From Rodan and Fields. Like new, used 4 times! Comes with everything in pictures. Including 4 extra cooling gels, and 4 extra exfoliating tips, include 1 used tip. Which is picture above! That should be removed and sanitized with barbicide before use. I am a licensed esthetician this is basically a professional microdermabrasion for at home use. This is over a $300 value! Please feel free to ask additional questions if you have them! Clinically proven desquamation technology with DOC-SMART programming, MACRO Exfoliator smooths and retexturizes the skin's outer surface for an immediately noticeable improvement in texture and long-term improvement in radiance and tone! Includes: -User Guide -Quick Start Guide -Rechargeable Macro Exfoliator -Exfoliation Tip (4 new, 1 used) -Macro Exfoliator Cooling Gels (12 gels, 2 mL each) -Charging base -AC Adaptor -Filter Pads (48) -Filter Pad Tweezers -Spare Exfoliation Filter -Spare Rubber Gaskets (2)