Candela Vbeam Perfecta Instruction Manual

Candela Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
8502-00-0891 Revision G Candela Proprietary Sheet 1 of 8
Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
These guidelines were developed from clinical experience and are subject to change as additional experience
is gained. Be sure to inquire with your Candela Sales Representative, Clinical Consultant or visit
MyCandela.com regularly for the latest updates and a comprehensive bibliography list of references/published
articles. Treatment Guidelines do not take the place of the procedures and instructions found in the Operator’s
Manual. FAILURE TO USE THE LASER IN ACCORDANCE WITH SUCH PROCEDURES AND
INSTRUCTIONS COULD RESULT IN SERIOUS INJURY TO THE OPERATOR, THE PATIENT AND
OTHERS, AS WELL AS DAMAGE TO THE LASER SYSTEM. Follow OSHA and ANSI standards for laser
safety. Protective eyewear must be worn by all persons in the treatment room during laser operation. Perform
User Verification tests as outlined in the Operators Manual at the start of each treatment day and when the
hand piece is changed. Check the delivery system for any damage (i.e.: dropped). Discontinue use of your
laser delivery system if you suspect a problem.
Lesion
Spot
size
(mm)
Pulse
Duration
(ms)
Fluence
(J/cm2)
DCD
Spray / Delay
(ms)
Retreat
(weeks)
Comments
Telangiectasia
Facial
Nasal
5
7
10
3x10
5, 7
10
3x10
6,10,20
6,10,20
6,10,20
10
40
7.5-12
7-12
5.5-7.5
11-14
8-12
6.5-7.5
10-12
medium
30/20
4-6
Double or triple pulse
depending on the refill of
the vessel.
Use 3x10 on linear vessels.
For vessels which do not
clear immediately: treat first
with the round spot followed
by the 3x10 spot.
Use of shorter pulse
durations will induce
purpura but may clear
vessels faster.
Leg
3x10
10,20,30,
----------
40
11-18
------------
15-25
medium
30/20
-------------
high
40/20
8-12
Select longer pulse
durations to decrease
purpura.
Telangectatic
Matting
7
10
10,20,30
11-15
6-7
medium
30/20
6-10
Larger spot size may
improve results.
Expect erythema.

Candela Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
8502-00-0891 Revision G Candela Proprietary Sheet 2 of 8
Photo-
Rejuvenation
Wrinkles
Diffuse Facial
Telangiectasia
Rosacea
Dyschromia
Benign
Epidermal
Pigmented
Lesions
7
10
----------
7
10
12
---------
7
10
---------
7PL
10PL
10
6
---------
6,10,20
40
------------
10
-----------
1.5
7
6
-----------
8-11
5.0 -7
5-7
-------------
7-8
5-7
-------------
7-10
5.5-8
medium
30/20
--------------
OFF
4 – 6
Treat full face with one
pass using dyschromia
parameters followed by an
additional pass using
wrinkles/diffuse redness
parameters.
Diffuse vessels/background
blush: may treat the entire
cosmetic unit w/ 50%
overlap using a larger spot.
Shorter pulse durations and
higher fluences may induce
purpura.
Vessels may be pulsed 2-3
times to obtain transient
intravascular purpura,
which will disappear and
become bluish pink" dusky
erythema.”
May use 10-12mm spot
then retreat larger vessels
immediately with smaller
spot size.
---------------------------------------------
Press the lens firmly onto the skin
until the skin turns pale.
Clinical endpoint = darkening or
color change at the treatment site-
observe tissue response. Always
start with the lowest fluence and
observe the lesion for several
minutes before adjusting fluence.
Darker lesions may require lower
fluences.
Peri-lesional erythema may occur.
Poikiloderma of
Civatte
10
10
5-6.5
medium
30/20
4-6
Always perform test spots
laterally. Apply pulses close
to one another to minimize
uneven pattern. Feather
edge (decrease fluence by
1-2 J/cm2@ periphery) to
minimize sharp line of
demarcation.
Expect erythema
Cherry
Angioma;
Spider
Angioma
3
5
7
10
1.5
12
10
8-11.5
5-10
medium
30/20
4-6
Use white, moist template
to isolate lesion. Double
pulse center of angioma
first, then treat peripheral
vessels. Clinical
endpoint=purpura.

