Cutera limelight IPL treatment guidleine

1. CUTERA
LIMELIGHT
Yasemin Saray, Acıbadem Hospital

2. Indications
• The LimeLight Handpiece
• 520-1100 nm
• Treatment of vascular and pigmented
lesions
• Hair removal
• Rejuvenation

3. General Considerations
• Intense pulsed light (IPL)
• Non-laser high intensity light
• High-output flashlamp
• 500-1200 nm broad wavelength light
• Chromophores/Selective photothermolysis
• Green, yellow, red, infrared wavelengths/various
chromophores targeted concurrently
• Cut-off filters
• Treatment of various targets with the same device
.

4. Contraindications
• Pregnant Patients
• Skin Cancer

5. Precautions
• Do not treat dysplastic nevi or any questionable
pigmented lesions.
• 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.
• This device is not intended for treatment of leg veins.

6. Preparing for Treatment
• General Information
• Preparing for Treatment
• Selecting Parameters
• Entering Parameters
• Treatment Technique
• Treatment Examples
• Post-Op

7. Pre-Op – Medical History
 Current medications
 Accutane – do not treat if taken in the last 6 months
 Aspirin, ibuprofen, herbs (such as St. John’s Wort), vitamins, and
anticoagulants
 increase risk of purpura or bruising.
 Gold Therapy
 blue-gray discoloration
 Photosensitizing drugs (Tetracyclines, etc.)
 History of vitiligo
 flare-up in patients with pre-existing vitiligo.

8. Pre-Op – Medical History
Continued
 History of Melanoma
 Recent sun exposure in treatment area
 May need to adjust program and/or fluence
 Do not treat if the patient has had significant sun
exposure, or artificial tanning (light based or
sunless tanning products), in the 4 weeks prior to
treatment.
 Skin type using the Fitzpatrick Scale
 Patients with skin type IV should be treated with
caution.
 Treatment of skin type V and VI is not
recommended.

9. Pre-Op – Consent
Consent
 Provides treatment information
 Informs of expected and unexpected side effects

10. Pre-Op – Photos
Pre-op photos are your MOST valuable tool and
protection. You only have one chance to obtain good pre-
op photos.
 Document baseline condition
 Use for comparison purposes later on in treatment
 Consistent technique is important for useful, comparable
photos.
 Matched patient positioning
 Camera settings
 Room lighting

11. Patient Prep – Clean
• Remove all make-up, sunscreen, topical anesthetics, etc.

12. Patient Prep – Shave
• Shave the treatment site.
 Remove all hair from the surface of the skin.
 Unshaved hair will absorb energy, possibly
causing a burn, and reduce the total delivered
energy.

13. • These treatments can be tolerated without
anesthesia.
• Topical anesthesia
Optional Procedure
Patient Prep – Patient
Comfort

14. Patient Prep – Marking
• Large areas are easier to treat if divided into smaller grids.
 Mark with a white eyeliner pencil.
 Use only WHITE pencil as it will not absorb light.
 Because eyeliner pencil components are not standardized, test the
pencil before using on patients.
Optional Procedure

15. Selecting Parameters
• General Information
• Preparing for Treatment
• Selecting Parameters
• Entering Parameters
• Treatment Technique
• Treatment Examples
• Post-Op

16. Selecting Parameters–Fixed Parameters
• Spot Size
Fixed at 10 mm x 30 mm
30 mm
10 mm
Treatment
Window
Pulse width
 Duration of each light pulse
 Pulse width is automatically set based on the
program and fluence chosen.

17. Selecting Parameters – Sun Mode
• Sun Mode increases the treatment window temperature
from the standard setting, 5° or 10° C, to 20° C.
 Sun Mode, without the use of gel, allows for the treatment of lentigines at
lower fluences than would otherwise be required.
 When treating telangiectasia, it is best to use standard cooling (5° or 10° C)
in combination with a thin layer of clear (no color) ultrasound gel.
Screen with Sun Mode on
Screen with Sun Mode off
Standard Cooling

18. Selecting Parameters – Fluence
Fluence
 Amount of energy applied in a given area
 Joules/cm2 (J/cm2)
 Adjust based on skin type, bronzing, lesion(s)
to be treated, hair density, and epidermal
response.
 Select initial setting based on patient evaluation, do
a test area treatment, and watch for epidermal
response.

19. Selecting Parameter– Fluence
Continued
Fluence settings should be selected to provide treatment without
affecting the pigmentation of background skin.
 CAUTION: Lightening of the entire treatment area can occur, even at low
fluences, in tanned skin and skin type IV.
Pre-Treatment Desired Response for Lentigines on Skin
Type II (45 minutes after test shot)

20. Selecting Parameters –
Guidelines
The following are typical treatment parameters for skin types I-IV.
Treatment of skin type V and VI is not recommended.
Lower fluences for darker targets, both pigmented and vascular, or
over bony areas.
The potential for over-treatment is greatest with skin type IV and
bronzed skin.
Chest, neck and body at lower fluences.

