---

---

Exhibit 4(b)21

# AMENDMENT NO. 1 TO
REGISTRATION RIGHTS AGREEMENT

THIS
AMENDMENT NO. 1 TO REGISTRATION RIGHTS AGREEMENT (this
Amendment) is entered into as of the 25 day of June, 2009, by and among
LUMENIS LTD., a company incorporated under the laws of the State of Israel, Yokneam
Industrial Park, P.O.B. 240, Yokneam 20692, Israel (the Company) and
the entities whose name is listed on Schedule 1 attached hereto (each
a Holder and collectively, the Holders).

WHEREAS,
the Holders, the Company and Bank Hapoalim B.M. are parties to that certain Registration
Rights Agreement, dated December 5, 2006 (the Agreement);

WHEREAS,
the Company and the Holders desire to amend the Agreement, in accordance with the terms
and conditions contained herein, and the Holders executing this Amendment constitute,
under Section 14.2 of the Agreement, a sufficient majority in order to validly amend the
Agreement as set forth herein.

NOW,
THEREFORE, in consideration of the mutual agreements, covenants and other promises set
forth herein, the mutual benefits to be gained by the performance thereof, and for other
good and valuable consideration, the receipt and sufficiency of which are hereby
acknowledged and accepted, the parties hereby agree as follows:

|1. | The
definition of Registrable Securities in Section 1.12 of the
               Agreement shall be deleted in its entirety and replaced with the
following:
|-- | ------------------------------------------------------------------------------------------------------------------------------------------------------------

| | Registrable
Securities means (i) in case of the Investors, any Ordinary Shares purchased by
or issued to the Investors pursuant to (A) the Purchase Agreement (including Ordinary
Shares issued or issuable upon exercise or conversion of securities, including warrants,
convertible into or exercisable for Ordinary Shares as well as any Ordinary Shares issued
or issuable as indemnity and/or pursuant to adjustment provisions under the Purchase
Agreement) and ; (B) those certain Purchase Agreements, dated June 21, 2009 by and among
the Company and the Investors signatory thereto (the 2009 Purchase Agreements)
(including Ordinary Shares issued or issuable upon exercise or conversion of securities,
including warrants, convertible into or exercisable for Ordinary Shares issued under the
2009 Purchase Agreements), (ii) in case of the Bank, Ordinary Shares issued or issuable
upon exercise of the option granted under the Bank Option Agreement, and (iii) in each of
clauses (i) or (ii), together with any and all securities issued or issuable with respect
to the securities described in clauses (i) and (ii) above, respectively, upon any stock
split, stock dividend or the like, or into which such Ordinary Shares have been or may be
converted to or exchanged into in connection with any merger, consolidation,
reclassification, recapitalization or similar event; in each case, until their effective
registration under the Securities Act and their resale in accordance with the
registration statement in which such Registrable Securities are included or until their
sale in the open market pursuant to Rule 144.
| | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

|2. | The
Section numbers of Sections 1.8  1.12 shall be replaced with 1.9
                1.13, and the following definitions shall be added as new Section
1.8:
|-- | -------------------------------------------------------------------------------------------------------------------------------------------------------------

| | Investor means,
an Investor, as defined in the Purchase Agreement, and an Investor as
defined in the 2009 Purchase Agreements.
| | --------------------------------------------------------------------------------------------------------------------------------------

| | Agate means
Agate Medical Investments (Cayman) L.P., and Agate Medical Investment L.P.
| | ------------------------------------------------------------------------------------------



---

---

|3. | Section
4.1.is hereby amended by adding the following sentence at the end of           Section
4.1:
|-- | ---------------------------------------------------------------------------------------------------

| | As
long as Agate holds shares of the Company that are Original Registrable Securities that
constitute at least 1.5% of the issued and outstanding share capital of the Company,
Agate shall have the right, alone, to require a Shelf Registration Statement under this
Section 4.1 (provided that the total expected offering price of the Original Registrable
Securities required to be registered by Agate is at least $2.5 million), at the earlier
of (a) three (3) years after the date on which the Registrable Securities have been
issued to Agate, and (b) 30 days after one registration statement is effected under
Sections 2 or 4 hereunder, or is effected under Section 3, provided Registrable
Securities are actually included in such registration, and, in each case, is declared
effective.
| | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

|4. | The
following words shall be added to Section 4.3.2 of the Agreement after the
          words: in an aggregate amount greater than 10% of the aggregate amount
          invested by the Investors pursuant to the Purchase Agreement:
|-- | -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