Candela Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
8502-00-0891 Revision G Candela Proprietary Sheet 3 of 8
Hemangiomas
5
7
10
1.5
8-10
6-10
5-6
medium
30/20
high 40/20
for larger,
thicker
lesions
2 weeks
(neonate
and
Infant)
8-12
weeks
(Adult)
Use caution and lower
fluences for neonates and
infants.
Treat proliferative
hemangiomas every two
weeks. Improper treatment
may cause scars. Refer to
specialist if not within your
typical practice. Clinical
endpoint=purpura.
Venous Lake
7 1.5 7-10
medium
30/20
4-6
Two treatments may be
required.
Clinical endpoint=purpura.
Port Wine
Stains
Facial
Neck, Head
Trunk,
Extremities
Hypertrophic
PWS
5
7
7
10
5
7
10
5
7
10
0.45
1.5
1.5
1.5
10-15
8-12
4-7.5
6-12
6-7.5
5-7
10-15
10-15
10
medium
30/20
medium
30/20
high
40/20
8-12
Use caution lower
fluences and DCD for
neonates and infants.
Clinical endpoint=
purpura
Use lower fluences on neck
and extremities.
Ectatic vessels associated
with hypertrophic PWS may
be double pulsed.
Warts
Non- Facial
----------------------
Facial
5
7
----------
5
1.5
----------
1.5
12-15
------------
9-9.5
0
----------
medium
30/20
2-3
Non-Facial Warts:
Pare thick warts before treatment.
Cryogen may be sprayed pre and
post laser to cool area. Topical or
injected anesthetic may be utilized.
Pulse stack (1-3 pulses) if
tolerated. Clinical endpoint=
purpura. Treat a 1-2 mm margin
of uninvolved skin with single
pulses at the periphery of the wart.
Use of home topical therapy may
increase efficacy.
Facial Warts: CAUTION:
Single pulses only
Observe tissue response
Use DCD
Inflammatory
Acne Vulgaris 10
3 4.5 medium
30/20
4
Slight redness and light
purpura may be
experienced, observe
closely.
Scars
7
--------
10
.45, 1.5
7-8
-----------
4-5
medium
30/20
4-6
Treatment may begin after
suture removal.
Newer more vascular scars
may respond better than
older, atrophic scars.
Clinical
endpoint=erythema-
purpura.

Candela Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
8502-00-0891 Revision G Candela Proprietary Sheet 4 of 8
Striae
10
0 .45
3-7
medium
30/20
4-6
Newer more vascular striae
may respond better than
older, atrophic striae.
Clinical
endpoint=erythema-
purpura
Benign
Cutaneous
Vascular
Gynecological
Lesions
including
Vulvodynia
7
0.45
5-6
medium
30/20
8
Clinical endpoint is light
purpura,
Psoriasis
5
7
10
0.45,1.5
6-8
4-8
3-8
optional,
may use
30/20
for patient
comfort
2-4
May require several
treatments. Remove scale
prior to treatment. Clinical
response =purpura.
BOLD SETTINGS ARE DISPLAY SCREEN DEFAULT PARAMETERS FOR:
Vbeam Perfecta, Platinum, Aesthetica
SPECIAL CONSIDERATIONS WHEN USING DCD CRYOGEN SPRAY:
SELECT MEDIUM (30/20) DEFAULT SETTING
ADJUST BASED UPON EPIDERMAL RESPONSE AND PATIENT COMFORT
Note: The use of epidermal cooling is strongly recommended. Cooling reduces the rise in temperature in the epidermis,
allows for higher tolerated fluences, and provides partial anesthesia.
Do NOT Spray Cryogen into the eyes or into an open wound.
The DCD spray should be sufficient to cover the treatment area and provide epidermal cooling in opposition to the heat
generated from the laser. It is important to maintain both skin protection and patient comfort.
Begin with suggested guidelines and increase or decrease settings based on the skin reaction and the patient’s
tolerance.
Darker skin types do not tolerate excessive amounts of DCD spray. Use caution when increasing DCD spray time on
darker skin types. Pre and post cooling with a cold compress may be beneficial.
When using the V Beam laser with multiple pulses, the user should monitor the distance gauge condition and wipe the
distance gauge as required. After approximately 30 pulses, check the condition of the distance gauge for hair, cryogen
buildup, etc. and wipe if necessary before continuing treatment.
SPECIAL CONSIDERATIONS WHEN DCD CRYOGEN SPRAY IS OMITTED:
If the Dynamic Cooling Device Option is not utilized and cooling is desired, another method of cooling (air cooling or
contact cooling, etc.) should be utilized.
Several applications including non-facial warts and benign epidermal pigmented lesions are treated without DCD
cryogen spray. Application of a cool compress following the treatment may enhance patient comfort post treatment.