21. Selecting Parameters – Guidelines*
Skin Type Condition Program Fluence
(Face)
Fluence
(Neck, Chest & Body)
I-II Fine Telangiectasia and
Diffuse Redness
A 12 – 18 J/cm2
Treatment in these areas
usually requires 2-4 J/cm2
less than on the face for
similar conditions.
I-III Telangiectasia, Diffuse
Redness and Solar
Lentigines
B 12 – 26 J/cm2
IV and III with
actinic bronzing
Telangiectasia, Diffuse
Redness and Solar
Lentigines
C 12 – 22 J/cm2
The LimeLight has three program modes (A, B and C) which control the
wavelength distribution, pulse duration and epidermal cooling:

22. Entering Parameters
• General Information
• Preparing for Treatment
• Selecting Parameters
• Entering Parameters
• Treatment Technique
• Treatment Examples
• Post-Op

23. Eye Safety
Operator Eyewear Patient Eyewear
Observer Eyewear

24. Entering Parameters –
Controls and Indicators
Fluence
Repetition
Rate
Standby
Mode
Ready
Mode
Pulse Count
Indicator
Emission
Indicator
Sun Mode
Indicator
Program
Indicator
8 0.0
3
Treatment Tip Temperature

25. Treatment Technique
• General Information
• Preparing for Treatment
• Selecting Parameters
• Entering Parameters
• Treatment Technique
• Treatment Examples
• Post-Op

26. Treatment Technique – Test
Spot – Lentigines
Before Treatment Immediately After Treatment 45 Minutes After Treatment 1 Hour After Treatment

27. Treatment Technique – Test
Spot
Before Treatment 5 Minutes After Treatment 10 Minutes After Treatment 25 Minutes After Treatment

28. Treatment Technique – Test Spot
Program B; 10 J/cm2
Sun Mode On
(Not recommended for
skin type IV)
Program C; 15 J/cm2
Sun Mode On
Test spot on Skin Type IV
Before
Treatment
20 Minutes After
Treatment
1 Day After
Treatment
2 Days After
Treatment
22 Days After
Treatment

29. Treatment Technique – Overview
1. Place the entire light-emitting window in contact with the skin.
Note: When telangiectasias are present, apply a thin layer of clear (no
color) ultrasound gel and use standard cooling (5° to 10° C). For treatment of
areas with only solar lentigines, use Sun Mode and no gel.
2. Deliver one light pulse by depressing the footswitch.
3. Repeat process at next location, covering each area only once.

30. Treatment Technique –
Overview Continued
1. Deliver the first pulse.
2. Move 10 mm for adjacent
pulse placement.
3. Deliver next pulse.

31. Treatment Technique
• For patients with both pigmented and vascular lesions,
treat the vascular component first with gel and standard
cooling (Sun Mode off). At a later visit the pigmented
component may be treated with no gel and the Sun Mode
on.
• For patients with significant sun damage, treat in layers.
 Start with a low fluence to treat the darkest spots.
 Increase fluence at subsequent treatment visits to treat lighter
lesions.
 For a uniform result, treating the entire face is generally desired.

32. Treatment Technique – Actinic
Bronzing
Patients with pigmentary effects of long-term tanning (actinic bronzing) must
be treated carefully.
The initial low fluence
The fluence that is sufficient to treat the lentigines, but not affect the
pigmentation in the surrounding skin.
Lightening of the pigmentation in the entire area treated. If this is the goal,
treated areas will be noticeably lighter compared to the surrounding skin. The
result may not be satisfactory unless the entire site is uniformly treated.
Before Skin Type III Actinic Bronzing After 1 Treatment

33. Treatment Examples
• General Information
• Preparing for Treatment
• Selecting Parameters
• Entering Parameters
• Treatment Technique
• Treatment Examples
• Post-Op

34. Example Series I
Female, Skin Type III
 Treated with Program B at 22 J/cm2, Sun Mode on, no gel
 Note that even low contrast lentigines show an efficacious result.
Immediately After Treatment
Before Treatment

35. Example Series I
20 Minutes After Treatment
Before Treatment
Female, Skin Type III
 Treated with Program B at 22 J/cm2, Sun Mode on, no gel

36. Example Series I
1 Hour After Treatment
Before Treatment
Female, Skin Type III
 Treated with Program B at 22 J/cm2, Sun Mode on, no gel

37. Example Series I
1 Day After Treatment
Before Treatment
Female, Skin Type III
 Treated with Program B at 22 J/cm2, Sun Mode on, no gel

38. Example Series I
11 Days After Treatment
Before Treatment
Female, Skin Type III
 Treated with Program B at 22 J/cm2, Sun Mode on, no gel

