US20070010811A1 - energy delivery device for treating tissue - Google Patents

Abstract

An electrode assembly adapted to be coupled with a handpiece and powered to treat skin and underlying tissues. A sensor is coupled to the energy delivery device. The sensor may comprise, for example, a force sensor or a thermal sensor.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. application Ser. No. 10/072,610, which is a continuation-in-part of U.S. application Ser. No. 09/522,275, filed Mar. 9, 2000, now U.S. Pat. No. 6,413,255, which claims the benefit of U.S. application Ser. No. 60/123,440, filed Mar. 9, 1999. The disclosure of each of these applications is hereby incorporated by reference herein in its entirety.
FIELD OF THE INVENTION
• This invention relates generally to an electrode delivery device for treating tissue for treating skin and underlying tissues.
BACKGROUND OF THE INVENTION
• The human skin is composed of two elements: the epidermis and the underlying dermis. The epidermis with the stratum corneum serves as a biological barrier to the environment. In the basilar layer of the epidermis, pigment-forming cells called melanocytes are present. They are the main determinants of skin color.
• The underlying dermis provides the main structural support of the skin. It is composed mainly of an extra-cellular protein called collagen. Collagen is produced by fibroblasts and synthesized as a triple helix with three polypeptide chains that are connected with heat labile and heat stable chemical bonds. When collagen-containing tissue is heated, alterations in the physical properties of this protein matrix occur at a characteristic temperature. The structural transition of collagen contraction occurs at a specific “shrinkage” temperature. The shrinkage and remodeling of the collagen matrix with heat is the basis for the technology.
• Collagen crosslinks are either intramolecular (covalent or hydrogen bond) or intermolecular (covalent or ionic bonds). The thermal cleavage of intramolecular hydrogen crosslinks is a scalar process that is created by the balance between cleavage events and relaxation events (reforming of hydrogen bonds). No external force is required for this process to occur. As a result, intermolecular stress is created by the thermal cleavage of intramolecular hydrogen bonds. Essentially, the contraction of the tertiary structure of the molecule creates the initial intermolecular vector of contraction.
• Collagen fibrils in a matrix exhibit a variety of spatial orientations. The matrix is lengthened if the sum of all vectors acts to distract the fibril. Contraction of the matrix is facilitated if the sum of all extrinsic vectors acts to shorten the fibril. Thermal disruption of intramolecular hydrogen bonds and mechanical cleavage of intermolecular crosslinks is also affected by relaxation events that restore preexisting configurations. However, a permanent change of molecular length will occur if crosslinks are reformed after lengthening or contraction of the collagen fibril. The continuous application of an external mechanical force will increase the probability of crosslinks forming after lengthening or contraction of the fibril.
• Hydrogen bond cleavage is a quantum mechanical event that requires a threshold of energy. The amount of (intramolecular) hydrogen bond cleavage required corresponds to the combined ionic and covalent intermolecular bond strengths within the collagen fibril. Until this threshold is reached, little or no change in the quaternary structure of the collagen fibril will occur. When the intermolecular stress is adequate, cleavage of the ionic and covalent bonds will occur. Typically, the intermolecular cleavage of ionic and covalent bonds will occur with a ratcheting effect from the realignment of polar and nonpolar regions in the lengthened or contracted fibril.
• Cleavage of collagen bonds also occurs at lower temperatures but at a lower rate. Low-level thermal cleavage is frequently associated with relaxation phenomena in which bonds are reformed without a net change in molecular length. An external force that mechanically cleaves the fibril will reduce the probability of relaxation phenomena and provides a means to lengthen or contract the collagen matrix at lower temperatures while reducing the potential of surface ablation.
• Soft tissue remodeling is a biophysical phenomenon that occurs at cellular and molecular levels. Molecular contraction or partial denaturization of collagen involves the application of an energy source, which destabilizes the longitudinal axis of the molecule by cleaving the heat labile bonds of the triple helix. As a result, stress is created to break the intermolecular bonds of the matrix. This is essentially an immediate extra-cellular process, whereas cellular contraction requires a lag period for the migration and multiplication of fibroblasts into the wound as provided by the wound healing sequence. In higher developed animal species, the wound healing response to injury involves an initial inflammatory process that subsequently leads to the deposition of scar tissue.
• The initial inflammatory response consists of the infiltration by white blood cells or leukocytes that dispose of cellular debris. Seventy-two hours later, proliferation of fibroblasts at the injured site occurs. These cells differentiate into contractile myofibroblasts, which are the source of cellular soft tissue contraction. Following cellular contraction, collagen is laid down as a static supporting matrix in the tightened soft tissue structure. The deposition and subsequent remodeling of this nascent scar matrix provides the means to alter the consistency and geometry of soft tissue for aesthetic purposes.