Candela Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
8502-00-0891 Revision G Candela Proprietary Sheet 5 of 8
A. Pre Treatment Preparation
1. Pretreatment Visit
Patient selection should be based upon the physician’s assessment of the individual patient,
including a detailed medical and medication history. The treatment protocol should be discussed in
detail including risks & benefits, possible side effects and expected results, alternative or concurrent
therapies and follow up care. The physician should set proper expectations based upon their
clinical experience. Informed consent and photographs should be obtained. Individual patient
characteristics such as skin condition and type, sex, age and medications may influence the
response to and efficacy associated with treatment. The response to treatment may vary on
subsequent visits and the skin reaction must be carefully assessed on each visit. These guidelines
are intended for use by practitioners who are knowledgeable in laser tissue interactions.
2. Contraindications and Precautions
a. Accutane: Wait 6 months after the completion of Accutane therapy
b. Tattoos: Do not treat tattooed skin, including decorative, permanent makeup and radiation port
tattoos.
c. History of photosensitivity to 595 nm light
d. Pregnancy: Refer to Candela Corporation policy # 0920-23-0814.
e. Seizure disorders: Do not treat patients with a history of light-triggered seizures.
f. Medications: Daily anticoagulation therapy, iron supplements, herbal supplements such as
ginkgo, ginseng or garlic may bruise more readily.
g. Photosensitizing Medications: Medications that induce photosensitivity or medications within or
above the 595 wavelengths. Refer to Candela Corporation Drugs That May Cause
Photosensitivity. Stop the medication if possible for 3-5 days prior to treatment.
h. Topical Medications and skin care products: Stop 72 hours pre and post. Self-tanning products
must be removed.
i. Herpes Simplex Virus (HSV) 1 & 2: Do not treat if active lesion(s) are present within the
intended treatment area. Patients with a known history of frequent HSV 1&2 lesions should
begin prophylaxis prior to treatment as prescribed by their physician.
j. Active skin infection: Avoid treatment of open wounds and skin that is actively infected.
k. Cold sensitivity: Use caution when treating patients with Raynaud’s phenomenon.
l. Keloid scarring: Perform test spots prior to treating larger areas.
m. Implanted medical devices: Pacemakers, cardioverters and other implantable devices or fillers:
consult MD.
n. Use caution when treating recently tanned skin. Blisters and hyper/hypopigmentation may
occur, allow tan to fade prior to treatment to reduce this risk. When in doubt, perform test spot
on tanned treated area and un-tanned area for comparison before proceeding.
o. Treatment of warts may result in hypopigmentation or a scar.

Candela Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
8502-00-0891 Revision G Candela Proprietary Sheet 6 of 8
3. Skin Preparation for Treatment
a. Topical anesthetics may be used prior to laser treatment per manufacturers’ directions.
HOWEVER, the topical anesthetics should be removed from the skin prior to treatment.
b. Skin must be clean and dry; remove all lotions, perfumes, make-up, deodorant, self
tanners, etc.
c. Candela does not recommend the use of alcohol to clean the skin prior to treatment.
Rinse the treatment area thoroughly with water after cleaning with soap (or similar mild
cleanser) and water.
d. Shave hair-bearing areas prior to treatment.
4. Test Areas
a. Perform test areas when a concern exists regarding the potential response to treatment.
Select a small area in the anticipated treatment site
Apply a series of 1-3 pulses with several incremental increased fluences.
b. Evaluate the sites in 2 weeks
c. Treatment may proceed when the expected treatment response is noted.
B. Procedure for establishing the Purpura – Free Threshold
1. Select spot size, pulse duration, fluence and DCD settings.
2. Apply escalating fluences until purpura appears, then reduce the energy by 0.25-0.50 J/cm2.
3. Optimum parameters may be achieved by matching pulse duration to vessel size.
Note: Treatment at sub-purpuric fluences may necessitate additional treatments for complete clearance
of vessels on the face.
C. Laser Treatment Considerations
1. Perform User Verification Tests prior to each treatment session. This test procedure is outlined in
the Operator’s Manual.
2. Position patient comfortably and confirm that the patient and everyone in the treatment room are wearing the
corrective protective eyewear.
3. Always hold the laser handpiece perpendicular to the skin to apply laser energy, otherwise an
uneven application of cryogen and energy may occur, resulting in an adverse skin reaction.
4. The aiming beam and laser beam are dimensionally identical, so the aiming beam can be used to
accurately define the treatment area. The spot will be absolutely circular if the handpiece is held at
the appropriate 90 degree angle.

