System for treating tissue

DISCLAIMER

1( is 10 he ncred rhar only iobjeol matter embraced in the socpe of rhe claims appended herein, whether in the manner defined in Ilie claim' dr in a manner similar ttipwro and involving the insin features as defined in the claims is intended m he s included in the scope of the presem mvenlinn, while subject matter described and exemplified to provide background and better understanding of rhe invention, is not inlp.nded for inclusion 3s pan of die present invention.

FIELD OF THE INVENT^O^

The present invention generally relates Io the field of laser irpatmem of !issue, in and particularly. 1jO s sysletn and method for rrearing microablated channel. in skin The present invention is more parfirmaiiy directed to !rearing subsurface tissue through the created channel; By doing ireaimg subsurface liqque I h.rough uniquely crested channels, skm mavtf treated with herd t! fore unrealized results

RAf KGROIIND OF THF INVENTION .' Skjr is primarily made of an outer layer, or epidermis, !hat has a rieptj] of approximately i Οίΐιΐτπ 611111 Ilie outer Surface of rhe skin and an inner Inyer, Cir dentils, that has depth of approximately 3000 fm from the ouler surface of the skin As used herein, ‘,dermal lis'iie or “skin” lifers le Feith the dermis and epidermis layers.

There is ongniup demand for procedures Io improve skin defects Such תג improvement? inclndp reducing wrinkles, rediieiiig dyschromia (a variety of abnormalities nr irregularities of skin color resulting from, inter alia, irregular pigment distribmiiin, dilared hJrwi vessels. £rc.) and etc, 4 wide vanpiy of 'kin treafirg techniques have heen inlrnduced in rec&nr years for attempting to achieve this oblPrlive. The skin treating techniques that lave been employed may be generally careenrized into ?s two general types of treatment ablative laser skin resurfacing f“LSR'’' and non-abfaLlVt ccHagen renii dolmg (“NCR}. LSR generally may result in fairly extensive i hernial damage to either the epidermis and/Or the dermic NTTL cm the Cther hand, 1' designed rci ax did ±ermal damage of rhp epidenUi'

Nevertheless, T SR if an effective la'er treatment for !rearing skin A typical LSR procedure comprises thermally damaging a region of the epidermis 100 and a corresponding lower region of rhe dermis 110 for promoting wound healing. Elec trornagne tic energy 120 i* directed toward* a region of skin, ?hereby ahlaEing die 5 *kin and removing bodh epidermal tissue and ilemd tissue Combining 1 SR with a pulsed laiei, for example a CO ג or an ErYAG hsef: is typically referred tc as laser resurfacing or ablative resurfacing. This is cons ide red m he an efTecdve treatment prctncnl phrtr aged nr chronically aged skin. scars, superficial pigmented lesious. stretch marks, and/or superficial skin lesions Ma!0i drawhacks include, however. תו edema, oozing, and hnrning dNrnmfon up io the first Fourteen (Id) days after treatment

Swh drawbatks art wnatcHpralnle frt many patients. A further prolckm wilh LSR procedures is that they are re!3iive|y painful Therefore. Ihev gene!a 11y require an application of a .significant amount of analgesia While L$R of relatively small areas can be performed under local aneslhesia LSR procedures that include relatively large ]5 areas frequently require general anesthesia or nerve blockage hy multiple anestheiic in er lions.

Another limitation of 15R is that ablative laser lesurfacmg geueially can ne ז be performed on rhe patients having dark complexions Ablation of pigmented epidermis tissue can cause severe cosmetic disfiguiernent to paitenls having a dark complexion. 2¢ Such disfigurement can last from several weeks up to years This is generally considered tn he unacceptable by most patients and physicians. Yet another limitation of LSR i* ihal aMsfive resurfacing ge-neraJly has a gnaiei ri*k of scarring in areas other than the face and refill ש an increased incidence of an uri acceptable scar fonnattaj] because the recovery from skin injury within these areas is nor very effective

Several NCR techniques have attempted to overcome the aforesaid problems associated with Γ SR procedures These techniques may be variously referred to a* rcitablative resurfacing non-ablative stihsurfacinp. or no ת-ablative skin remodeling Such NCR techniques generally use non-ablalive lasers. flash lamp*, or radio Frequency current foi damaging the dermal tissue and avoiding damage Io the epidermal tissue.

?(1 NCR techniques apply die concept that it is the thermal damage of tbe dermal n*snes that is thought to Induce wrund healing. This results in hidegicjtl repait and the formation of new derma] collagen which in turn can result in decreased photoagmg relied slructura) damage Avoiding the epidemal damage hy using NCR techniques may alio decrpase both the severity *nd ihe duration of treatment related side effects, Fer example. posi procedural oozing, cmrtinE figment changes, and Ihe incidence of infeclious.

Trealmg skin using the NCR method involves healing selective portions of 5 dermal tissue within the demoa! layer for inducing wound healing withoul damaging the fpidemus above By cooling Ihe «airfare of the skin and fneusin״ electromagnetic eneigy, for example a laser beam. 3 selected ri erm a I damaged region can he achieved urhile leaving the epidermis undamaged Using ncn-ab lalive lasers for damaging the dermis while leaving Ihe epidermis undamaged 12 Ccmmon to NCR treatmenl methods 1Π Apnerally, using ποη-ablahVE la^rs result in deeper dermal penetration depths as compared co the ablative lasers than the superficially-absorbed ablative EnYAG and CD9 lasers used in typical LSR procedures Further, when NCR techniques are med, they generally do noi have the undesirable side efte-rte characteristic of the T SR npatmenl, such *5 the risk of scarring or mfecricm Examples of NCR lechniques and is apparatus nr? disclosed by Anderson pt nl in U.S. Parent Puhlicarion No. 70ti?/0161357

Although these NCR techniques may avoid epidermal damage, 3 major drawback of Ihis method is נ Is limited effectiveness For example, this is significantly less im prove πιετιι of pholraged skin rr scars after the NCR treatment than when LSR 3d ablative lechniques is used In tael, even when multiple NCR [reafments are employed, improvement in ihe pmienl's ;kin is often far below experlotions Tn addition, improvement is efien delayed for several months when a senes of freatmen[ procedures are used Al [hough NCR techniques have been found 10 be rr odemlely effective for wnnkle removal, they have generally nor been found to he effective fcr dyschromia