• In light of the preceding discussion, there are a number of dermatological procedures that lend themselves to treatments which deliver thermal energy to the skin and underlying tissue to cause a contraction of collagen, and/or initiate a would healing response. Such procedures include skin remodeling/resurfacing, wrinkle removal, and treatment of the sebaceous glands, hair follicles adipose tissue and spider veins. Currently available technologies that deliver thermal energy to the skin and underlying tissue include Radio Frequency (RF), optical (laser) and other forms of electromagnetic energy. However, these technologies have a number of technical limitations and clinical issues which limit the effectiveness of the treatment and/or preclude treatment altogether. These issues include the following: i) achieving a uniform thermal effect across a large area of tissue, ii) controlling the depth of the thermal effect to target selected tissue and prevent unwanted thermal damage to both target and non-target tissue, iii) reducing adverse tissue effects such as burns, redness blistering, iv) replacing the practice of delivery energy/treatment in a patchwork fashion with a more continuous delivery of treatment (e.g. by a sliding or painting motion), v) improving access to difficult-to-reach areas of the skin surface and vi) reducing procedure time and number of patient visits required to complete treatment. As will be discussed herein the current invention provides an apparatus for solving these and other limitations.
• One of the key shortcomings of currently available RF technology for treating the skin is the edge effect phenomenon. In general, when RF energy is being applied or delivered to tissue through an electrode which is in contact with that tissue, the current patterns concentrate around the edges of the electrode, sharp edges in particular. This effect is generally known as the edge effect. In the case of a circular disc electrode, the effect manifests as a higher current density around the perimeter of that circular disc and a relatively low current density in the center. For a square- shaped electrode there is typically a high current density around the entire perimeter, and an even higher current density at the corners where there is a sharp edge.
• Edge effects cause problems in treating the skin for several reasons. First, they result in a non-uniform thermal effect over the electrode surface. In various treatments of the skin, it is important to have a uniform thermal effect over a relatively large surface area, particularly for dermatologic treatments. Large in this case being on the order of several square millimeters or even several square centimeters. In electrosurgical applications for cutting tissue, there typically is a point type applicator designed with the goal of getting a hot spot at that point for cutting or even coagulating tissue. However, this point design is undesirable for creating a reasonably gentle thermal effect over a large surface area. What is needed is an electrode design to deliver uniform thermal energy to skin and underlying tissue without hot spots.
• A uniform thermal effect is particularly important when cooling is combined with heating in skin/tissue treatment procedure. As is discussed below, a non-uniform thermal pattern makes cooling of the skin difficult and hence the resulting treatment process as well. When heating the skin with RF energy, the tissue at the electrode surface tends to be warmest with a decrease in temperature moving deeper into the tissue. One approach to overcome this thermal gradient and create a thermal effect at a set distance away from the electrode is to cool the layers of skin that are in contact with the electrode. However, cooling of the skin is made difficult if there is a non-uniform heating pattern. If the skin is sufficiently cooled such that there are no burns at the corners of a square or rectangular electrode, or at the perimeter of a circular disc electrode, then there will probably be overcooling in the center and there won't be any significant thermal effect (i.e. tissue heating) under the center of the electrode. Contrarily, if the cooling effect is decreased to the point where there is a good thermal effect in the center of the electrode, then there probably will not be sufficient cooling to protect tissue in contact with the edges of the electrode. As a result of these limitations, in the typical application of a standard electrode there is usually an area of non-uniform treatment and/or burns on the skin surface. So uniformity of the heating pattern is very important. It is particularly important in applications treating skin where collagen-containing layers are heated to produce a collagen contraction response for tightening of the skin. For this and related applications, if the collagen contraction and resulting skin tightening effect are non-uniform, then a medically undesirable result may occur.
• There is a need for an improved RF handpiece for cosmetic applications.
SUMMARY OF THE INVENTION
• Accordingly, an object of the present invention is to provide an RF handpiece which provides a substantially uniform delivery of energy to a target tissue site.
• Another object of the present invention is to provide an RF handpiece which includes at least one RF electrode that is capacitively coupled to a skin surface when at least a portion of the RF electrode is in contact with the skin surface.
• Yet another object of the present invention is to provide an RF handpiece that provides a uniform thermal effect in tissue at a selected depth, while preventing or minimizing thermal damage to a skin surface and other non-target tissue.
• A further object of the present invention is to provide an RF handpiece configured to reduce or eliminate the edge effects and hot spots of RF electrodes applied to skin surfaces.
