K Number
K161692
Device Name
Diode Laser Therapy Machine
Date Cleared
2016-11-16

(149 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Diode Laser Therapy Machine is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI), including tanned skin. Permanent hair reduction is defined as the long-term, stable reduction in the number of hairs regrowing when measured at 6, 9, and 12 months after the completion of a treatment regime.
Device Description
The proposed device, Diode Laser Therapy System, is a surgical device, which is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI); There are 4 models included, FG 2000, FG 2000-B, FG 2000-C and FG 2000-D, the four models have same intended use, mechanism of action, principle and specification, only difference is the configuration. The main components of proposed device shown as following: Handpiece, Touchscreen, Emergency Switch, Key Switch, Connector, Indicator Lamp, Foot Switch. The proposed system provides 36 working modes, which are six modes for men and six modes for women, the men or women mode includes face, armpit, arm, body, bikini, leg mode respectively for different treatment part, and each particular treat mode includes three submode as mode 1, mode 2 and mode 3. The difference for each mode is only the default parameters for each mode can be adjustable in the parameter range. The treatment can be applied on different Fitzpatrick skin type, including I (White), II (White with pigment), III (Yellow), IV (Yellow with pigment), V (Brown) and VI (Black);
More Information

Not Found

No
The description focuses on pre-set modes and adjustable parameters based on treatment area and skin type, with no mention of adaptive learning or data-driven decision making.

No.
The device is intended for hair removal and permanent hair reduction, which are considered cosmetic procedures rather than treatments for a disease or medical condition.

No

The device is intended for hair removal and permanent hair reduction, which are therapeutic and cosmetic procedures, not diagnostic ones. It does not perform any assessment, detection, or analysis of a medical condition.

No

The device description explicitly lists hardware components such as a handpiece, touchscreen, emergency switch, key switch, connector, indicator lamp, and foot switch, indicating it is a physical device with software control, not a software-only device.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is clearly stated as "hair removal, permanent hair reduction". This is a therapeutic/cosmetic procedure performed directly on the patient's body.
  • Mechanism of Action: The device uses a diode laser, which works by targeting hair follicles within the skin. This is a physical interaction with the body, not an analysis of samples taken from the body.
  • Device Description: The description details a surgical device with components like a handpiece, touchscreen, and foot switch, all indicative of a device used for direct treatment.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), performing tests outside of the body (in vitro), or providing diagnostic information about a patient's health condition.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device does not fit that description.

N/A

Intended Use / Indications for Use

The Diode Laser Therapy Machine is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI), including tanned skin.

Permanent hair reduction is defined as the long-term, stable reduction in the number of hairs regrowing when measured at 6, 9, and 12 months after the completion of a treatment regime.

Product codes

GEX

Device Description

The proposed device, Diode Laser Therapy System, is a surgical device, which is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI);

There are 4 models included, FG 2000, FG 2000-B, FG 2000-C and FG 2000-D, the four models have same intended use, mechanism of action, principle and specification, only difference is the configuration. The detailed difference shown as following:

ModelFG 2000-BFG 2000-CFG 2000-DFG 2000
Size426354cm5646110cm5959146 cm5646112 cm
Weight30kg45kg45kg49 kg
HandpieceRefer to Fig 16Refer to Fig 4
Cooler Number1212

The main components of proposed device shown as following:

Table 2 Main Components of Proposed Device

ComponentsFunction DescriptionApplied Model(s)
HandpieceDeliver the laser to area to be treatedFG 2000/FG 2000-B/FG
2000-C/FG 2000-D
TouchscreenThe user interface and for controlling of the systemFG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D
Emergency
SwitchStop the system in case of emergency situationFG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D
Key SwitchStart the systemFG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D
ConnectorConnection of the device with the handpieceFG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D
Indicator LampIndicate current working state of the applianceFG 2000/ FG 2000-C
Foot SwitchActivate the laser emissionFG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D

The proposed system provides 36 working modes, which are six modes for men and six modes for women, the men or women mode includes face, armpit, arm, body, bikini, leg mode respectively for different treatment part, and each particular treat mode includes three submode as mode 1, mode 2 and mode 3.