| | and the 2009 Purchase Agreements
| | ----------------------------------

|5. | Each
Investor pursuant to the 2009 Purchase Agreements that was not an Investor
          pursuant to the Purchase Agreement and that executed and delivered to the
          Company a joinder to the Agreement in the form of Exhibit A          hereto,
shall upon such execution and delivery and thereafter be deemed to be a           Holder
under this Agreement.
|-- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

|6. | Section
14.2 of the Agreement shall be replaced by the following provisions:
|-- | ----------------------------------------------------------------------------

| | Amendment
of Registration Rights. Any provision of this Agreement may be amended and the
observance thereof may be waived (either generally or in a particular instance and either
retroactively or prospectively), with the written consent of the Company and Holders who
own at least sixty percent (60%) of the Registrable Securities then held by Holders,
provided however, that (i) in the event that such amendment adversely modifies the rights
of the Bank under this Agreement in a manner different then the other Holders, then such
amendment shall also require the separate consent of the Bank (ii) in the event that such
amendment adversely modifies the rights of Agate under this Agreement in a manner
different then the other Holders, then such amendment shall also require the separate
consent of Agate. Any amendment or waiver effected in accordance with this Section 14.2
shall be binding upon each Holder and the Company. By acceptance of any benefits under
this Agreement, Holders of Registrable Securities hereby agree to be bound by the
provisions hereunder.
| | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

|7. | Survival
of Provisions. Except as otherwise amended and modified hereby,           which
amendments shall have effect on the entire Agreement, the provisions of           the
Agreement shall remain in full force and effect.
|-- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

|8. | Entire
Agreement. This Amendment shall be deemed for all intents and           purposes as
an integral part of the Agreement.
|-- | -----------------------------------------------------------------------------------------------------------------------------

|9. | Governing
Law; Venue. This Amendment shall be governed by and construed           under the
laws of the State of Israel, without regard to the conflicts of law           principles
of such State. The parties hereto irrevocably submit to the exclusive
          jurisdiction of the competent courts located in Tel Aviv-Jaffa in respect of
any           dispute or matter arising out of or connected with this Amendment.
|-- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

|10. | Counterparts.
This Amendment may be executed in one or more counterparts,           all of which shall
be considered one and the same agreement and shall become           effective when one or
more counterparts have been signed by each of the parties           and delivered to the
other party, it being understood that all parties need not           sign the same
counterpart and that signatures may be provided by facsimile           transmission.
|--- | -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------


Signature page follow 

- 2 -

---

---

IN
WITNESS WHEREOF, the parties have duly signed this Amendment to Registration
Rights Agreement as of the date first written above.

# THE COMPANY:

# LUMENIS LTD.

By: /s/ Dov OferName: Dov OferTitle: Chief Executive
Officer

By: /s/ Aviram SteinhartName: Aviram
SteinhartTitle: Chief Financial
Officer

- 3 -

---

---

IN
WITNESS WHEREOF, the parties have duly signed this Amendment to Registration
Rights Agreement as of the date first written above.

# THE HOLDERS:

# OFER HI-TECH INVESTMENTS
LTD.

/s/ Yoav Doppelt
Name: Yoav DoppeltTitle: CEO

- 4 -

---

---

IN
WITNESS WHEREOF, the parties have duly signed this Amendment to Registration
Rights Agreement as of the date first written above.

# LM PARTNERS L.P.

By: L.M. (GP) L.P., its managing
general partner By: LM (GP) Company Ltd., its general partner

/s/ Harel Beit-On

|Name: Harel Beit-On          
Title: Authorized signatory          
|-----------------------------------------------------------------------------------------------------

|/s/ Eylon Penchas | /s/ L.M Partners L.P
|----------------------------- | --------------------------------

|Name: Eylon Penchas          
Title: Authorized signatory          
|-----------------------------------------------------------------------------------------------------

- 5 -

---

---

# SCHEDULE 1

# SCHEDULE OF HOLDERS

LM Partners L.P.

Ofer Hi-Tech Investments
Ltd.

- 6 -

---

---

# EXHIBIT A

COUNTERPART
SIGNATURE PAGE AND JOINDER TO REGISTRATION RIGHTS AGREEMENT

The
undersigned hereby consents to and agrees to be bound by and entitled to all the terms,
rights, covenants and provisions of the Registration Rights Agreement dated December
5, 2006, as amended on June __, 2009 (the Registration Rights
Agreement;) by and among Lumenis Ltd. and the Holders (as defined therein).