• Another object of the present invention is to provide an RF handpiece configured to provide an atomizing delivery of a cooling fluidic medium to the RF electrode.
• Still another object of the present invention is to provide an RF handpiece configured to evaporatively cool the back surface of the RF electrode, and conductively cool a skin surface adjacent to a front surface of the RF electrode.
• A further object of the present invention is to provide an RF handpiece configured to controllably deliver a cooling fluidic medium to the back surface of the RF electrode at substantially any orientation of the front surface of the RF electrode relative to a direction of gravity.
• Yet another object of the present invention is to provide an RF handpiece that includes an RF electrode with both conductive and dielectric portions.
• Another object of the present invention is to provide an RF handpiece that includes a force sensor that zeros out gravity effects created by the weight of the electrode assembly of the RF handpiece in any orientation of the front surface of the RF electrode relative to a direction of gravity.
• These and other objects of the present invention are achieved in a handpiece that has a handpiece assembly. The handpiece assembly includes a handpiece housing and a cooling fluidic medium valve member. An electrode assembly is coupled to the handpiece housing. The electrode assembly has a least one RF electrode that is capacitively coupled to a skin surface when at least a portion of the RF electrode is in contact with the skin surface.
• In another embodiment of the present invention a handpiece, a handpiece assembly includes a handpiece housing and a cooling fluidic medium valve member with an inlet and an outlet. An electrode assembly is removeably coupled to the handpiece housing. The electrode assembly has a least one RF electrode with a front surface and a back surface. The RF electrode is capacitively coupled to a skin surface when at least a portion of the RF electrode is in contact with the skin surface.
• In another embodiment of the present invention, a handpiece includes a handpiece assembly with a handpiece housing. An insert is at least partially positionable in the handpiece housing. An RF electrode is coupled to the insert. The RF electrode has a back surface that faces the handpiece housing and an opposing front surface. A cooling fluidic medium dispensing assembly is coupled to the handpiece housing and the insert.
• In another embodiment of the present invention, a handpiece includes a handpiece assembly with a handpiece housing. An insert is detachably coupled to the handpiece housing. The insert includes an RF electrode with a conductive portion and a dielectric.
• In another embodiment of the present invention, a handpiece includes a handpiece assembly with a handpiece housing. An insert is detachably coupled to the handpiece housing. An RF electrode is positioned in the insert. The RF electrode includes a flex circuit.
• In another embodiment of the present invention, a handpiece includes a handpiece assembly with a handpiece housing. An insert is detachably coupled to the handpiece housing. The insert includes a flex circuit and an RF electrode that with a conductive portion and a dielectric.
• In another embodiment, an electrode assembly is adapted to be coupled with a handpiece and powered to treat skin and underlying tissues. A sensor is coupled to the energy delivery device. The sensor may comprise, for example, a force sensor or a thermal sensor.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a cross-sectional view of one embodiment of the handpiece of the present invention.
• FIG. 2 is an exploded view of theFIG. 1 insert assembly.
• FIG. 3 is a close-up view of one embodiment of an RF electrode of the present invention.
• FIG. 4 is another cross-sectional view of a portion of the handpiece housing fromFIG. 1.
• FIG. 5 is a cross-sectional view of the insert fromFIG. 1.
DETAILED DESCRIPTION
• Referring now toFIG. 1, one embodiment of the present invention is ahandpiece10 with a handpiece assembly12. Handpiece assembly12 includes ahandpiece housing14 and a cooling fluidicmedium valve member16. Anelectrode assembly18 is coupled to handpiecehousing14.Electrode assembly18 has a least oneRF electrode20 that is capacitively coupled to a skin surface when at least a portion ofRF electrode20 is in contact with the skin surface. Without limiting the scope of the present invention,RF electrode20 can have a thickness in the range of 0.010 to 1.0 mm.
• Handpiece10 provides a more uniform thermal effect in tissue at a selected depth, while preventing or minimizing thermal damage to the skin surface and other non-target tissue.Handpiece10 is coupled to an RF generator.RF electrode20 can be operated either in mono-polar or bi-polar modes.Handpiece10 is configured to reduce, or preferably eliminate edge effects and hot spots. The result is an improved aesthetic result/clinical outcome with an elimination/reduction in adverse effects and healing time.
• Afluid delivery member22 is coupled to cooling fluidicmedium valve member16.Fluid delivery member22 and cooling fluidicmedium valve member16 collectively form a cooling fluidic medium dispensing assembly.Fluid delivery member16 is configured to provide an atomizing delivery of a cooling fluidic medium toRF electrode20. The atomizing delivery is a mist or fine spray. A phase transition, from liquid to gas, of the cooling fluidic medium occurs when it hits the surface ofRF electrode20. The transition from liquid to gas creates the cooling. If the transition before the cooling fluidic medium hitsRF electrode20 the cooling ofRF electrode20 will not be as effective.
