K Number
K120775
Device Name
LIGHT FOR WRINKLES
Date Cleared
2012-06-04

(82 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The LightStim for Wrinkles is an over-the-counter hand-held device intended for the use in the treatment of full-face wrinkles
Device Description
The LightStim for Wrinkles is a hand-held device with a power output of 65mW/cm2, consisting of light emitting diodes (LED's) that emit Low and Sub IR light for direct exposure to the skin. The components include an LED array of 605nm, 630nm, 660nm, and 855nm wavelength, a (non-flammable plastic) hand piece housing, a printed circuit board upon which the LED's are mounted, single non-timer on/off switch with a resistor, receiver jack in the hand piece accommodating a removable power cord and a separate AC to DC (9-volt) power supply. Treatment time is recommended to be 3 minutes and is controlled by the user.
More Information

No
The device description details a simple LED-based light therapy device with a basic on/off switch and power supply. There is no mention of any computational processing, algorithms, or data analysis that would indicate the presence of AI or ML. The clinical study described is a standard performance evaluation, not a study of an AI/ML algorithm's performance.

Yes
The device is intended for the "treatment of full-face wrinkles", which indicates a therapeutic purpose. The summary of performance studies also details the reduction in wrinkle severity, further supporting its therapeutic claim.

No
The device is described as an over-the-counter hand-held device intended for the treatment of full-face wrinkles, not for diagnosis. Its description and clinical study focus on wrinkle reduction.

No

The device description clearly outlines hardware components such as LEDs, a hand piece housing, a printed circuit board, a switch, a receiver jack, and a power supply. It is a physical device that emits light.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is "for the use in the treatment of full-face wrinkles." This is a therapeutic use, not a diagnostic one. IVDs are used to diagnose diseases or conditions by examining samples from the body (like blood, urine, or tissue).
  • Device Description: The device description details a light-emitting device for direct application to the skin. It does not involve the analysis of biological samples.
  • Lack of IVD Characteristics: The description does not mention any components or processes related to collecting, preparing, or analyzing biological specimens, which are fundamental to IVDs.

The device is a therapeutic device intended for a cosmetic or medical treatment (wrinkle reduction) applied directly to the body, not for diagnosing a condition by analyzing samples.

N/A

Intended Use / Indications for Use

The LightStim for Wrinkles is an Over-The-Counter handheld device intended for the use in the treatment of full-face wrinkles.

Product codes

OHS

Device Description

The LightStim for Wrinkles is a hand-held device with a power output of 65mW/cm2, consisting of light emitting diodes (LED's) that emit Low and Sub IR light for direct exposure to the skin. The components include an LED array of 605nm, 630nm, 660nm, and 855nm wavelength, a (non-flammable plastic) hand piece housing, a printed circuit board upon which the LED's are mounted, single non-timer on/off switch with a resistor, receiver jack in the hand piece accommodating a removable power cord and a separate AC to DC (9-volt) power supply. Treatment time is recommended to be 3 minutes and is controlled by the user.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

full-face

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Home

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

Usability Study: 50 participants; goals were: (1) to attract participants that represented the "intended users" of the device; (2) to determine if consumers could correctly self-select using the Packaging labeling only; (3) to test consumer knowledge of the Packaging labeling and Instruction Manual; (4) to have consumers demonstrate their ability to adhere to what they had read in the Instruction Manual and actually operate and care for the device correctly. All four goals of the Study were met. indicating that the LightStim for Wrinkles K120775 has similar consumer usability to the Light for Wrinkles K101190.

Clinical Study: An 8-week Clinical Study with 40 participants was conducted with the premise that the LightStim for Wrinkles K120775 will deliver similar results in full-face wrinkle reduction to the Light for Wrinkles K101190 that was clinically tested for periorbital wrinkle reduction. The Study utilized the Fitzpatrick Wrinkle Scale (FWS) to judge wrinkle severity on a 1 through 9 basis. The outcome of the K120775 Clinical Study was that the participant's average fullface wrinkles base line was 5.73 on the FWS and at the end of the 8-weeks of treatment the average score revealed a reduction in full-face wrinkles to 4.54 on the scale. Further reduction to 4.2 on the scale was found at the 3-month follow-up after cessation of treatment.

Key Metrics

Not Found

Predicate Device(s)

K101190

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.4810 Laser surgical instrument for use in general and plastic surgery and in dermatology.

(a)
Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.
(b)
Classification. (1) Class II.(2) Class I for special laser gas mixtures used as a lasing medium for this class of lasers. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 878.9.

0

510(k) Summary of Safety and Effectiveness

LED Intellectual Properties, LLC.

Device: LightStim for Wrinkles K120775

This summary of safety and effectiveness information is being submitted in accordance with the requirements of the SMDA 1990 and 21 CFR 807.92.

  1. General Information

Date: March 8, 2012

Submitter:

LED Intellectual Properties, LLC . 16552 Von Karman Avenue Irvine, Calif. 92606 Fax: (949) 502-4090 Tel: (949) 502-4088 Email: steve@lightstim.com cell: (949) 394-2427 Contact: Steve Marchese

  1. Device name and code

Device Proprietary Name: LightStim for Wrinkles Class Name: Laser Instrument for General and Plastic Surgery Classification Code: OHS, Class II Indications: Light Based Over-The-Counter Wrinkle Reduction

  1. Predicate Devices

LED Intellectual Properties, LLC - Light for Wrinkles (K101190)

  1. Device Description

The LightStim for Wrinkles is a hand-held device with a power output of 65mW/cm2, consisting of light emitting diodes (LED's) that emit Low and Sub IR light for direct exposure to the skin. The components include an LED array of 605nm, 630nm, 660nm, and 855nm wavelength, a (non-flammable plastic) hand piece housing, a printed circuit board upon which the LED's are mounted, single non-timer on/off switch with a resistor, receiver jack in the hand piece accommodating a removable power cord and a separate AC to DC (9-volt) power supply. Treatment time is recommended to be 3 minutes and is controlled by the user.