Another problem with using 3 NCR technique 11 th? limited the breadth of aonppiable nreatmenl parameters for safe and effective treatment of dermatological disordets. This is became NCR procedures generally rely on an optimum comdinatirri of laser energy and cooling parameters This results in an nnfhvotable temperature profile in the skin. An nnfavcrakle temperature profile consequently results in either no therapeutic effect on one hand, or scar formation due to the overhearing of a relalively large volume of the tissue. 011 the other

A problem ihai i< common [0 both ablaljve and non ablative resurfacing procedures JS thal they do not significantly use keralinocvtes which play an active rote in tie wtund healing it !pause Kerttinccyte! relrase cytokines when tje keratinijeyre is damaged. Cytokine's raicOursge Wound herding. Far example. during ablative res 111 inning ρητχίΰιττηί keratin ncyies are remrvrd from rhe skill along with Lhe epidermis. This nemoves keratin alites entirely from the hcalirig pmeess altogether

J During non-ablarivt prucedure!, kerniiniwiytes, 1crated in the epidermic are not damaged al all and thus do not release cytokines tor aiding the healing praopis

T15 djsxlnses a cragulatinri system is provided fcr use !ת binloftical tissue The coagulation system Inchides 3 handle a radiofrequency fRF) genera to (, and an elerirnde array The elecPcde array includes IWO Or mere pair nF 10 blpolBi ekotrndes slideably mupled in fhannels nf the handle. The hipolflr *!ectnciries el auri c ally couple to !he RF giucraior, and the electrode anay is con figured tn deliver a b also r ? d etieigy density in a latgel vclnne of the biclugica] tisfue The Ira hr cod energy demKifty delivered lay1 fire eiectmde array results rn ihertnsl coagulation nermsis of e rictanpulsi vchime of hie ley jc al tissue

IS US ?ateld tin 6,432,199 di s dr «ϋ a method and jpparatus far fast precis material processing and modification which minimises cal lateral damage Utilising □ptimizsd, pulsed electrums gjjatic energy passjueisrS leads to ft π mtaBcdrn ־regime which minimize! res'Clial enerffy deposition. Advantageously ramoval of cumulative puls? train residua! raiEigy is hiTthc! maximized thmugh the rapid progression af the 3tl ah rid ton i ron I which mnve faster ihsE di? thermal energy diEtiision hnnf, tons ensuring iubiletifiaJ removal nF residual energy tn further minimize ;oUatera] ib^rmal iamage.

WO discloses a dual mode laser delivery system thart provides a controllable depth of both nb la I irm and ana galarirm nf an Urea nf skin to be treated The lai er delivery system includes a j^ser source having a short fenerratki] depth The 25 η ο η cm flab ] e ablation depth 1S achariEd by providing air appropriate series of pulses from the h.scr having An snergy and exposure time to achieve ablution ef fhe exposed bits nf .skin lr Ihe desired dftpfh, Once ah laden rif the skin has fwen perfcmiftri, a coagulation regjtm to the desired coagulation depth is dteii generated within (he remaining exposed layer cf ־kin by preferably applying a series 11 f one rn more very short on 11-ah 1311 we lasei pulses 3 1>ז hipfa repetition rale in order bn raise Eihe temperature of Ihe surface nf the skin to a desired temperature fora period of rime This genes of nna|Suto1ir1n pulses urrll also serve in ־raise the teraptratHre of the skin nmder the MTrfaoe cf the skin to a temperature high enough fa cato? tnagulatirn 10 the desired depth, Tht otora of delivery of the s

ablation sequence and rhe coagidation sequence can also he reversed from that described if desired A graphical user interface is included within the system in order in allow the user in easily select and monitor the necessary parameters such as ablaiחסו depth, coagulation depth, application order, somi pattern, scan size and rate cf la^er ' pulses. The la<er pulses are generated from a laser source and delivered through ar artkulaled arm The articulated arm includes a series cf relay focussing lenses in order roperiodically refocus the laserbeam as it travels through the articulated arm.

US 2005/004958? discloses a method and apparatus for providing fractional healmem ni tissue (e.g. sirin'] using lasers is ducksed The method involves creating ill one or more microscopic treatment zones of necrotic tissue and thermally altered tissue and inlEncionally leaving viable tissue tn surround the microscopic treatment ?ones Tie dermatological apparatus includes one or more tight scutices and a delivery system 10 generate the microscopic ireatmenr zones m a predetermined partem. The microscopic neatmeiif zones maybe (Orfmed to the epidermis, dennis or span the epidernial dermal 1’ junction, and birther rhe stratum Ccimeiim above the micro'copir treatment zones may he spared

SUMMARY OF THE INVENTION

Accordingly, there is now provided with this invention an improved system and method having rhe feamres of rhe respective independent claims that effectively 2n overcomes the aforementioned di fi! rn I ties and longstanding problems inherent in uring either a LSR or a NCR procedure These probIem5 have heen solved in a simple, convenient, and highly effective way by which to treat skin

According to! one aspect of the. invention, there is provided a method of operating an elenttrmagneiic radiation 11011. the method comprising

2' moving an electro magnetic radiation emitting device to a first position:

producing a firs 1 electromagnetic radiation puke having a firsi intensity with the electromagnetic radiation emitting device, rhe first intensity being sufficient to ablate 3 volume of lis.sue having a first width and a first depth, wherein the firxt depth is shorter than a target depth:

T after producing the first electromagnetic radiation pulse producing a second electro magnetic radiation pulse having a second width and a second intensity with ihe electromagnetic radiation emitting device while located at th? first position. wherein the fsecond intensify is sufficient 1□ heat the tissue ad ficenl tn an inner surface of the ablated volume 10 a tempremture that is suilficieni tn denature the !issue and that js he I ow a level al which the tissue is ahlsned. wherein the ssrnnd width is approximately equal to or smallet than the first width: and after producing 1he second electromagnetic radiation pulse, pre du cm״ a !bird elechOmaenflir radiation pulse having a third intensity with the clectiritrisgne lie radiation emiltmg device while located at the find position, wherein rhe third inten'ity is sufficient to ablate a volume of tissue having a third width and a second depth; wherein the third wirilh זו appmximainly equal tc cr smaller than rhe First width