• In one embodiment, the cooling fluidic medium is a cryogenic spray, commercially available from Honeywell, Morristown, N.J. A specific example of a suitable cryogenic spray is R134A₂, available from Refron, Inc., 38-18 33^rdSt., Long Island City, N.Y. 11101. The use of a cryogenic cooling fluidic medium provides the capability to use a number of different types of algorithms for skin treatment. For example, the cryogenic cooling fluidic medium can be applied milliseconds before and after the delivery of RF energy to the desired tissue. This is achieved with the use of cooling fluidicmedium valve member16 coupled to a cryogen supply, including but not limited to a compressed gas canister. In various embodiments, cooling fluidicmedium valve member16 can be coupled to a computer control system and/or manually controlled by the physician by means of a foot switch or similar device.
• A key advantage of providing a spray, or atomization, of cryogenic cooling fluidic medium is the availability to implement rapid on and off control. Cryogenic cooling fluidic medium allows more precise temporal control of the cooling process. This is because cooling only occurs when the refrigerant is sprayed and is in an evaporative state, the latter being a very fast short-lived event. Thus, cooling ceases rapidly after the cryogenic cooling fluidic medium is stopped. The overall effect is to confer very precise time on-off control of cryogenic cooling fluidic medium.
• Referring now toFIG. 2,fluid delivery member22 can be positioned inhandpiece housing14 orelectrode assembly18.Fluid delivery member22 is configured to controllably deliver a cooling fluidic medium to aback surface24 ofRF electrode20 and maintain backsurface24 at a desired temperature. The cooling fluidic medium evaporatively coolsRF electrode20 and maintains a substantially uniform temperature offront surface26 ofRF electrode20.Front surface26 can be sufficiently flexible and conformable to the skin, but still have sufficient strength and/or structure to provide good thermal coupling when pressed against the skin surface.
• RF electrode20 then conductively cools a skin surface that is adjacent to afront surface26 ofRF electrode20. Suitable fluidic media include a variety of refrigerants such as R134A and freon.Fluid delivery member22 is configured to controllably deliver the cooling fluidic medium to backsurface24 at substantially any orientation offront surface26 relative to a direction of gravity. A geometry and positioning offluid delivery member22 are selected to provide a substantially uniform distribution of cooling fluidic medium onback surface24. The delivery of the cooling fluidic medium can be by spray of droplets or fine mist, flooding backsurface24, and the like. Cooling occurs at the interface of the cooling fluidic medium with atmosphere, which is where evaporation occurs. If there is a thick layer of fluid onback surface24 the heat removed from the treated skin will need to pass through the thick layer of cooling fluidic medium, increasing thermal resistance. To maximize cooling rates, it is desirable to apply a very thin layer of cooling fluidic medium. IfRF electrode20 is not horizontal, and if there is a thick layer of cooling fluidic medium, or if there are large drops of cooling fluidic medium onback surface24, the cooling fluidic medium can run down the surface ofRF electrode20 and pool at one edge or corner, causing uneven cooling. Therefore, it is desirable to apply a thin layer of cooling fluidic medium with a fine spray.
• In various embodiments,RF electrode20, as illustrated inFIG. 3, has aconductive portion28 and adielectric portion30.Conductive portion28 can be a metal including but not limited to copper, gold, silver, aluminum and the like.Dielectric portion30 can be made of a variety of different materials including but not limited to polyimide, and the like. Other dielectric materials include but are not limited to silicon, sapphire, diamond, zirconium-toughened alumina (ZTA), alumina and the like.Dielectric portion30 can be positioned around at least a portion, or the entirety of a periphery ofconductive portion28. Suitable materials for adielectric portion30 include, but are not limited to, Teflon® and the like, silicon nitride, polysilanes, polysilazanes, polyimides, Kapton and other polymers, antenna dielectrics and other dielectric materials well known in the art. In another embodiment,RF electrode20 is made of a composite material, including but not limited to gold-plated copper, copper-polyimide, silicon/silicon-nitride and the like.
• Dielectric portion30 creates an increased impedance to the flow of electrical current throughRF electrode20. This increased impedance causes current to travel a path straight down throughconductive portion28 to the skin surface. Electric field edge effects, caused by a concentration of current flowing out of the edges ofRF electrode20, are reduced.
• Dielectric portion30 produces a more uniform impedance throughRF electrode20 and causes a more uniform current to flow throughconductive portion28. The resulting effect minimizes or even eliminates, edge effects around the edges ofRF electrode20.
• In one embodiment,conductive portion28 adheres todielectric portion30 which can be substrate with a thickness, by way of example and without limitation, of about 0.001″. This embodiment is similar to a standard flex circuit board material commercially available in the electronics industry. In this embodiment,dielectric portion30 is in contact with the tissue, the skin, andconductive portion28 is separated from the skin. The thickness of thedielectric portion30 can be decreased by growingconductive portion28 ondielectric portion30 using a variety of techniques, including but not limited to, sputtering, electro deposition, chemical vapor deposition, plasma deposition and other deposition techniques known in the art. Additionally, these same processes can be used to depositdielectric portion30 ontoconductive portion28. In one embodimentdielectric portion30 is an oxide layer which can be grown onconductive portion28. An oxide layer has a low thermal resistance and improves the cooling efficiency of the skin compared with many other dielectrics such as polymers.