The difference for each mode is only the default parameters for each mode can be adjustable in the parameter range.

The treatment can be applied on different Fitzpatrick skin type, including I (White), II (White with pigment), III (Yellow), IV (Yellow with pigment), V (Brown) and VI (Black);

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Non clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:

  • IEC 60601-1:2012 Medical Electrical Equipment - Part 1: General Requirements For Basic Safety And Essential Performance;
  • IEC 60601-2-2:2007, Medical Electrical Equipment - Part 2-22: Particular Requirements For Basic Safety And Essential Performance Of Surgical, Cosmetic, Therapeutic And Diagnostic Laser Equipment;
  • IEC 60825-1: 2007, Safety of laser products - Part 1: Equipment classification and requirements.
  • IEC 60601-1-2:2007, Medical electrical equipment- Part 1-2: General requirements for basic safety and essential performance- Collateral standard: Electromagnetic compatibility-Requirements and tests.
  • ISO 10993-5:2009, Biological Evaluation of Medical Device, Part 5-Tests for Vitro cytotoxicity
  • ISO 10993-10:2002/Amd. 1: 2006, Biological Evaluation of Medical Device, Part 10-Test for irritation and delay-type hypersensitivity AMENDMENT 1
  • Performance Testing for Spot Size Accuracy and Energy Output Accuracy.
    No clinical study is included in this submission.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K141973, K123483

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

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, stacked on top of each other.

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

March 24, 2017

Beijing Adss Development Co., Ltd % Ray Wang General Manager Beijing Believe Technology Service Co., Ltd 5-1206, Build 332, Dafangju, No. 25 Banbidian Rd. Liyuan Town, Tongzhou District, Beijing, 101121 CN

Re: K161692 Trade/Device Name: Diode Laser Therapy Machine Regulation Number: 21 CFR 878.4810 Regulation Name: Laser Surgical Instrument For Use In General And Plastic Surgery And In Dermatology Regulatory Class: Class II Product Code: GEX. Dated: October 13, 2016 Received: October 17, 2016

Dear Ray Wang:

This letter corrects our substantially equivalent letter of November 16, 2016.

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.

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

1

Part 807); labeling (21 CFR Part 801); medical device reporting of medical devicerelated 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 contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely,

Jennifer R. Stevenson -S

For Binita S. Ashar, M.D., M.B.A., F.A.C.S. Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

K161692

Device Name

Diode Laser Therapy Machine

Indications for Use (Describe)

The Diode Laser Therapy Machine is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI), including tanned skin.

Permanent hair reduction is defined as the long-term, stable reduction in the number of hairs regrowing when measured at 6, 9, and 12 months after the completion of a treatment regime.

Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use (21 CFR 801 Subpart C) CONTINUE ON A SEPARATE PAGE IF NEEDED. This section applies only to requirements of the Paperwork Reduction Act of 1995. DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW. The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Druq Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

Type of Use (Select one or both, as applicable)

3

Tab #7 510(k) Summary

This 510(k) Summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of SMDA 1990 and Title 21, CFR Section 807.92.

The assigned 510(k) Number: __

    1. Date of Preparation
      06/07/2016
  • Sponsor 2.

Beijing ADSS Development Co., Ltd

F6, Xiandao Bldg., Jinyuan Rd. 36, Daxing Economic Development zone, Beijing, China, 102628

Establishment Registration Number: Not yet registered or the Number Contact Person: Gao Yurong Position: sales manager Tel: 86-10-83625120 Fax:86-10-83625121 Email: gyr@adss.com.cn

  • Submission Correspondent 3.
    Mr. Ray Wang

Beijing Believe Technology Service Co., Ltd. 5-1206, Build 332, DaFangJu, No.25 BanBiDian Rd., LiYuan Town, TongZhou District, Beijing, 101121, China