Candela Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
8502-00-0891 Revision G Candela Proprietary Sheet 7 of 8
5. Always observe the epidermal response throughout the treatment and adjust the fluence and DCD
as needed.
6. Measures to prevent untoward effects and decrease discomfort
Cool compress or cold gel packs may be applied immediately after treatment to increase patient
comfort.
After each laser pulse, a gentle rub of the area with a gloved hand may minimize discomfort.
7. Treating Specific Body Areas
Upper and lower eyelids may only be treated following the insertion of intraocular corneal eye
shields.
Insert moistened white gauze cotton in nose or ears during treatment to prevent laser absorption by
unintended targets.
Patients with dental work may experience sensitivity when the laser pulse is administered in the perioral
area; a moistened dental roll or moistened white gauze between the teeth during treatment to prevent
unintentional treatment of adjacent tissue.
Cover any area requiring shielding with moistened white gauze or a moistened white card to prevent
absorption of light. Refer to the Laser Accessory Vendor sheet for additional product information.
If desired, a white makeup pencil may be used to draw a treatment area grid.
When treating anal area, place wet gauze over the anus first. Methane gas is flammable.
8. The Cleaning and Disinfecting Policy is outlined in Section 6 of the Operator’s Manual. Follow the
procedures outlined in the distance gauge cleaning protocol to prevent buildup of debris on the
distance gauge and to maintain good visibility. The Compression Handpiece Distance Gauge
Cleaning and Disinfecting Policy is located in Section 6.
D. Post-treatment care
1. Cool compresses or cold gel packs or chilled aloe Vera gel may be applied after treatment
2. Prolonged exposure to the sun should be avoided; a moisturizing sunblock of at least
SPF30+ should be applied per manufacturer’s instructions at all times throughout the course
of treatment.
3. Clean the area gently and avoid irritation from friction or rubbing.
4. Resume use of usual topical agents when any irritation resolves.
E. Expected Responses
1. Purpuric Treatment: purpura, edema, minimal to moderate discomfort relieved by cold
compress or cool gel pack.
2. Non-Purpuric treatment: edema, slight to moderate erythema, and a tight sensation with
minimal discomfort.
F. Untoward Effects
Itching (hive-like response)
Burning, blistering, scabbing, crusting, color and/or texture changes
Herpes simplex activation
Hyperpigmentation (darkening of the skin, transient or long term)
Hypopigmentation (lightening of the skin; transient, long term or possibly permanent)

Candela Vbeam Perfecta, Platinum, Aesthetica Treatment Guidelines
8502-00-0891 Revision G Candela Proprietary Sheet 8 of 8
If hypo or hyperpigmentation occurs treatment should not be performed until pigmentation returns
to normal.
Scarring (rare, possibly permanent)
G. Determining the end of treatment
1. Multiple treatments over a period of several months may be required.
2. The provider’s judgment will determine the end of treatment. Treatment should cease when
the desired clinical endpoint and patient result has been achieved.
3. Maintenance treatments may be required to maintain the desired result.
H. Additional Warnings and Precautions
CAUTION
A buildup of frost may occur on the distance gauge during extended treatments. Wipe the distance gauge
with a warm moist cloth to prevent accumulation of frost
CAUTION
If crescent shaped marks, welts or wheals are noted during treatment, the fluence and or DCD settings
should be adjusted immediately. Failure to adjust these parameters can result in subsequent crusting,
blistering, or other adverse reactions. Crescents may result from not holding the distance gauge properly. If
problem persists, discontinue treatment and refer to user verification test section of the Operator’s Manual.
CAUTION
Do not use Flammable products on the skin or in the vicinity of the laser.
WARNING
When using the Vbeam laser with the Dynamic Cooling Device (DCD) in use in conjunction with an ECG
monitoring device interference with the ECG monitoring device may result.
WARNING
Oxygen will accelerate combustion of any flammable material.Oxygen should never be directed towards or
over the laser field, extreme caution should be used. When oxygen is in use, gauze, sponges, and hair near
the treatment area should be moistened with water. Be aware that hairspray, gel, deodorants, and other
grooming products may contain flammable substances.
CAUTION
Treatment to areas bearing hair may cause the hair to be singe and may cause it to ignite. A fire
extinguisher should be available.
CRYOGEN REORDER - Replacement canisters of cryogen are ordered by the part number listed on the
GentleCooltm canisters shipped with laser. Use only 1000-gram size canisters for this product.