• Fluid delivery member22 has aninlet32 and anoutlet34.Outlet34 can have a smaller cross-sectional area than a cross-sectional area ofinlet32. In one embodiment,fluid delivery member22 is anozzle36.
• Cooling fluidicmedium valve member16 can be configured to provide a pulsed delivery of the cooling fluidic medium. Pulsing the delivery of cooling fluidic medium is a simple way to control the rate of cooling fluidic medium application. In one embodiment, cooling fluidicmedium valve member16 is a solenoid valve. An example of a suitable solenoid valve is a solenoid pinch valve manufactured by the N-Research Corporation, West Caldwell, N.J. If the fluid is pressurized, then opening of the valve results in fluid flow. If the fluid is maintained at a constant pressure, then the flow rate is constant and a simple open/close solenoid valve can be used, the effective flow rate being determined by the pulse duty cycle. A higher duty cycle, close to 100% increases cooling, while a lower duty cycle, closer to 0%, reduces cooling. The duty cycle can be achieved by turning on the valve for a short duration of time at a set frequency. The duration of the open time can be 1 to 50 milliseconds or longer. The frequency of pulsing can be 1 to 50 Hz or faster.
• Alternatively, cooling fluidic medium flow rate can be controlled by a metering valve or controllable-rate pump such as a peristaltic pump. One advantage of pulsing is that it is easy to control using simple electronics and control algorithms.
• Electrode assembly18 is sufficiently sealed so that the cooling fluidic medium does not leak fromback surface24 onto a skin surface in contact with a front surface ofRF electrode20. This helps provide an even energy delivery through the skin surface. In one embodiment,electrode assembly18, and more specificallyRF electrode20, has a geometry that creates a reservoir at backsurface24 to hold and gather cooling fluidic medium that has collected at backsurface24. Back surface24 can be formed with “hospital corners” to create this reservoir. Optionally,electrode assembly18 includes avent38 that permits vaporized cooling fluidic medium to escape fromelectrode assembly18. This reduces the chance of cooling fluidic medium collecting at backsurface24. This can occur when cooling fluidic medium is delivered to backsurface24 in vapor form and then, following cooling ofback surface24, the vapor condenses to a liquid.
• Vent38 prevents pressure from building up inelectrode assembly18.Vent38 can be a pressure relief valve that is vented to the atmosphere or a vent line. When the cooling fluidic medium comes into contact withRF electrode20 and evaporates, the resulting gas pressurizes the inside ofelectrode assembly18. This can causeRF electrode20 to partially inflate and bow out fromfront surface26. Theinflated RF electrode20 can enhance the thermal contact with the skin and also result in some degree of conformance ofRF electrode20 to the skin surface. An electronic controller can be provided. The electronic controller sends a signal to openvent38 when a programmed pressure has been reached.
• Various leads40 are coupled toRF electrode20. One or morethermal sensors42 are coupled to RF electrode. Suitablethermal sensors42 include but are not limited to thermocouples, thermistors, infrared photo-emitters and a thermally sensitive diode. In one embodiment, athermal sensor42 is positioned at each comer ofRF electrode20. A sufficient number ofthermal sensors42 are provided in order to acquire sufficient thermal data of the skin surface.Thermal sensors42 are electrically isolated fromRF electrode20.
• Thermal sensors42 measure temperature and can provide feedback for monitoring temperature ofRF electrode20 and/or the tissue during treatment.Thermal sensors42 can be thermistors, thermocouples, thermally sensitive diodes, capacitors, inductors or other devices for measuring temperature. Preferably,thermal sensors42 provide electronic feedback to a microprocessor of the RF generator coupled toRF electrode20 in order to facilitate control of the treatment.
• The measurements fromthermal sensors42 can be used to help control the rate of application of cooling fluidic medium. For example, the cooling control algorithm can be used to apply cooling fluidic medium toRF electrode20 at a high flow rate until the temperature fell below a target temperature, and then slow down or stop. A PID, or proportional-integral-differential, algorithm can be used to precisely controlRF electrode20 temperature to a predetermined value.