1

5. Indications for Use

The LightStim for Wrinkles is an Over-The-Counter handheld device intended for the use in the treatment of full-face wrinkles.

  1. Substantial Equivalency

(a) The "LightStim for Wrinkles" K120775 is a new name for the predicate device "Light for Wrinkles". Substantial Equivalency Comparison chart is attached separately.

(b) (1) A Usability Study (equivalent to the Study conducted under K101190) with the following four goals was conducted utilizing 50 participants: (1).to attract participants that represented the "intended users" of the device; (2) to determine if consumers could correctly self-select using the Packaging labeling only; (3) to test consumer knowledge of the Packaging labeling and Instruction Manual; (4) to have consumers demonstrate their ability to adhere to what they had read in the Instruction Manual and actually operate and care for the device correctly. All four goals of the Study were met. indicating that the LightStim for Wrinkles K120775 has similar consumer usability to the Light for Wrinkles K101190.

(b) (2) An 8-week Clinical Study (equivalent to the Clinical Study conducted under K101190) with 40 participants was conducted with the premise that the LightStim for Wrinkles K120775 will deliver similar results in full-face wrinkle reduction to the Light for Wrinkles K101190 that was clinically tested for periorbital wrinkle reduction. The Study utilized the Fitzpatrick Wrinkle Scale (FWS) to judge wrinkle severity on a 1 through 9 basis. The outcome of the K120775 Clinical Study was that the participant's average fullface wrinkles base line was 5.73 on the FWS and at the end of the 8-weeks of treatment the average score revealed a reduction in full-face wrinkles to 4.54 on the scale. Further reduction to 4.2 on the scale was found at the 3-month follow-up after cessation of treatment.

(b) (3) The conclusion drawn by LED Intellectual Properties LLC, based on the facts that the LightStim for Wrinkles K120775 produced similar results in the Usability Study and similar results in the Clinical Study to the Light for Wrinkles K101190 is that the LightStim for Wrinkles raises no new issues of safety and has proven efficacy in the treatment of full-face wrinkles.

2

6(a) Substantial Equivalence Comparision
CharacteristicLight for Wrinkles K101190LightStim for Wrinkles K120775
Intended UseThe Light for Wrinkles is an
Over-The-Counter handheld
device intended for the use in
treatment of periorbital
wrinkles.The Light for Wrinkles is an
Over-The-Counter hand-held
device intended for the use in
treatment of full-face wrinkles.
Indications for UsePeriorbital WrinklesFull-Face Wrinkles
Target PopulationWomen and men with
periorbital wrinklesWomen and men with full-face
wrinkles
Anatomical SitesPeriorbital AreaEntire Face
Where UsedHomeHome
Energy Used and/or Delivered9-volt DC power
transformer/approx.
65mW/cm29-volt DC power
transformer/approx.
65mW/cm2
Usability Study with Labeling
Comprehension and self-
selection conducted, with both
exhibiting results of
effectiveness and safety.Usability Study with Labeling
Comprehension and self-
selection conducted, with both
exhibiting results of
effectiveness and safety
Human factors
DesignHand-held device
Clinical Study of 100% of the 44
participants exibiting a
reduction in fine lines and
wrinkles in the periorbital area.Hand-held device
Clinical Study of 100% of the 40
participants exibiting a
reduction in facial wrinkles in
the periorbital area.
PerformancePower is approximately
65mW/cm2.Power is
approximately 65mw/cm2.
Standards MetIEC-60601-1-2, IEC-60601-1, ISO
10993, ISO-13485IEC-60601-1-2, IEC-60601-1, ISO
10993, ISO-13485
Materialsglass polymer, plastic, metalglass plymer, plastic, metal
glass polymer, ABS Lustran 348
plastic
Compatibility with the Environment and Other Devicesglass polymer and plastic
IEC-60601-1-2IEC-60601-1-2
Power Supply delivering a safe
9-volts DC to the hand-held
device. IEC-60601-1-2, and IEC-
Electrical Safety60601-1
Mechanical SafetyIEC-60601-1
Thermal SafetyIEC-62471
Radiation SafetyIEC-62471

:

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image contains a circular logo for the U.S. Department of Health & Human Services. The logo features the department's emblem, which is a stylized representation of an eagle or bird-like figure with three curved lines forming its body and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged around the emblem in a circular fashion, with "DEPARTMENT OF HEALTH & HUMAN SERVICES" at the bottom and "USA" at the top.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

JUN - 4 2012

LED Intellectual Properties % Mr. Steve Marchese CEO 16552 Von Karman Avenue Irvine . California 92606

Re: K120775

Trade/Device Name: LightSlim for Wrinkles Regulation Number: 21 CFR 878.4810 Regulation Name: Laser surgical instrument for use in general and plastic surgery and dermatology Regulatory Class: Class II

Product Code: OHS Dated: May 11, 2012 Received: May 22, 2012

Dear Mr. Steve Marchese:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you; however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

4

Page 2 - Mr. Marchese

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Mark N. Melkerson

Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K120775, 1 of 1

Indications for Use Statement

| 510(k)
Number

(if known)K120775
Device NameLightStim for Wrinkles

__ and__

Indications for Use

The LightStim for Wrinkles is an over-the-counter hand-held device intended for the use in the treatment of full-face wrinkles

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801. 109) OR

. Over-The-Counter Use

Nil RPOgden for nkm
(Division Sign-Off)

Division of Surgical, Orthopedic, and Restorative Devices

. 510(k) Number K120775