All terms not otherwise defined
herein shall have the meanings ascribed to such terms in the Registration Rights
Agreement.

The
undersigned acknowledges and agrees that upon execution and delivery of this Counterpart
Signature Page and Joinder to the Registration Rights Agreement, the undersigned
shall be deemed a Holder (as such term is defined in the Registration Rights Agreement)
for all intents and purposes of the Registration Rights Agreement, except, with respect to
Agate, Section 9.1 thereof.

The
undersigneds execution of this Counterpart Signature Page and Joinder to the
Registration Rights Agreement shall constitute, for all intents and purposes, its
execution of the Registration Rights Agreement.

___________________________________________

[________________]

Name: ______________________________________Title: _______________________________________Date: _______________________________________Address:

The above is agreed to and confirmed
by the undersigned:

|___________________________________________
|-------------------------------------------

|LUMENIS LTD.
|------------

Name: ______________________________________Title: _______________________________________Date: _______________________________________

- 7 -

---

---

COUNTERPART SIGNATURE PAGE AND JOINDER TO REGISTRATION RIGHTS AGREEMENT

The
undersigned hereby consents to and agrees to be bound by and entitled to all the terms,
rights, covenants and provisions of the Registration Rights Agreement dated December
5, 2006, as amended on June 25, 2009 (the Registration Rights
Agreement;) by and among Lumenis Ltd. and the Holders (as defined therein).

All terms not otherwise defined
herein shall have the meanings ascribed to such terms in the Registration Rights
Agreement.

The
undersigned acknowledges and agrees that upon execution and delivery of this Counterpart
Signature Page and Joinder to the Registration Rights Agreement, the undersigned
shall be deemed a Holder (as such term is defined in the Registration Rights Agreement)
for all intents and purposes of the Registration Rights Agreement, except, with respect to
Agate, Section 9.1 thereof.

The
undersigneds execution of this Counterpart Signature Page and Joinder to the
Registration Rights Agreement shall constitute, for all intents and purposes, its
execution of the Registration Rights Agreement.

AGATE MEDICAL INVESTMENTS L.P.

|    |                                        |  | 
|--- | -------------------------------------- |  | 
|
|
|
|
|By: | Agate R.M. Investments & Medical      
|    | Technologies Ltd., its general partner
|   
|By: | /s/ Agate R.M. Investments & Medical  
|    | Technologies Ltd.                     

Name:
Title:
Date:
Address:

The above is agreed to and confirmed
by the undersigned:

LUMENIS LTD.

By: /s/ Dov OferName: Dov Ofer
Title: Chief Executive Officer
Date:
By: /s/ Aviram SteinhartName: Aviram Steinhart
Title: Chief Financial Officer
Date:



---

---

COUNTERPART SIGNATURE PAGE AND JOINDER TO REGISTRATION RIGHTS AGREEMENT

The
undersigned hereby consents to and agrees to be bound by and entitled to all the terms,
rights, covenants and provisions of the Registration Rights Agreement dated December
5, 2006, as amended on June 25, 2009 (the Registration Rights
Agreement;) by and among Lumenis Ltd. and the Holders (as defined therein).

All terms not otherwise defined
herein shall have the meanings ascribed to such terms in the Registration Rights
Agreement.

The
undersigned acknowledges and agrees that upon execution and delivery of this Counterpart
Signature Page and Joinder to the Registration Rights Agreement, the undersigned
shall be deemed a Holder (as such term is defined in the Registration Rights Agreement)
for all intents and purposes of the Registration Rights Agreement, except, with respect to
Agate, Section 9.1 thereof.

The
undersigneds execution of this Counterpart Signature Page and Joinder to the
Registration Rights Agreement shall constitute, for all intents and purposes, its
execution of the Registration Rights Agreement.

|    |                                        |  | 
|--- | -------------------------------------- |  | 
|
|
|
|
|By: | Agate R.M. Investments & Medical      
|    | Technologies Ltd., its general partner
|   
|By: | /s/ Agate R.M. Investments & Medical  
|    | Technologies Ltd.                     

Name:
Title:
Date:
Address:

The above is agreed to and confirmed
by the undersigned:

LUMENIS LTD.

By: /s/ Dov OferName: Dov Ofer
Title: Chief Executive Officer
Date:
By: /s/ Aviram SteinhartName: Aviram Steinhart
Title: Chief Financial Officer
Date:



---

---