If According tn auerhet aspect of the inveiitioa a system for treating (issue, is disclosed which comprises an electromagnetic radiation source:

an electromagnetic ladiairOn emitting device Configured to apply the e’eeticmagnetic radialion hem the eleclromagneiic radiation source io ihe tissup׳ and

H a co ה rrc IJer configured to contro I appl icalion of the electromagnetic radia Hon wherein the controller is configured to direct th? etertrnmaguelic radiation emitting device in apply ablative electromagnetic radiation to the tissue 10 ablate a microchannel in the [issue, the mi r roc han nd having a piedelenuined width, predelemvined depth. and a tbennal affected 7cwc of predetermmtd volume prexhr ate ?r said channel.

wherein the co ה [roll er is furrher configured to direct th? electiomiignelir radiation emitting device to apply an altemaiing partem of non-ablalivt and ablative elpctromagnetir radiation tn an inne r surface of the rtlicrochaune ablated iu ihe! tissue:

wherein the width of the micronhannel is smaller than a width of a treatment י. י area of rhe (issue in which Ilie luicrochannel ri loojated,

As will he appreciated by those person' skilled in the art, a major advantage provided by the present invention is hill conircil of. depth of treatment, the amounl and placement of beat, and ihe amount and placement of channels.

It is therefore an nhjecl of che present invention to rejuvenare skin and reduce חי wrinkles, scars, dyschromia and ether condilicns *noh m melasma and hyperpigmeniaticm

It is another ch ecr tc provide a channel with or without heat For delivery orher therapy (vitamins, drugs, etc).

Additional objects of ths present invention will hecoojE apparent from the following description

The methad and apparatus of the preseitl invention will be better nndersmod by reference to rhe following detailed discussion of specific embodinienh; and the attached figures whirl. iustrait and exemplify ™cl. e-mViodrmenis

BRIEF DESCRIPTION OF THE DRAWINGS

Tn order io understand the invention and 10 see how if may he carried out in practice, embodiments will now he described, by way of non-limiciiip examy e only, with reference to the accompanying drawings, in which

1(1 FIG. 1 is a schematic tlliLstralior of a rnicmahhtiori meihrid and system 10 accordance with an embodiment of the invention;

FIGS. 2A. IB, 3C, and ID are schematic illmtrations of sequential stages of microablafion and treatment in accordance with an embodiment of the invention.

FIGS 3A, HR .IC. and 3D are schematic iIhistrahicns of sequential stages of is micmablalian in accordance with an embodiment of the invention;

FTGS- 4A, 4B. ΛΓ, and 4D are schematic illiislraticns of tisane manipulation in accordance with an embodiment cf the invention:

F1G כ is a schematic illustration of tissue IreatiTKnl according to an embodiment of the invention; and חי FIG 6 is a schematic flow chart cf a method of producing micmablalian am a tissue in accordance with ari enabadirnent of rhe invention; and

FIG. ד is a schematjc flow chan nF a methed of producing niicrtiahlation on a tissue in accordance with an emhodiment of the invention

DET All FD DESCRIPTION OF EMBODIMENTS

The fohowing preferred embodimeni as exemplified by the drawings is illustrative of tbs invenuvn sud is rwt intended 10 binit the ΐηνεπύοη as emcoirprssed by the claims nf thii application A system for treating skin 1' disclosed herein In skin tissue, for example. prcrfins such as collagen reside in the dermal layer of the skin, The microchaonel disclosed in an embodimeni of the present invention may itself rarget and til alter the cohagen fibers within (he dermis a_s mi effective treatment for wrinkles of the skin Alternatively an emhrriimenl of the micro channel disclosed herein may create a passage through which targeted tissue it treated

As shown generally in FIG- h an embodiment of (he present invention provides a sysiem end melhnd fen ץBiicinninp micTCfccipic abtatinri nr partial microablaiicn of 5 eg !issue and forming a microchanuel through a snrfsce of tissue to treat subsurface tissue The microchannel may provide access 10 subsutfsce tissue targeted foi a prescribed treatment, nr the mi cm channel itself may provide a prescribed treatment In same emhodiments of the ptesent itivenlicm, the taiorochaflue1 may produce partis lateral denaturation of pmieins collagen] within the wall. and/or at the hoTtom ΰί ]0 rhe channel

Arcordifig to some e !סו bodi men Is of ihe invention, a tissne ablation system 1 may include; a laser unit 2 and a laser emitting device 3 for ablating a micrnchannel 6 into a Li' sue 5 for example, for applying a Ireauneni the rem as will he described helow in detail The MicroChannel 6 may be. e g a column. a well 3 hole, or ihe like, created 15 in lire tissue 5 by ablating the tissue 5 by rhe laser emitting device 3 and the laser beam 4, for example, an ablating laser beam Microablatinn of the tissue 5 may result in ahlslion of the Microchannel Micro ablation of the tissue may she refill in dissipation of hear from the healed and evaporated tissue by the tissue surrounding rhe resultant micro channel 6. 'Thus, ah la ri on of the tissue 5, producing the Tniorccbannel 6, may result 20 in a thermal affected zone 7 surrounding rhe walls andor bottom of the mi cm channel 6.

The iberrnal affected zene 7 is generally indicative of damaged !issue ard of tissue necrosis (rhe death of cells] in particular As used herein, “damaged' is defined as inducing cel] death in one or mere regions of the dermal tissue of interest (lethal damage’), or siimulating Ihe release of cyratines, heai shock proteins, and other wound 25 healing far I ore without sciiTuliltmg necrotic cell death C'suhlerhaI damage'1)

Selection of the laser beam 4 may also be based cn the absorptive qualities of the tissue 5 tc be healed The absorptive properties of rhe tissue 5 to be treated may dictate or influence specific ihe type of laser 0t the characteristics of that laser suitable for a particular treatment for arid'or microchsnnel For exarrp'e, certain taxers may 0¢ reach depths unable tn be reached by other types of lasers Ac an example, an ablative laser may reach up to any depth required while aon-ablalive laseri mav he unable to penetrate skin below, fnr example, ahom 50 μτη. Similarly, it may be difficnlr lo reach energy doses with one type of laser that ace easily reached with others, Gf emase, ¢6 IE we 11 known in Ihe art, if the wavelength is altered. Ebe ccn־efording absorption level of Ihe skin treatment area will be altered Therefore, as long as the fluence described herein is maintained for achieving the microablation disclosed herein, different lasers having di ffereni characteristic; may he used fm achieving the same ar similar re nils disclosed

