f two minutes pri to proceeding. Increase energy until observation of end point. 7. Maintain contact with the treatment area but do not apply pressure with the handpiece the vessel will blanch. An immediate post-treatment cat scratch appearance is nmal. 8. Do not retreat f 8 to 12 weeks. The default laser parameters are based on the minimum fluence and average pulse width settings from the Leg Vein chart listed below. Leg Veins Vessel Size Spot Size PPS* Cooling Gel Red Veins 1.5 mm msec J/cm pps < 1.0 mm Red/Purple mm Blue mm Blue/Green 1.5 mm msec J/cm pps 3 mm msec J/cm pps 5 mm msec J/cm 2 1 pps Facial Veins No vascular treatments should be done above the zygomatic arch. Facial Vein Vessel Size/Col mm Red mm Blue Disappear Disappear Disappear Disappear Spot Size PPS Cooling Gel 1.5 mm 1.5 mm msec msec J/cm pps J/cm pps Venous Lake of the Lip You should notice a lightening blanching effect. Venous Lake of the Lip *s Per Second Part No , Rev. D 31/07/2009 Page 6.5 Disappear Spot Size PPS Cooling Gel 4.6 mm 50 msec J/cm 2 1 pps Turns black blanches Blue/Purple Pt Wine Stains/Hemangiomas Note: Nd:YAG is most effective on thick PWSs, use the 532 nm f pink and flat PWSs. You should notice a slight darkening of col. Col Spot Size PPS Cooling Gel Dark 3 mm msec 125 J/cm pps

6 Pigmented Lesions Gemini KTP 532 nm Caution: The following treatment parameters are those repted by physicians using IRIDEX products either in published literature (Clinical References Chapter 16) repted directly to IRIDEX. These treatment parameters are only relevant to Fitzpatrick Skin Types I-IV. It is the physician s professional responsibility to determine individualized safe treatment parameters to be used on a case by case basis. These procedures should only be perfmed by physicians who have completed a specialized medical preceptship clinical in-service. Begin treatments at the lowest fluence level increasing fluence until lesion darkens. Perfm test spots to determine the highest fluence that can be tolerated. 1. Pre-treat me pronounced lesions with 2 passes in a basket weave pattern. 2. Treat twice in a basket weave pattern, keeping handpiece perpendicular to the skin. 3. With the 4.0 mm use a 10% overlap when treating. 4. Use cooled, clear (colless) gel where indicated. 5. These parameters must be used with cooling as indicated. 6. Reduce fluence by 15% if you cannot cool as directed. 7. Maintain contact with the treatment area but do not apply pressure with the handpiece. When treating with the 10 mm handpiece, start with lower fluence (4-6 J/cm 2 ). Pass over the pigmented lesion until you see a darkening of the lesion. Immediately after treatment, apply cold compresses to lasing site f minutes. This will reduce the amount of post-treatment discomft. Increase the fluence by 1 to 2 J/cm 2 on subsequent treatments. If swelling ensues after cold compresses are applied, lower the fluence by 1 J/cm 2. The physician and patient may decide to apply additional cold compresses after the session at their discretion. Pigmented Lesions Spot Size Solar Lentigos (treat twice) Lighter = me fluence Darker = less fluence Café-au-Lait (Treat twice in a basket weave pattern) Post Trauma Hyperpigmentation Melasma 1.5 mm 4 mm 5 mm DermaStat 1.5 mm 4 mm DermStat DermaStat 4 mm 4 mm 5 mm (Two passes) 10 mm (One pass) 9 msec msec msec 2-5 msec 2-10 msec 9 msec msec 3-5 msec 3-5 msec 3 msec 5-10 msec J/cm J/cm J/cm J/cm J/cm J/cm J/cm J/cm J/cm 2 per 1-2 pps 1 3 pps 1-2 pps 1-2 pps 2-3 pps 2-3 pps 2-3 pps J/cm pps 8-12 J/cm pps Cooling Gel Graying Graying msec 6-12 J/cm msec msec 6-12 J/cm J/cm 30 msec 4-9 J/cm 2 Page 6.6 Part No , Rev. D 31/07/2009