Tel: +86-10-18910677558 Fax: +86-10-52214696 Email: ray.wang@believe-med.com

4

4. Identification of Proposed Device

Trade Name: Diode Laser Therapy Machine Common Name: Powered Laser Surgical Instrument Model(s): FG 2000/FG 2000-B/FG 2000-C/FG 2000-D

Regulatory Information: Classification Name: Powered Laser Surgical Instrument Classification: II; Product Code: GEX; Regulation Number: 21 CFR 878.4810; Review Panel: General& Plastic Surgery;

Intended Use:

The Diode Laser Hair Therapy Machine is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI), including tanned skin. Permanent hair reduction is defined as the long-term, stable reduction in the number of hairs

regrowing when measured at 6, 9, and 12 months after the completion of a treatment regime.

    1. Device Description
      The proposed device, Diode Laser Therapy System, is a surgical device, which is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI);

There are 4 models included, FG 2000, FG 2000-B, FG 2000-C and FG 2000-D, the four models have same intended use, mechanism of action, principle and specification, only difference is the configuration. The detailed difference shown as following:

ModelFG 2000-BFG 2000-CFG 2000-DFG 2000
Size426354cm5646110cm5959146 cm5646112 cm
Weight30kg45kg45kg49 kg
HandpieceRefer to Fig 16Refer to Fig 4
Cooler Number1212

The main components of proposed device shown as following:

Table 2 Main Components of Proposed Device

ComponentsFunction DescriptionApplied Model(s)
HandpieceDeliver the laser to area to be treatedFG 2000/FG 2000-B/FG
2000-C/FG 2000-D
TouchscreenThe user interface and for controlling of the systemFG 2000/ FG 2000-B/ FG

5

| Emergency
Switch | Stop the system in case of emergency situation | 2000-C/FG 2000-D
FG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D |
|---------------------|-------------------------------------------------|----------------------------------------------------------------|
| Key Switch | Start the system | FG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D |
| Connector | Connection of the device with the handpiece | FG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D |
| Indicator Lamp | Indicate current working state of the appliance | FG 2000/ FG 2000-C |
| Foot Switch | Activate the laser emission | FG 2000/ FG 2000-B/ FG
2000-C/FG 2000-D |

The proposed system provides 36 working modes, which are six modes for men and six modes for women, the men or women mode includes face, armpit, arm, body, bikini, leg mode respectively for different treatment part, and each particular treat mode includes three submode as mode 1, mode 2 and mode 3.

The difference for each mode is only the default parameters for each mode can be adjustable in the parameter range.

The treatment can be applied on different Fitzpatrick skin type, including I (White), II (White with pigment), III (Yellow), IV (Yellow with pigment), V (Brown) and VI (Black);

6

    1. Identification of Predicate Device
      Predicate 1# 510(k) Number: K141973 Product Name: Diode Laser Hair Removal System Manufacturer: Beijing Anchorfree Technology Co., Ltd

Predicate 2# 510(k) Number: K123483 Product Name: Diode Laser Manufacturer: Beijing Syntech Laser Co., Ltd

    1. Non-Clinical Test Conclusion
      Non clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:
  • IEC 60601-1:2012 Medical Electrical Equipment - Part 1: General Requirements For Basic Safety And Essential Performance;

  • IEC 60601-2-2:2007, Medical Electrical Equipment - Part 2-22: Particular Requirements For Basic Safety And Essential Performance Of Surgical, Cosmetic, Therapeutic And Diagnostic Laser Equipment;

  • IEC 60825-1: 2007, Safety of laser products - Part 1: Equipment classification and requirements.

  • IEC 60601-1-2:2007, Medical electrical equipment- Part 1-2: General requirements for basic safety and essential performance- Collateral standard: Electromagnetic compatibility-Requirements and tests.

  • ISO 10993-5:2009, Biological Evaluation of Medical Device, Part 5-Tests for Vitro cytotoxicity

  • ISO 10993-10:2002/Amd. 1: 2006, Biological Evaluation of Medical Device, Part 10-Test for irritation and delay-type hypersensitivity AMENDMENT 1

  • Performance Testing for Spot Size Accuracy and Energy Output Accuracy.