39. Example Series IV
Female, Skin Type II
 Chest treated with Program B at 16 J/cm2, Sun Mode on, no gel used
3 Days After Treatment
Before Treatment

40. Example Series IV
Female, Skin Type II
 Chest treated with Program B at 16 J/cm2, Sun Mode on, no gel used
6 Weeks After Treatment
Before Treatment

41. Example Series V
Female, Skin Type IV
 Cheeks treated with Program C at 15 J/cm2, Sun Mode on, no gel used
Immediately After 1st Treatment
Before 1st Treatment

42. Example Series V
2 Hours After 1st Treatment
Before 1st Treatment
Female, Skin Type IV
 Cheeks treated with Program C at 15 J/cm2, Sun Mode on, no gel used

43. Example Series V
1 Week After 1st Treatment
Before 1st Treatment
Female, Skin Type IV
 Cheeks treated with Program C at 15 J/cm2, Sun Mode on, no gel used

44. Example Series V
Female, Skin Type IV
 Cheeks treated a 2nd time 1 month later with Program C at 15 J/cm2,
Sun Mode on, no gel used
Immediately After 2nd Treatment
Before 2nd Treatment
(1 Month After 1 Treatment)

45. Example Series V
20 Minutes After 2nd Treatment
Female, Skin Type IV
 Cheeks treated a 2nd time 1 month later with Program C at 15 J/cm2,
Sun Mode on, no gel used
Before 2nd Treatment
(1 Month After 1 Treatment)

46. Example Series V
1 Hour After 2nd Treatment
Female, Skin Type IV
 Cheeks treated a 2nd time 1 month later with Program C at 15 J/cm2,
Sun Mode on, no gel used
Before 2nd Treatment
(1 Month After 1 Treatment)

47. Example Series V
1 Day After 2nd Treatment
Female, Skin Type IV
 Cheeks treated a 2nd time 1 month later with Program C at 15 J/cm2,
Sun Mode on, no gel used
Before 2nd Treatment
(1 Month After 1 Treatment)

48. Example Series V
2 Days After 2nd Treatment
Female, Skin Type IV
 Cheeks treated a 2nd time 1 month later with Program C at 15 J/cm2,
Sun Mode on, no gel used
Before 2nd Treatment
(1 Month After 1 Treatment)

49. Example Series V
5 Days After 2nd Treatment
Female, Skin Type IV
 Cheeks treated a 2nd time 1 month later with Program C at 15 J/cm2,
Sun Mode on, no gel used
Before 2nd Treatment
(1 Month After 1 Treatment)

50. Post-Op
• General Information
• Preparing for Treatment
• Selecting Parameters
• Entering Parameters
• Treatment Technique
• Treatment Examples
• Post-Op

51. Post-Op – Immediate
• 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.

52. Post-Op – Wound Care
• If a blister or other wound develops, keep the treatment
area clean with soap and water.
• Apply a dressing with antibiotic ointment twice a day.
• Keeping a wound “greasy” with plain Vaseline or any
ointment enhances wound healing and reduces the risk
of scarring.

53. Post-Op – Micro-Crusting
• Treated lentigines
usually darken after
treatment, and crusting
begins to form within a
few days.
 Crusting usually resolves
in 1-3 weeks and should
be allowed to naturally
flake off for best results.
Before Treatment
1 Day Post-Treatment
Photos courtesy of Adrian Yi MD and Walter Dishell MD

54. Post-Op – Follow-Up
• Localized erythema may also be present and typically resolves
within 24-48 hours. If prolonged erythema occurs, future
treatments should be performed at a lower fluence.
• The recommended time interval between treatments is 4 weeks or
longer, depending on the rate of clearance following treatments.
• Patients should avoid artificial tanning, or sun exposure without
sun protection, between treatments and 4 weeks following the final
treatment.
• The use of harsh chemicals (i.e., depilatories, acids, etc.) should
not be used immediately before and after treatment for a minimum
of 24 hours.

55. Post-Op – Handpiece Care
• Disinfect the handpiece and window
between patients with a germicidal
disposable wipe, such as Sani-Cloth®.
Handpiece Window

56. Program B at 14 j/cm2, Sun Mode on, no gel

57. Program B at 14j/cm2, Sun Mode on, no gel

58. 1st treatment, Program B at 12 j/cm2,
Sun Mode on, no gel

59. 2nd treatment, Program B at 15 j/cm2,
Sun Mode on, no gel

61. 1st treatment, Program B at 12 j/cm2,
Sun Mode on, no gel

62. 1st treatment, Program B at 16 j/cm2,
Sun Mode on, no gel

63. 1st treatment, Program B at 12 j/cm2,
Sun Mode on, no gel

64. 1st treatment, Program B
at 12 j/cm2,
Sun Mode on, no gel

65. 1st treatment, Program B at 12 j/cm2,
Sun Mode on, no gel