7 Vascular Lesions Gemini KTP 532 nm Caution: The following treatment parameters are those repted by physicians using IRIDEX products either in published literature (Clinical References Chapter 16) repted directly to IRIDEX. These treatment parameters are only relevant to Fitzpatrick Skin Types I-IV. It is the physician s professional responsibility to determine individualized safe treatment parameters to be used on a case by case basis. These procedures should only be perfmed by physicians who have completed a specialized medical preceptship clinical in-service. Begin all treatments at the lowest fluence level increasing fluence until vessel blanches. 1. Keep the handpiece perpendicular to the skin and use cooled, clear (colless) gel where indicated. These parameters must be used with cooling as indicated. 2. Reduce fluence by 15% if you cannot cool as directed. 3. Maintain contact with the treatment area but do not apply pressure with the handpiece the vessel will blanch. When using the f defined, red, facial telangiectasia, set the appropriate parameters f a spot size. Then adjust the spot size to reflect 25-50% wider than the vessel size. The laser defaults to the lowest and average f all spot sizes. When treating with the 10 mm handpiece, start with lower fluence (4-6 J/cm 2 ) making one pass only. Immediately after treatment, apply cold compresses to lasing site f minutes. This will reduce the amount of post-treatment discomft. Increase the fluence by 1 to 2 J/cm 2 on subsequent treatments. If swelling ensues after cold compresses were applied, lower the fluence by 1 J/cm 2. The physician and patient may decide to apply additional cold compresses after the session at their discretion. (Continued on page 6.8) Part No , Rev. D 31/07/2009 Page 6.7

8 Vascular Lesions Gemini KTP 532 nm cont. (Continued from page 6.7) Vascular Lesions Defined Red Facial Telangiectasias with cooling Shallow-up to Defined Red Facial Telangiectasias without cooling Matted Facial Telangiectasias, Spider Angiomas, Rosacea Cherry Angioma Pt Wine Stain-Red Pt Wine Stain-Pink Pt Wine Stain- Purple Venous Lake AVM Skin Tags Warts Spot Size DermaStat 4 mm 5 mm msec msec 10 msec 10 msec msec msec J/cm J/cm J/cm J/cm J/cm J/cm 2 per Cooling 10 mm 30 msec 6-9 J/cm 2 4 mm 1.5 mm DermaStat DermaStat 15 msec 15 msec J/cm J/cm pps 1-2 pps Gel Thin Layer Thin Layer Thin Layer Thin Layer msec 6-12 J/cm msec 15 msec 35 msec 35 msec J/cm J/cm 2 18 J/cm J/cm 2 1 pps 1 pps Thin Layer Thin Layer Disappear Disappear Disappear Blackening Turns Black Blanches Disappear 9 msec J/cm pps Necrosis 2-5 msec 2-10 msec msec msec J/cm J/cm J/cm J/cm 2 Necrosis Necrosis Page 6.8 Part No , Rev. D 31/07/2009

9 Enhanced Skin Rejuvenation Gemini KTP 532 nm/nd:yag 1064 Caution: The following treatment parameters are those repted by physicians using IRIDEX products either in published literature (Clinical References Chapter 16) repted directly to IRIDEX. These treatment parameters are only relevant to Fitzpatrick Skin Types I-IV. It is the physician s professional responsibility to determine individualized safe treatment parameters to be used on a case by case basis. These procedures should only be perfmed by physicians who have completed a specialized medical preceptship clinical in-service. Enhanced Skin Rejuvenation combines treatments with both the 532 nm and 1064 nm wavelength. Each treatment is usually done in three steps. First, use the 532 nm wavelength to treat solar lentigos and vascular lesions. Then, use the 532 nm wavelength to treat diffuse, undefined pigmented and vascular irregularities. The last step is to use the 1064 nm wavelength f wrinkle reduction. These steps can also be done alone to treat problem areas. In addition, two weeks following this treatment, you may follow up with a Lunchtime Laser Peel using the Venus i 2940 nm laser. This procedure is described on page 8.1. The patient must have a clear understanding of the following: Several treatments (up to six) may be needed f Enhanced Skin Rejuvenation every two to four weeks. The patient may see dramatic results in lightening of defined pigmented areas veins in just one to two treatments with the 532 nm wavelength. Treat every four weeks at a minimum. Areas of diffuse undefined pigment rosacea treated with the 532 nm wavelength will show progressive improvement. Treat every 2 to 4 weeks. Wrinkle reductions are subtle and will begin to be evident after a series of treatments. Treat every 2 to 4 weeks. Some redness and swelling may last from a few hours to a few days. Photo damage will recur if the patient does not avoid sun exposure and use sun block of at least SPF45 on a daily basis. Perfm test spots to determine highest fluence that can be tolerated. (Continued on page 6.10) Part No , Rev. D 31/07/2009 Page 6.9