The micnochannel 6 may he characterized by certain parameters, for example, diameter D and depth b Hie diameter מ of the miciochanne] and the depth h of die micrcchannel generally may be crmimlled hy the energy characferisiics of the la'er Such energy ch ar ar 1 eristics include, for example, wavelength, power, and the beam profile of the luer Chara; lerislies of the beam profile of the laser inclnde, for example 1f puke width, pulse diiraticn. and pulse frequency) Furthermore. rhe profile and volume of rile thermal affected zone may be formed by uririg different larer heam characteristics, such as chesen wavelength. energy of individual pulse or defined sequence of pukes, duration of each puke, power distribution. shape of the laser spnr, and ihe like as will be miiiinecl in detail below fa Jr seme embodiments of the invention the diameter of the־ ablated tiucmchannel may range from about 1(1 pm 10 about *flfl pm, preferably in the range from abonr *fl μ1η td about 2 *fl pm Mi cm channel diameter ח may depend on rhe type cf laser used and other parameters. Tor example, the elasticity of the skin Tl has been found that rhe haHorn of the formed miemchannel is after! ocnieal due to die elastic (nites efibe xkim

2Γ 3s well 35 Ihe power energy distribution of the spot termed by the laser

The depth of the microchannel may be determined by rhe abending physician based upon the tTRalmenl required or selected by the physician For example, treatment of collagen {collagen remodeling) typically 1003126 al 3 depth in ihe range from shout 200 dm to about 1 mm from the .Inrtace of skin tlSSUfi may he desired Treatment of 2* hlood vessels may nececrirale a micro channel extending up re approximately fl * mm, which is where blond vessels are typically located. The microchannel 6 may therefore be created in accordance with an embodiment of this invention tn a predetenriined depth h tn effect treatment tn collagen ot blncd vessels or any other portion of Ihe dermis selected by the attending physician According to some embodiment of Ihe present 1fl inventiCiL the laser device A may produce the microchannel 6 reachiuE, for example, in rhe range from ahonl 1 (10 urn lo about י mm in depth below the surface of die Tissue *

Any 'nitnhle type of laser may be used. for ablating the mi eno channel for example, CO; laser. Er YAG. Im YAG, Tm fiber laser. Er fiber laser. Ho fiber laser,

- ]0de. (זי any other laser tvpe 3s is well knowח in the art which may match a predetermined operational parameter such as, for example: optical aksorprinn by tissue and intensity of laser that are ffronp enough to ahlare small volumes with minimal lateral damage The laser emitting device 3 may therefore be adapted for emitting sr 5 ablative laser beam 4 having any suitable power level and/or spot size and/or other associated characteristics The laser power level may range, for example in the range trom about (1 י m.l to abcul 25(1 ml The spot size of the laser beam 4 on the tissue surface may range, for example, in the range from ahoul 10 pm «1 about 50 μπι For example, a CD? laser may use a spar size ranging from about 80 pm to about 150 um 1(1 for ablative treatment and preferably about £0 pm

In some embodiments of the present invention, th? ablation may be produced by a continuous wave laser. l־y a single pulse of a taser, or by a series of pulses The selection of these farms may depend, for example, upon die depth of the tnicrochannel required, the diameter of rhe miemehannel ?is well as the ίΰκ of the thermal affected J* zone, that is, rhe width of the lateral damage 1ת an embodiment using 3 continuous wave taser, far example, an ablating taser operating in a wavelength nF 10 6 tun. the laser emitting device 3 may be operated 31 a power level of. eg, m the range from about 1.0 W tn about 250 W for a duration of, e g. in the range from about 0.02 msec Io about 500 m^r Tn an embodiment nsmg a pulsed CGj laser, far example, 3 series of. זג for example, 1 fl pulses, each having a duration of. for example in the range from about (1.05 msec io about 10(1 msec may be fired al an energy level of e g in the range fmm about 0.2 ml 1□ aboil( 20 ml. In an embodiment using a pulsed laser, a series of pulses, each having ?1 ΤΛΠ’ίΐΟΰ of ftem abow 0 05 m&c tn 3h™ 1100 msRc τηπγ be iiftd mar he fired 01 an energy level of in the range frem abeut fl ? mJ fc ahnm ?(] m.l Tn skin for יד example, applying a pulsed laser as indicated above may result in a microchannel 6 of a diameter in [he range of from abmil SO μηΐ In abnnl 1(1(1 pm, a depth m the range of From about 100 pm to about 500 μτη, and a thermal affected zone of lateral width in the range of from about 20 pm io about 5C(1 fim Additionally, as described helaw in an embodiment of the inventim. a series of pubes, cf pulsed laser may he fired at the -0 tissue 5 to further deepen the microchannel 6. created as identified above The mjcrochannel 6 may be deepened to 3 desired depth, preferably to the level of (he tissue 1c be non ahTallvely treated II should be nr red that the diameter of the deepened

II

MicroChannel 6 may be jn Ihe vm5־c range or differenl range as the previously c re a fed miemchannel in !he fame location.

In some embodiments of the invention, the nticroablacion channel 6 may he sculpted by employing different pulse characteristics of the laser beam Pnlse י characteristics of a laser beam, e g laser beam 4. may further inehide differpnl energy profiles As mentirned abcve, the depfh b of rhe micnxbanriel !nd the resuIting width of lateral damage and the profile of the rherma! affected zone 7 may he control led by different laser Ham cbaracteoslics For example, the laser heam 4 may have character!sties resulting in the Thermal affected zone 7 having a substantially rcnstAnl in width (linear profile) 7. It will he -recognized that some embodiments of the invention may have a thermal affected zone 7 profile different from the one depicted in FIG 1 Furthermore, it is now possible io produce a micnochannel 6 according m embodiments of the present mvernion with a minimal thermal affected zone 7. e g a width in the range from ahnni 1 pm to about 5 gm with die ilsp of the FriYAG laser