  • Clinical Test Conclusion 8.

No clinical study is included in this submission.

7

9. Substantially Equivalent (SE) Comparison

ItemProposed DevicePredicate DevicePredicate DeviceRemark
Product CodeGEXGEXGEXSE
Regulation Number21 CFR 878.481021 CFR 878.481021 CFR 878.4810SE
Intended UseThe Diode Laser Therapy Machine is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI), including tanned skin.
Permanent hair reduction is defined as the long-term, stable reduction in the number of hairs regrowing when measured at 6, 9, and 12 months after the completion of a treatment regime.The Diode Laser Hair Removal System is intended for hair removal, permanent hair reduction on all skin types (Fitzpatrick skin type I-VI), including tanned skin.
Permanent hair reduction is defined as the long-term, stable reduction in the number of hairs regrowing when measured at 6, 9, and 12 months after the completion of a treatment regime.The Diode Laser is intended for use in dermatologic and general surgical procedures.
The Standard Mode is intended for hair removal, permanent hair reduction.
The FHR Mode is intended for hair removal, permanent hair reduction.
The diode laser system is intended for use on all skin types (Fitzpatrick skin types I-VI), including tanned skin.SE, with
difference in
wording,
while the
actual
indications
are the same.
ConfigurationMain Unit
Handpiece
Foot ControlMain Unit
Handpiece
Foot ControlMain Unit
Handpiece
Foot ControlSE
Principle of
OperationDiode LaserDiode LaserDiode LaserSE

Table 3 General Comparison

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ItemProposed DevicePredicate DevicePredicate DeviceRemark
Laser TypeDiode LaserDiode LaserDiode LaserSE
Laser ClassificationClass IVClass IVClass IVSE
Laser Wavelength808 nm808 nm808 nmSE
Spot Size1.44 cm²1.44 cm²1.2 cm²SE
Fluence2-120J/ cm²1-120 J/cm²1-120 J/cm²SE
Frequency1-10Hz1Hz, 2Hz, 3Hz,10Hz≤10 HzSE
Pulse Duration9-143ms2.9-348ms5-200 msDiscussion 1
Power SupplyAC 110V/50Hz-60HzAC220V, 50Hz/ AC110V, 60Hz100-240 V 50/60HzSE
Dimension5646112 cm
426354cm
5646110cm
5959146 cm380mm×540mm×1200mm460X 365 X350 mmDiscussion 2
Weight49 kg
30kg
45kg
45kg55kg25 kgDiscussion 2
Table 4 Performance Comparison

Discussion 1

The proposed device is different in Pulse Duration of HR mode from the proposed devices' pulse duration range is cover the predicates' and both proposed device and predicate has same Fluence, this difference will not affect the substantially equivalency.

Discussion 2

The proposed device is different in dimension and weight from the proposed device is a trolley type, while the predicate device is a desktop type. By complying with IEC 60601-1, the mechanical performance of the proposed device is determined to be accepted, therefore, this difference will not affect the substantially equivalency.

9

ItemProposed DevicePredicate DeviceRemark
Patient Contact Materials and Biocompatibility
Patient Contact
MaterialsSapphire in handpiece and handpiece tip
(Stainless Steel)Stainless steel and Sapphire in handpieceSE
CytotoxicityNo CytotoxicityComply with ISO 10993-1
SensitizationNo evidence of sensitizationSE
IrritationNo evidence of irritation
EMC, Electrical and Laser Safety
Electrical SafetyComply with IEC 60601-1, IEC
60601-2-22Comply with IEC 60601-1, IEC
60601-2-22SE
EMCComply with IEC 60601-1-2Comply with IEC 60601-1-2SE
Laser SafetyComply with IEC 60601-2-22, IEC 60825Comply with IEC 60601-2-22, IEC 60825SE
Table 5 Safety Comparison
-----------------------------

10. Substantially Equivalent (SE) Conclusion

Based on the comparison and analysis above, the proposed device is determined to be Substantially Equivalent (SE) to the predicate device.