10 Enhanced Skin Rejuvenation Gemini KTP 532 nm/nd:yag 1064 cont. (Continued from page 6.9) Step 1: Treat defined pigmented and vascular lesions with the 532 nm wavelength. These treatment parameters should be used on Fitzpatrick skin types I IV. Start with treating pigmented lesions at the lowest settings and increase fluences. Look f an end point of the lesions darkening turning a light gray col. When treating vascular lesions, look f an end point of clear resolution of small superficial vessels. Maintain contact with the treatment area, but do not apply pressure with the handpiece the vessel will blanch. Caution: Never treat suspicious moles lesions. Follow appropriate dermatologic protocols. Pigmented Lesions Solar Lentigos (treat twice) Lighter = me fluence Darker = less fluence Spot Size per Cooling Gel 10 mm 50 msec 4 12 J/cm pps and 5 mm msec 9-12 J/cm pps DermaStat 2-5 msec J/cm 2 Graying 2-10 msec 7-16 J/cm 2 Graying Step 2: Treat diffuse, undefined pigmented and vascular irregularities and rosacea using the 532 nm wavelength. These treatment parameters should be used on Fitzpatrick skin types I IV. Paint over the entire treatment area. A subtle reaction is seen with the end-point f improvement at two to four weeks. Maintain contact with the treatment area but do not apply pressure with the handpiece. Glide over the skin. Cover affected area twice in different directions (basket weave pattern). Then, if needed, Paint the entire face treatment area (including affected area) with the same settings. When treating with the 10 mm handpiece, start with lower fluence (4-6 J/cm 2 ) making one pass only. Immediately after treatment, apply cold compresses to lasing site f minutes. This will reduce the amount of post-treatment swelling. Increase the fluence by 1 to 2 J/cm 2 on subsequent treatments. If swelling ensues after applying cold compresses, lower the fluence by 1 J/cm 2 f subsequent treatments. Caution: Never treat suspicious moles lesions. Follow appropriate dermatologic protocols. Paint the area Paint the face treatment area, usually covered twice in different directions (4-5 mm only). These settings are also used in diffuse undefined pigmented areas, rosacea, matted fine telangiectasias, and melasma Spot Size 4 mm 5 mm 10 mm = One pass msec msec per 6-12 J/cm J/cm 2 Cooling Required Required Page 6.10 Part No , Rev. D 31/07/2009 Gel 30 msec 4-9 J/cm pps Required * Use longer s with skin types III and IV. (Continued on page 6.11)

11 Enhanced Skin Rejuvenation Gemini KTP 532 nm/nd:yag 1064 cont. (Continued from page 6.10) Step 3: Use the 1064 nm wavelength f wrinkle reduction. Apply light pressure with the handpiece. These treatment parameters should be used on Fitzpatrick skin types I - VI. Cautions Lower fluence over bony and thin-skinned areas, and avoid larger deeper facial vessels. Never treat within the peribital ridge. The patient must wear wavelength appropriate eyewear metal eye shields. Always point the handpiece away from the eye. Avoid the eyebrow area to reduce the chance of unintended hair reduction. Always protect teeth with folded wet gauze pads, the tongue a white/clear (colless) mouth guard if treating in that area. Contact cooling must be maintained at all times. Cover fehead, upper lip and temples in one direction (one pass). Paint over the cheeks and chin, covering twice in different directions (two passes). Longer pulse widths and lower fluence should be used on darker skin types. Test spots should be perfmed to determine the highest fluence tolerated. Chilled, clear (colless) gel should be used during treatments. Skin Type and Ranges 10 mm 5 mm per Cooling Gel I and II 50 ms 40 J/cm 2 40 ms 125 J/cm pps Required Slight III 50 ms 35 J/cm 2 40 ms 100 J/cm pps Required Slight IV 50 ms 30 J/cm 2 45 ms 75 J/cm pps Required Slight V 50 ms 26 J/cm 2 50 ms 55 J/cm pps Required Slight VI 55 ms 20 J/cm 2 60 ms 40 J/cm pps Required Slight 5 mm Spot Size should be used to stimulate Local Wrinkle Reduction within the wrinkle crease pockmark. 1. Make one pass in affected area with 5 mm spot traveling in one direction. 2. Paint over entire face with 10 mm handpiece, as mentioned above. Make one pass over fehead, temples, and upper lip in single direction. Make two passes over cheeks and chin in alternate Basket Weave pattern. 3. If patient experiences increased discomft, lower settings by going one skin type darker. Note: Patients may be treated every 2 weeks f a series of 6 treatments. Visible Wrinkle Reduction may not occur until 6 to 8 weeks after the first treatment. Part No , Rev. D 31/07/2009 Page 6.11