In some embodiments of the present invention, die laser unit 7 may inelnde a

COillroller 1? able to Centro] the later emining device 3. and an input inter face 13 capable of receiving input parameters from user of syslem 1 Such input parameters may be tor defining iuicroablatior treatment parameters, for example! User input parameters tn the interface 13 may further include the microchannel depth, the spatial local inn of rhe miorochannel 6 on ths tissue! surface 1. etc. Parameters may be provided at the iriprr[ interface 13 by ar operalor of !he systertL for example, a phvsiciar. or aliemarively through an imager program detailed below The controller 12 may he ahle to perform at least one of We folloiving functions, as Wil] be described in more detail below (a) identifying at least one locauon for trftafmenl: (b) selecting treatmenlfsl for each of at least cne location: (c) eperaring a laser and directing mechanism In produce ihe al least one microablation; and (d) delivering the selected Inpatmenl(s) at the at least one site

Reference is now made to FIGS 7A, 7Ώ. 2C, and 2D which schematically illustrate sequential 41 ages of mi cm ablation and treatment in accordance with an 30 embodiment of rhe invention According to an ernbcriimeril cf the invention it may he desirable te apply treatment to Huie which may be, for example, in ihe hypodermis 1(1 in a way that substantially aiainiainj the profile of rhe thermal affected ?one throughout ihe treatment protocol As 11 i; desirable 10 minimize Ihe necrosis of tissue al Ihe surface

I, ίι may be beneficial fa apply a plurality of laser pulses on io ihe !issue 5 in order Io reach a depth cF treahnerii area in ihe hypodermis 10 A? illustrated m FIG )A. the mirrnrhannel 6 created hy a firs! 3b13tive later pulse, may have the desired thermal affected zone 7, e.g. linear profile cf crustam width, for example, a minimal width, and 5 may have a depth of hl that is not s 11 fficiently deep to provide treatment tn the hypridpimis 10 A seennd ablative laser puke maybe applied through microchannel 6 of FIG 2A 10 deepen the miciCChannel 6 having a minimal thermal affected zone tn a depth h2 into, for example, the dermis 9 of the tissue 5. while maintaining the predetermined min until thermal affected 2one profile, as ilhu hated in FIG 7R Finally, in as indicated in FIG 7C, a third ablative laser puke may he applied through the microchannel 6 of FIG. 2R to deepen the mkrochamtel 6 having a minimal thermal affected zone 7 further tn a depth 117 into rhe targeted hypodermis layer 10, while maintaining the predetermined thermal affected zone profile 7 Alternatively, if a non ablative puke is applied after the profile depicted in FIG חל, the profile may appear as 1ר depicted in FIG 2D.

According to some embodiments of the invention, 3 delay representing a minimum time. e p I to ICO mrec. may pass between each laser pulse, thereby allowing relevant pert ions of tissue 5 tc Cool down between each puke This delay may Fe between any succession 0F laser pulses wherher they are ahlaiive or [ion-ablative If is 20 preferable 10 have a delay after an ablative laser pulse. To allow for cooling of tissue 5. the. minimum time between pulses may he determined according in, for example, a predetermined tissue relaxafior time which may define, e p the time required tn dissipate 3 certain ameuni of heat ah'orbed by. e.g the tissue 5. hiring a laser puke applied by die laser device י The delay may also allow venting of ablative tissue and or 2s gases that may 113ve developed during an ablative pulse of light. Accordingly, if 3 time nF an applied pulse is shorter than the tissue relaxation time and the beam has a lop hat profile 3 very law amount of heat mav dissipate ihreugh walls of the mic cochannel fi

A beam profile thar would conform to ת π inverted lop bat may he preferable in some emhodimeuts of the piesem invention for forming a channel with well defined side walk, minimal micro channel diameter, and 3 minimal [herma! effected zone. Typically, 8 beam has a Gaussian power distribution across the diameter of ils spot Since the power on the adges of such a spri is less than the power in the center of the spot, ii is often difficult to fcmi a straighi w3Ued channel or hole Uy having 3 beam profile rhal has 3 tmifonr ח ין we r distributian across its spot (a top hat profile) it will he easier fn form a straight walled channel.

Tn some ernhodimenls of the inventirn ripen producing rhe mi cm channel and dealing a path fn the treatment site a wide variety nt’ types of treatment may be s delivered to the site, as detailed W.ow 10־ some ernhntF merits, the tfeahnenl may Ine (ion-ablative laser treatment Such non-ablative hser a :went may be used, for example, for remcdeling cdlagen As is mon particularly 11lustrated in FIG ?D. a non ablative laser treatment may he delivered In rhe tissue 5 kt the dermis 3 after the microchannel 6 has been created The path created for the □on-ahfarive hearing of the 1<1 target tissue may follow emhedimenis of the invention detailed above regarding FIGS

2A. 9 זחB and/ciT 2C. Thai is, healing af subsurface tissue by a nrn-ahlative laser through the created inicreir-tiannel may be through s micnochanne] that was created by one or hy more that one ablative pulses T user treatment by the laser beam 4 may he applied to the tissue 5 in the dermis 9, whereby the tissue 5 is healed In a temperature 1* below that at whirl] the l1S‘11e is ablated though heated to 3 temperature sufficient 10 denature collagen, for example, in the range 0Γ from ahont 5OCC io about 67 :C The non-ahlalive laser beam 4 may further create a thermal affected 7one of denatured collagen 17, without tissue ablation, whereby collagen is heated. The collagen thereupon cnnlmr.ls. thus removing wrinkles The nr n-ablative laser beam 4 may further 3(1 be applied to targeted tissue for removing pi ״me trial ion treating blond vessels, arid

Other ireatrnents. as is well knowm In those skilled iu the art

Aerordingly. it will he appreciated that the us? of the microchannel 6 of the present invention 33 a conduit for applying nm-ahlahve heat to targeted subsurface tissue, enables the healing of the subsurface tissue fo be treated withoni excessively 3* damaging non-largefet! tissue for example, the surface tissue, Further the thermal affected zone may be additionally cautrolkd hy having non ablative heating applications inlcrposed between ablative hratmenls Tot creating a larger thermal affected zone 17 daesp >n the tissue, for example in the dermis 9.