• Thermal sensors42 can be positioned placed onback surface24 ofRF electrode20 away from the tissue. This configuration is preferable ideal for controlling the temperature of theRF electrode20. Alternatively,thermal sensors42 can be positioned onfront surface26 ofRF electrode10 in direct contact with the tissue. This embodiment can be more suitable for monitoring tissue temperature. Algorithms are utilized withthermal sensors42 to calculate a temperature profile of the treated tissue.Thermal sensors42 can be used to develop a temperature profile of the skin which is then used for process control purposes to assure that the proper amounts of heating and cooling are delivered to achieve a desired elevated deep tissue temperature while maintaining skin tissue layers below a threshold temperature and avoid thermal injury. The physician can use the measured temperature profile to assure that he stays within the boundary of an ideal/average profile for a given type of treatment.Thermal sensors42 can be used for additional purposes. When the temperature ofthermal sensors42 is monitored it is possible to detect whenRF electrode20 is in contact with the skin surface. This can be achieved by detecting a direct change in temperature when skin contact is made or examining the rate of change of temperature which is affected by contact with the skin. Similarly, if there is more than onethermal sensor42, thethermal sensors42 can be used to detect whether a portion ofRF electrode20 is lifted or out of contact with skin. This can be important because the current density (amperes per unit area) delivered to the skin can vary if the contact area changes. In particular, if part of the surface ofRF electrode20 is not in contact with the skin, the resulting current density is higher than expected.
• Referring now toFIG. 4, aforce sensor44 is also coupled toelectrode assembly18.Force sensor44 detects an amount of force applied byelectrode assembly18, via the physician, against an applied skin surface.Force sensor44 zeros out gravity effects of the weight ofelectrode assembly18 in any orientation offront surface26 ofRF electrode20 relative to a direction of gravity. Additionally,force sensor44 provides an indication whenRF electrode20 is in contact with a skin surface.Force sensor44 also provides a signal indicating that a force applied byRF electrode20 to a contacted skin surface is, (i) below a minimum threshold or (ii) above a maximum threshold.
• Anactivation button46 is used in conjunction with the force sensor. Just prior to activatingRF electrode20, the physician holdshandpiece10 in position just off the surface of the skin. The orientation ofhandpiece10 can be any angle relative to the angle of gravity. Toarm handpiece10, the physician can pressactivation button46 which tares forcesensor44, by setting it to read zero. This cancels the force due to gravity in that particular treatment orientation. This method allows consistent force application ofRF electrode20 to the skin surface regardless of the angle ofhandpiece10 relative to the direction of gravity.
• RF electrode20 can be a flex circuit, which can include trace components. Additionally,thermal sensor42 andforce sensor44 can be part of the flex circuit. Further, the flex circuit can include a dielectric that forms a part ofRF electrode20.
• Electrode assembly18 can be moveable positioned within handpiece housing12. In one embodiment,electrode assembly18 is slideably moveable along a longitudinal axis of handpiece housing12.Electrode assembly18 can be rotatably mounted in handpiece housing12. Additionally,RF electrode20 can be rotatably positioned inelectrode assembly18.Electrode assembly18 can be removably coupled to handpiece housing12 as a disposable ornon-disposable insert52, seeFIG. 5. For purposes of this disclosure,electrode assembly18 is the same asinsert52. Once movably mounted to handpiece housing12, insert52 can be coupled to handpiece housing12 viaforce sensor44.Force sensor44 can be of the type that is capable of measuring both compressive and tensile forces. In other embodiments,force sensor44 only measures compressive forces, or only measures tensile forces.
• Insert52 can be spring-loaded with aspring48. In one embodiment,spring48biases RF electrode20 in a direction toward handpiece housing12. This pre-loadsforce sensor44 and keeps insert52 pressed againstforce sensor44. The pre-load force is tared whenactivation button46 is pressed just prior to application ofRF electrode20 to the skin surface.
• Ashroud50 is optionally coupled tohandpiece10.Shroud50 serves to keep the user from touchinginsert52 during use which can cause erroneous force readings.
• Anon-volatile memory54 can be included withinsert52. Additionally, non-volatile memory can be included with handpiece housing12.Non-volatile memory54 can be an EPROM and the like. Additionally, a secondnon-volatile memory56 can be included in handpiece housing12 for purposes of storinghandpiece10 information such as but not limited to, handpiece model number or version, handpiece software version, number of RF applications that handpiece10 has delivered, expiration date and manufacture date. Handpiece housing12 can also contain amicroprocessor58 for purposes of acquiring and analyzing data from various sensors on handpiece housing12 or insert52 including but not limited tothermal sensors42,force sensors44, fluid pressure gauges, switches, buttons and the like.Microprocessor58 can also control components onhandpiece10 including but not limited to lights, LEDs, valves, pumps or other electronic components.Microprocessor58 can also communicate data to a microprocessor of the RF generator.
• Non-volatile memory54 can store a variety of data that can facilitate control and operation ofhandpiece10 and its associated system including but not limited to, (i) controlling the amount of current delivered byRF electrode20, (ii) controlling the duty cycle of thefluid delivery member22, (iii) controlling the energy delivery duration time of theRF electrode20, (iv) controlling the temperature ofRF electrode20 relative to a target temperature, (v) providing a maximum number of firings ofRF electrode20, (vi) providing a maximum allowed voltage that is deliverable byRF electrode20, (vii) providing a history ofRF electrode20 use, (viii) providing a controllable duty cycle tofluid delivery member22 for the delivery of the cooling fluidic medium to backsurface24 ofRF electrode20, (ix) providing a controllable delivery rate of cooling fluidic medium delivered fromfluid delivery member22 to backsurface24, and the like.
