Inclusion Criteria:  Males and females 18 years of age or older. Patients with a clinical diagnosis of NF1 based on germline genetic testing or by meeting the internationally recognized criteria given by the Clinical Care Advisory Board of the National Neurofibromatosis Foundation (now the Children's Tumor Foundation) Patients must be seeking active treatment for cNF. Patients must have ≥ 8 paired cNF that are visible and measure a minimum of 2 mm in size. These must be in areas amenable to treatment and surveillance. Patients with Fitzpatrick Type I to VI skin-type Able and willing to comply with all visits, treatments, evaluations, schedules, and requirements. Patients shall have received oral and written study information, accepted participation and signed the informed consent document. Patients who are willing and mentally and physically capable to understand and follow the treatment and follow-up schedule including post-treatment care instructions. Patients who are willing to have photographs and images taken of the treated lesions to be used anonymously or coded in evaluations and publications.  Exclusion Criteria:  Patients who are undergoing other treatment modalities or investigational agents for their cNF lesions. Individuals who cannot give informed consent or adhere to study schedule. Patients who are actively tanning during the course of the study. Patients with adverse reactions to compounds of any external agent in use. Patients with known allergy to injectable anesthetics (relevant for biopsy only). Patients with any condition which, in the Investigator's opinion, would make it unsafe (for the participant or study personnel) to treat the participant as part of this research study. Patients, where target treatment may cause the acoustic beam to enter the eye. Pregnant females, due to possible discomfort with the procedure even though the procedure is localized and there is no new drug. Patients with tendency for keloid and hypertrophic scar formation . Patients with impaired wound healing. Patients with any other acute or chronic condition which, in the opinion of the investigator, could interfere with the conduct of the study.