Reference is now additionally made m FIGS 1A. 3R. qG. and W which 1>י schematically 11 Imtrate sequential stages nF treatmen[ in micrcablaticin channels in accordance with embodiments of die invention Tn accordance with 1□ some embodiments of the invention, it may be desirable to create a predetermined non uniform thermal affected zone profile and/Ci lateral width damaged area sirup the depth nFthe channel lo other embrdirnftvls of the invEnrien. an area of [i^ue in the dermis 9 may he. treated for forming a predeterminer thermal afTecled zone having a profile different from the profile of the thermal affected zone in !he epidermis 8 near the surface As is more particularly i !hrIrawd in FIG ΊΑ. rhe microchannel fi havinf a צ predetermined thermal affected zone and/or profile 7a and a depth h I may he created by a first ablaiive laser pulse. As 1 !]))slmed un FIG 2D. a swond ]flier nen shlative laser pdse may hear the bottom of the microchannel 6 thereby damaging a spherical area sunonnduig the bottom of the channel to a depth hi reaching for example, heyond rhe dermii 9. Ibis second pulse may have differed 1 characieristics than the fird pulse, 1ח producing a thermal affected zone having a different area and/or profile than the First pulse and rafulliag in the profile ted in FIG 2D. When a second ahlzave la?e! pulse (that is. rhe I hind pulse tn this treatment area] is applied through rhe damaeed tissue on the hrrlnm of the tnicrochannel a profile h a? depicted in FIG 3 Fl is formed. Thus, FIG 3R depicts aju ablative laser pulse applied subsequent to the non-ablative laser pulse which formed ihe profile depicted in FTG. 2D Alterraiing ablative laser treatment with non ablative laser treatment may result for example, in a miorochannel having a thermal affected profile as illustrated in FIG 3C Tl will he understood that a micro channel may be produced τη any depth and by any number of pulses for creating a series of predetermined thermal affected zones that may xary along die depth of the

2« micmchannel Tn this way. a predetermined thermal affected zone profile along the microchannrl 61s formed 11 is ihm possible τη build a vaiiety of predetermined thermal affected zcne ureas mwVct profiles ulong Iba wzll amd or the bottom of ihe mi err ablated chanrel. using a sequence of pulses with different parameters (e.g energy and dliraticn or wavelength] and employing the naitiral thermal conductivity of tissue. For example.

io another embodiment of the invention, an ablative laser pulse applied tn th? tissue 5 may have characters 1׳cs producing a thermal affected zone having חפ area and/or profile '/d as illustrated in FJG 3D The thermal aFfecied zone 7d in FIG. 3D illustrates that the thermal affected zone area may decrease along the depth of the channel, according to predetermined laser beam parameters Of course, once the depth of the

0י rissue targeted for treatmEni is reached, die non ablative heating of the rissue shmijd preferably commence

1B some embodiments of the present invention, the system may be adapted co create ihe microcbauTie! 6 with ihe desired thermal affected zone profile 7 alrng the walls flrid/οτ hntinm of rhe microchannel 6 Additionally or alternatively, creating the mic™channel 6 itself may facilitate the desired rteatmeni method, hy providing acres1; directly In a subcutaneous site for ireamienl For example. upon completion 0Γ rhe micmchannel. a sub dance may be delivered 10 the treatment sire by any means.

including for example, u1tr3i0mc delivery Additionally or alternatively, the microchannel may serve 3S 3 conduit fm trans derm al substance delivery, for evampk, for diffusion, electrophoresis. cinlmmiLs, acids, healing substances, chemical peelinc agents, collagen mcdificalion agents, fillers, stem cells, or any variety of administering medicines and the like 11 will be noted Ihal the depth of rhe microchaiine need nm Fe IC the only or even the primary Ireatmenl site; rather the neatrnenl site may be any and all sites along the walls and'or bottom of rhe microchannel adjacent to or proximate the rnirrr channel

In some embodiments of the invention, the controlter ]2 may provide י a command via a signal M to the laser device for applying a pulse or senes of pulses to 15 the tissue 5 The cmt-rciUer may provide a variety of ccmmands to the laser device: 3. for example, the sequence and duration nf pulses to apply to the tissue 5. The cmutroller may 31 sc select form a variety of laser source? fc! applying a desired sequence of ablative and iion-ablativc laser applications to a panicular site The controller may also prescribe the desired delay between ihe laser applications Furthermore, the ccnh־nller 20 19 enables the laser emitting device 3 Io deliver precise mulli-qinl ablation to selective portions of tissue in accordance with preselected treatment protocols :13 is wall known by the physician

In some embodiments. more than one micmchannel may be podneed substantially r rm currently or in rapid .sequence on die tissue 5, for example, by directing 25 the laser emitting device י front cine predetermined -rile ra another of the tissue 5. applying a pulse at each site and returning precisely to the previously treated sile sn as to apply the next pulse in the sequence Thus, while the tissue 5 nt ore rmciochannel 1? cooling, the controller 19 may send a command co the taser device י to move among one or more sites on the tissue 5 fc< crearinp a plurality of nucTCchanneh al a plurality 1״fl of rites Such a device may use, for example, a laser scanner Such scanners may operate in accordance with Ihe teachings in U.S. Pat. Nos 5.713,907; 5.957,915; and £.398,733. For example, at a fhSt scanning sequence Ihe laser device י may provide rhe laser beam 4 on the first site resulting in a micro channel of depth h 1. Tie controller 17

- Id may then move the later device 3 10 a second tile to produce theieon a microchannel having a depth hi. This process may continue until rhe laser device 3 performed on each location has a microchannei resulting in depth hl. The 0οππη|Ι?τ 12 may then proceed to provide the laser beam 4 cn a rr i croc ha on el file Fm-rher ablating a mjcrochanne’ .ς resulting in another microchannel rvf rleplh h2 directly below the first micme hanne I site

Alcemalively. th? second laser applicalion rnav he a non-abhtive laser beam Th? controller 12 may rhen move the laser device 3 10 a second site to produce a mi crochan tie] of depth h2 This process may continue until ihe laser device 3 performed on each MicroChannel localion 0Γ depth hl a second laser beam pulse resulting in a ^i! TTiicrctbamiEl of depth V12 Of course the order of the seconf! beran across the seW-tpri treatment sites may be in a dfferenl order 01 sequence than Ihe first pass Alremative scanning sequences may apply laser beam pulses repeatedly al a location. Iben moving In another location to apply laser pulses II may nnt be necessary that the same serie׳; of pubes (chaiactcnsiies including duration and power) be applied al each location in rhe 15 sequence and any number of series of pulses may he applied 10 [issue al various locations;.