• Handpiece10 can be used to deliver thermal energy to modify tissue including, but not limited to, collagen containing tissue, in the epidermal, dermal and subcutaneous tissue layers, including adipose tissue. The modification of the tissue includes modifying a physical feature of the tissue, a structure of the tissue or a physical property of the tissue. The modification can be achieved by delivering sufficient energy to cause collagen shrinkage, and/or a wound healing response including the deposition of new or nascent collagen.
• Handpiece10 can be utilized for performing a number of treatments of the skin and underlying tissue including but not limited to, (i) dermal remodeling and tightening, (ii) wrinkle reduction, (iii) elastosis reduction, (iv) sebaceous gland removal/deactivation, (v) hair follicle removal, (vi) adipose tissue remodeling/removal, (vii) spider vein removal, and the like.
• In various embodiments,handpiece10 can be utilized in a variety of treatment processes, including but not limited to, (i) pre-cooling, before the delivery of energy to the tissue has begun, (ii) an on phase or energy delivery phase in conjunction with cooling and (iii) post cooling after the delivery of energy to tissue has stopped.
• Handpiece10 can be used to pre-cool the surface layers of the target tissue so that whenRF electrode20 is in contact with the tissue, or prior to turning on the RF energy source, the superficial layers of the target tissue are already cooled. When RF energy source is turned on or delivery of RF to the tissue otherwise begins, resulting in heating of the tissues, the tissue that has been cooled is protected from thermal effects including thermal damage. The tissue that has not been cooled will warm up to therapeutic temperatures resulting in the desired therapeutic effect.
• Pre-cooling gives time for the thermal effects of cooling to propagate down into the tissue. More specifically, pre-cooling allows the achievement of a desired tissue depth thermal profile, with a minimum desired temperature being achieved at a selectable depth. The amount or duration of pre-cooling can be used to select the depth of the protected zone of untreated tissue. Longer durations of pre-cooling produce a deeper protected zone and hence a deeper level in tissue for the start of the treatment zone. The opposite is true for shorter periods of pre-cooling. The temperature offront surface26 ofRF electrode20 also affects the temperature profile. The colder the temperature offront surface26, the faster and deeper the cooling, and vice verse.
• Post-cooling can be important because it prevents and/or reduces heat delivered to the deeper layers from conducting upward and heating the more superficial layers possibly to therapeutic or damaging temperature range even though external energy delivery to the tissue has ceased. In order to prevent this and related thermal phenomena, it can be desirable to maintain cooling of the treatment surface for a period of time after application of the RF energy has ceased. In various embodiments, varying amounts of post cooling can be combined with real-time cooling and/or pre-cooling.
• In various embodiments,handpiece10 can be used in a varied number of pulse on-off type cooling sequences and algorithms may be employed. In one embodiment, the treatment algorithm provides for pre-cooling of the tissue by starting a spray of cryogenic cooling fluidic medium, followed by a short pulse of RF energy into the tissue. In this embodiment, the spray of cryogenic cooling fluidic medium continues while the RF energy is delivered, and is stopping shortly thereafter, e.g. on the order of milliseconds. This or another treatment sequence can be repeated again. Thus in various embodiments, the treatment sequence can include a pulsed sequence of cooling on, heat, cooling off, cooling on, heat, cool off, and with cooling and heating durations on orders of tens of milliseconds. In these embodiments, every time the surface of the tissue of the skin is cooled, heat is removed from the skin surface. Cryogenic cooling fluidic medium spray duration, and intervals between sprays, can be in the tens of milliseconds ranges, which allows surface cooling while still delivering the desired thermal effect into the deeper target tissue.
• In various embodiments, the target tissue zone for therapy, also called therapeutic zone or thermal effect zone, can be at a tissue depth from approximately 100 μm beneath the surface of the skin down to as deep as 10 millimeters, depending upon the type of treatment. For treatments involving collagen contraction, it can be desirable to cool both the epidermis and the superficial layers of the dermis of the skin that lies beneath the epidermis, to a cooled depth range between 100 μm two millimeters. Different treatment algorithms can incorporate different amounts of pre-cooling, heating and post cooling phases in order to produce a desired tissue effect at a desired depth.
• Various duty cycles, on and off times, of cooling and heating are utilized depending on the type of treatment. The cooling and heating duty cycles can be controlled and dynamically varied by an electronic control system known in the art. Specifically the control system can be used to control cooling fluidicmedium valve member16 and the RF power source.
• The foregoing description of a preferred embodiment of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Obviously, many modifications and variations will be apparent to practitioners skilled in this art. It is intended that the scope of the invention be defined by the following claims and their equivalents.