12 Advanced Skin Rejuvenation Gemini KTP 532 nm/nd:yag 1064 nm Step 1. The following settings are applicable f pigmented and vascular lesions using 532 nm with the 10 mm handpiece. Pigmented and Vascular Lesions Spot Size per Cooling Gel Solar Lentigos Defined Facial Telangiectasias (with cooling) Acne Rosacea 10 mm Skin Type I-II 30 msec Skin Type III 40 mec Skin Type IV 50 msec Skin Type I-II 9-12 J/cm 2 Skin Type III 6-9 J/cm 2 Skin Type IV 4-6 J/cm 2 Required and/ Step 2. Use the 1064 nm f wrinkle reduction. Apply light pressure with the handpiece. Skin Type and Ranges 10 mm 5 mm per Cooling Gel I and II 50 ms 40 J/cm 2 40 ms 125 J/cm pps Required Slight III 50 ms 35 J/cm 2 40 ms 100 J/cm pps Required Slight IV 50 ms 30 J/cm 2 45 ms 75 J/cm pps Required Slight V 50 ms 26 J/cm 2 50 ms 55 J/cm pps Required Slight VI 55 ms 20 J/cm 2 60 ms 40 J/cm pps Required Slight 5 mm Spot Size should be used to stimulate local wrinkle reduction within the wrinkle crease pockmark. 1. Make one pass in affected area with 5 mm spot traveling in one direction. 2. Paint over entire face with 10 mm handpiece, as mentioned above. - Make one pass over fehead, temples, and upper lip in single direction. - Make two passes over cheeks and chin in alternate Basket Weave pattern. 3. If patient experiences increased discomft, lower settings by going one skin type darker. Note: Patients may be treated every 2 weeks f a series of 6 treatments. Visible Wrinkle Reduction may not occur until 12 weeks after the first treatment. Page 6.12 Part No , Rev. D 31/07/2009

13 Acne Treatment Gemini KTP 532 nm Caution: The following treatment parameters are those repted by physicians using IRIDEX products either in published literature (Clinical References Chapter 16) repted directly to IRIDEX. These treatment parameters are only relevant to Fitzpatrick Skin Types I-IV. It is the physician s professional responsibility to determine individualized safe treatment parameters to be used on a case by case basis. These procedures should only be perfmed by physicians who have completed a specialized medical preceptship clinical in-service. The patient must have a clear understanding of the following: Several treatment series may be needed f acne. Treatments are perfmed twice weekly f four weeks. (Twice weekly x four weeks = 8 treatments) One series of multiple treatments often reduce the severity of lesions but might not eliminate all lesions and break-outs. A percentage of patients might not respond to laser treatments f acne. Lesion improvement might be subtle; the acne lesions will heal over time. Some redness and swelling may last from a few hours to a few days after treatment. Patient MUST avoid sun exposure and use sun block of at least SPF 45 on a daily basis. Caution: Never treat suspicious moles lesions. Follow appropriate dermatologic protocols. Use lower fluences over bony and thin-skinned areas, and avoid larger deeper facial vessels. Use a 10% overlap when treating. Never treat within the peribital ridge. The patient must wear wavelength appropriate eyewear metal eye shields. Always point the handpiece away from the eye. Always protect teeth with folded wet gauze pads, tongue a white clear (colless) mouth guard if treating in that area. Contact cooling must be maintained at all times. Longer pulse widths and lower fluence should be used on darker skin types. Use a thin layer of cooled, clear (colless) gel. Always perfm test spots to identify highest fluence tolerated. Educate your patient that there may be increased outbreak post-treatment. This is tempary and is a result of the bacteria being destroyed. Outcomes can be improved with the use of an acne skin care regimen. Acne Spot Size per Cooling Gel Treat 2 times a week f 4 weeks and reassess 10 mm Skin Type I-II 30 msec Skin Type III 40 mec Skin Type I-II 9-12 J/cm 2 Skin Type III 6-9 J/cm 2 Required Mild to Moderate Skin Type IV 50 msec Skin Type IV 4-6 J/cm 2 F Skin Types V-VI, call IRIDEX to speak with a Clinical Nurse. Part No , Rev. D 31/07/2009 Page 6.13

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