In some embodimenis of Ihe invention, the tissue may he manipulated and Ihe laser emitting device 3 po'irioned fer applying the laser beam 4 la the tissue 5 For example, the skin !issue to he treated may he lifted and rhe laser beam 4 may he applied 0י from ihe side Furthermore the conhxiHei 12 may direct the laser cm in me device 10 י apply the laser team ? co the !issue 5 from a variety of angles from ihe perpendicular

In Another embodiment of ihn invention, it may he desirable to increase the; amour! of radial ion per 11זוח of suifac-t area of ihe ris^if י for esample, rhe !issue 5 may he stretched prior 10 applying laser beam 4 10 Ihe !issue Referring 10 FTC! 4A. laser י* beam 4 may he applied ic !lustreIrhed Ijs5ue 5 five! a surface area IS of rissne The !issue 5 may be strelrhed in a variety of directions as selected by the physician, for example, ihe lateral direciion. manually ar hy some device applying a stretch 20. prior to producing the microchannol 6 as dela!led above in an embodiment of the invention. Referring to FIG. 4B, applying serelch 20 to rhe rissne 5, effectively increases the amount nf radiation per unif surface area 19 af the !issue * The miciochannel 6 (FTC! JC] created in the stretched !issue * will possess dimensions and charac!eristics as detajlec above. Release of ihe tissue stretch J3. may result in a relaxed tissue 5 wherein the mi cro ch aim el f now po'sesses a sraaller dismetei IT (i.e D<O. Ref. FIG 4D] The reductien in miorochannel diameter may alsn be a function of fissup: pinperties, for example, 11ssue elasticity; tissue hydra ted conditions, and Ihe thickness nF the stratum comeum Thus, by streiching rhe 'km prio! to a lare! beam if applied the area nf damagec skin may be birther reduced Strekhina the skin hai many advanknees beyond 5 jusl minimizing the amomu of damaged skm For example, by stretching the skin during the application of 81ז ablative laser for Creming 3 micmchafltiel, the diajneifir of Lhe micTcchanflel wiU be further reduced In this infection has a s-midler erirrance point and Ihe chance for infection may be further minimized Stretching the 'kin during the appliratim of the laser h?3m (both an ablative laser hesm and a uon-ablative laser ir beam) provide' additional advantages, for example, better penetration, better evacuation of vapors, and being less sensitive in the position of the target redariv? m rhe applied beam

Th? system may also include an imager ro enable a user to view1 ihe tissue area and 10 chons? a treatment file For example, Ihe imager and an image pmne.ssor may be 1י used In deiennine (he wrinkle topology of a tissue For example, by using the imager combined with Hie application of polarized lighl, th? outline, depth, and profile of Lhe skin's topology may he more precisely dpiErrmned The wrinkle !apology may be provided to thp inpul interhoe Π In coinmiinicsie with lhe controller 13 and send a signa! 14 10 the laser device י to maximize the aim of ihe laser device י to the target 0ל [issue 5. The wrinkle topology may be 11«rt ro measure the effectiveness of the treatment as well as used for idemtitying targeted site? that may require additional treatment

An imager may also he used to e on era Ie optica! feedtack, eilher manually to the eye of lhe user, or aulomatically to an image process™ in order In return the laser tn a 2s previously trenred site. The processor may process Ihe image obtained from !he imager for providing uifcnration in the controller for varying lhe treatment locations, Ihe particular laser Io be used, Ihe laser spot size the 'pot location, etc In Ibis mannei. if [he patienl moved between pulses, an image! and prncessoi may enable returning the laser lo the precise site of rhe previous pulse Tlse of an imager to optically track or סר determine tissue position maybe n.sed in concert with the process described above of the sequential creation of microchannels as is well knowr I» those skilled in rhe art

As shown in Flf! f in anorher embodimenl of the inventinn, the microchannel may he used to fac il i iale treatment lo mb cutaneous Tissue hy a means niher than through

IS the microcbannel itself The vnid of the micTCchannel may act as a barrier 01 insulating separation of air. between layers of li”11e on eilhei side of Ilie microrhannel Therefore a microchanne may he used in conjunction with radio Frequency (RE) energv treatment 10 allow driving a current helow rhe microchannel As !Ilmira ted. the micro channel (ו is s created according to nn embodiment of rhe present invention detailed above, having a width W. a length L. and a rieplh h In Ihis embodiment, Ilie tnierocharmel depth h reaches into the dermis of the tissue and the tatgelsd tissue is benearh Hie! miorochannel 6 m th? dermis 9. Radio frequency elecnodes J5 and 1b maybe applied to the tissue at opposite sides ci the mic cochannel 6 When RF current IS is applied, the insulating io (nonconducting) property׳ of rhe micrnrhannfd 6 require«; the current to flow between electrodes 15 and 16. below Hie mi croc han 1? ח depth h, direr ling the current to deeper tissue than would have recurred in the ab'cnce of the micrnchannel 6 The length 1 of rhe micrcchanueJ should preferably he at least twice its depth (2B) so that the applied current may go through rhe targeted tissue and not find an alternate path of less ]( resi'taniv The length of the mic 1 or ha rm el in this embodiment df the invention maybe tn the range of ftom about 1(10 pm !0 about 500 pm. and preferablv about 300 pm Accordingly, if will be appreciated that by uiing the micro channels of (he present invention, the heating of deeper layers of nssue may be achieved without damaging the surface liscne II will further be ;appreciated that controlling the dimensions of !he

2(1 miernchanneb eg., the depth, width, and or length of the micrnchannels may define the treatment provided by the treatment device, e.g. the RF electrodes, to the treatment layer of (he tissue fl will be ncled that by ecidceni ויי ring the cunent, the rmcr&cbarmel may provide fci increased currcnl density al die desired n־eai1uent she A similar approach may be used for heating and followed shrinkage of collagen fibers al a

2s predetermined depth

Creating a mi er rich a nr d into (he tissue for reaching an area of targeted treatment may also he achieved without an ablative laser For example, a micrnchannel may he created mechanically with a hen ted microneftd]? After the micrnchannel is thus formed, non-ablative treatment may he applied

2(1 RoFerTTce is now made to FfG 6. which schematically־ i Hue pare c a flow-chan of a method for perfemomg niii ro-ablatinn on a tissue in accordance with an embodiment of the invention A’ indicared al block 6(11, the method may include, for example, positioning the laser device for performing MicroChannel ablation. For example, the

19user of ihe system 1 !nay initially pnsificm the laser device י relative tn rhe skin 3 to enable creating 1)1? microrhannel at a desirtd location. As indicated at block 602, the merhnd may also irchide. for example deientiminp !he depth of the microchannel For ?sample, the user may determine that th? desired depth of the microchannel 6 (FIGS.