Claims (13)

1. An apparatus for use with a handpiece to non-invasively treat tissue beneath a skin: surface using radiofrequency energy, the apparatus comprising:

an energy delivery device adapted to be removably coupled to the handpiece, the energy delivery device including a dielectric portion and a conductive portion disposed on the dielectric portion, the conductive portion configured to deliver the radiofrequency energy to the tissue, and the dielectric portion adapted to be positioned between the conductive portion and the skin surface such that the radiofrequency energy is transmitted from the conductive portion through the dielectric portion for capacitively coupling with the tissue to perform the non-invasive tissue treatment; and

a sensor coupled to the energy delivery device.

2. The apparatus ofclaim 1 wherein the sensor is a thermal sensor, a thermocouple, an optical sensor, a current sensor, voltage sensor, an impedance sensor, or a flow sensor.

3. The apparatus ofclaim 1 wherein the sensor is a force sensor.

4. The apparatus ofclaim 3 wherein the dielectric portion and the conductive portion comprise a flex circuit, and the force sensor is coupled to the flex circuit.

5. The apparatus ofclaim 1 wherein the sensor is a thermocouple, a thermistor, an infrared photo-emitter, or a thermally sensitive diode.

6. The apparatus ofclaim 1 wherein the energy delivery device further comprises a support structure, the energy delivery device is coupled to the support structure, and the sensor is carried by the support structure.

7. The apparatus ofclaim 1 further comprising:

a cooling media delivery member coupled to the energy delivery device, the cooling media delivery member configured to deliver a cooling media to the energy delivery device.

8. The apparatus ofclaim 7 further comprising:

a non-volatile memory coupled to the energy delivery device, the non-volatile memory configured to store at least one of a duty cycle for controlling the fluid delivery member, a number of times the energy delivery device has been moved relative to the skin surface, or a number of areas treated by the energy delivery device.

9. The apparatus ofclaim 8 wherein the non-volatile memory is mechanically coupled to the energy delivery device.

10. The apparatus ofclaim 1 further comprising:

a non-volatile memory coupled to the energy delivery device.

11. The apparatus ofclaim 10 wherein the non-volatile memory is configured to store at least one of:

a number of times the energy delivery device has been moved relative to the skin surface, or

a number of areas treated by the energy delivery device.

12. The apparatus ofclaim 10 wherein the non-volatile memory is mechanically coupled to the energy delivery device.

13. The apparatus ofclaim 1 wherein the energy delivery device is configured to reduce at least one of an edge effect, an electrode edge effect, an electrode temperature gradient an electrode current density gradient, or a tissue interface surface temperature gradient.

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