2A, 2R and 2C) is h^. As indicated al block 603, rhe method may also include, for example, detenniniuj (he width of the MicroChannel and/or the thermal affected תסל? For example., the user way determine that the desired width of the microchmwel 6 is Π (TIG 1) and the desired thermal affected ?one profile may vary as in 2a. Th 7c. and 7d (FJGS י A. 3B. and 3D) The density of mierochaoTieis (e g . number of channels per tn area) nan also he deiennined. The wavelength for ihe different stage? of the ablation may also he determined A' indicated at block 604. the method may also include, for example, preduring a mirrorhannel- For example, the laser device 3 may emit a laser beam and may !hereby produce the minor channel 6 in the tissue 5 As indicated at block 605. ihe rnethed may also inrlnrie, for example, applying treatmeni Onto a micrcchannel it location. For example, applying heat treatment 1o affect collagen at bottom of microehannel 6 (FIG. 2D) 11 will te recognized that die step 0Γ applying treatment i= optional and need nnl be practiced in every emtoriimenf of the invention

FIG 7 depicts a now char! meth rd in accordance with emhodimenh of rhe present invejriion At hlock TOO. rhe crieniatiOn of the hSsne 5 is selecrcd tor treatment.

9Π the tissue, e.g skin is stretched- lifted, nr left natural At Work 701, image analysis of the tissue surface is performed, fcr example, tn create wrinkle rcpolrgy, io provide information to rhe ronirtiller 12 (FIG. 1) 1ח order to maximize laser orientation It will be recognizid that the step ofimsge analysis is optional and reed not he piadiced in every embodiment of the invention. At blocks TH? and 7CA the depth and width of ihe 25 micrnchannels may he determined respectively, for example, based cm ths treatment program selected זח selected by rhe operator. Ai block 704, rhe ibermal affected zone (e g, area and'Or diameter of necrosis) may be determined for example hy setting the pu'se dwTafion. pulse energy, the number of pulses, or file density of (he pulses tased cm ihe treatment program, or based on seleciion by ihe operator Al Flock 7(15. Ihe area of vi collagen shrinkage (i e. thermal affected zone 17) may be deiermined (FJG. 2D) At hlock 7(16. ת treatnieiii partem or program may he determined, for example, by ihe operator of the device ieleciing an appropriate program At Hock 7(17 (he size of ihe micro chan wl pansm may be detenTnnMV fur example, suin mad tally by scanning or baspd on the henhrent program, or by an eperainr splecnn^ rhe appropriate patrert size Ai hlork /08, the fill factor, io! example, ihe density of the microchannels on the tissue, may be determined, for example. nutemaiically by rhe device, e g . based on the treatment pre gram. m ty selection hy the operator of the device. Ai block 7(19 the 5 device may he positioned rn ihe tissue, and al Hock 710, the treatment may be pErformed by forming ihe microchannels, and/or applying any other desired treatment

If will he appreciated by ppimns of ordinary skill in thp ail that according til some embodiment of the present invention riher applications according io the principles of the present invention are possible and aie in the scope of this application.

1(1 While certain fearnres ofthe 1nvrenti0T5 have been i I ] ט s era tad and described hpreir, many modifications, substitutions changes, and equivalents will now occur io those of Ordinary ski]] in thp art

EXAMPLE is re he under stood th 3i the following example of rhe present invention is not 15 intended 10 reshirt rhe present invention

A srudy was conducted that consisted nf two research criteria The First sri tenor evaluated difffreni laser energy doses cm 47 conspouiive samples of skm The doses ranged from 5 m.l rn 200 mJ. The width and depth of ihe ablated column'’ was measured as well a-; the suntmniling width and depth of necrosis The second criterion 2C compared the efFecis of doses ranging from 5 ml io 2(1 mJ on the arms nf selected vnlunieers. These evaluations were recorded immediately after thp filing of th? laser: al one hour; one day and four days.

Summary of Re.iuhs or Finding

The depth and diameter of ihe ablated columns correlated in a linear fashion 25 with ihe dose The column depth could he directly c out rolled And ringed fpom 1?ΰ to 1378 microns depending on the dose level nespice the wide range of dosing parameters the column diameter was tightly confined and only ranged from 16)4-1י microns with most nf column diameters being m the 5Π-70 micron range Necrosis depth ranged from 27 213 nucronc Necrosis width was extremely cemfined and ranged 30 only from 15-55 mierrm. Histologically, the ablated columns produced by 5 mJ and Hl mJ pulses reached (he mid- io ieep denms: rnlnmns only penetrated to the fat al the highest dcse (2(1(1 mJ) On doses nf 5. JO, and 2(1 mJ. the resnltan! skin eryThema and ede*ma was evident at 1-2 days, hnl the mild to moderate erythema faded by the Fourth day There were no cases of neomsis.

C,anfht^lOnS

F Utilizing his to logic evahiaticn, it is a novel carbon dioxide based mirrcahlalion device can produce selective digital injury to dermal collagen using very low energy levels The ccliaiemi necrosis 1¾ very limited P7elirrin3ry clinical evaluation using low energy doses demonstrates mild tn mederare ervthertia that fades a( feur days These findings will he used to delerrmne rhe dosing for future clinical studies

Although the particular embodiments shown and described above wiII prove io be useful in many application ז in the skin treatment art to which the presenr inveulion pertains, it is to be understood that Ihe description and examples are not inrended co be limiling Therefore, ihe scope of the present invention is defi.nec solely by the appended claims