WO1998005380A1 - Procede de raffermissement de la peau - Google Patents

Procede de raffermissement de la peau Download PDF

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Publication number
WO1998005380A1
WO1998005380A1 PCT/US1997/013608 US9713608W WO9805380A1 WO 1998005380 A1 WO1998005380 A1 WO 1998005380A1 US 9713608 W US9713608 W US 9713608W WO 9805380 A1 WO9805380 A1 WO 9805380A1
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Prior art keywords
tissue
skin
collagen
thermal
ablation
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PCT/US1997/013608
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English (en)
Inventor
Edward W. Knowlton
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Knowlton Edward W
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Publication date
Application filed by Knowlton Edward W filed Critical Knowlton Edward W
Priority to AU38250/97A priority Critical patent/AU3825097A/en
Priority to PCT/US1997/013608 priority patent/WO1998005380A1/fr
Publication of WO1998005380A1 publication Critical patent/WO1998005380A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/20—Applying electric currents by contact electrodes continuous direct currents
    • A61N1/28—Apparatus for applying thermoelectric currents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/02—Devices for expanding tissue, e.g. skin tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/40—Applying electric fields by inductive or capacitive coupling ; Applying radio-frequency signals
    • A61N1/403—Applying electric fields by inductive or capacitive coupling ; Applying radio-frequency signals for thermotherapy, e.g. hyperthermia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/02—Radiation therapy using microwaves
    • A61N5/04—Radiators for near-field treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N5/0613—Apparatus adapted for a specific treatment
    • A61N5/0616—Skin treatment other than tanning
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/203—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser applying laser energy to the outside of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A61B2018/0047—Upper parts of the skin, e.g. skin peeling or treatment of wrinkles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00505—Urinary tract
    • A61B2018/00523—Treatment of incontinence
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N2005/0635—Radiation therapy using light characterised by the body area to be irradiated
    • A61N2005/0643—Applicators, probes irradiating specific body areas in close proximity
    • A61N2005/0645—Applicators worn by the patient

Definitions

  • This invention relates generally to a method for contracting collagen containing tissue and tightening skin, and more particularly, to a method for tightening skin by modifying the impedance and/or the thermal conductivity of tissues.
  • the human skin is composed of two elements: the epidermis and the underlying dermis.
  • the epidermis serves as a biological barrier to the environment.
  • 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 extracellular protein called collagen. Collagen is produced by fibroblasts and exists as a triple helix with three polypeptide chains that are connected with heat labile and heat stable chemical bonds. When collagen is heated, alterations in the physical properties of this protein occur at a characteristic temperature. This structural transition occurs in a manner analogous to the melting of a crystal. However, just as there is a "melting" temperature, there is a “shrinkage” temperature. The shrinkage of collagen is the basis for the technology and applications discussed in this presentation.
  • Soft tissue contraction is a biophysical phenomenon that occurs at cellular and molecular levels.
  • Molecular contraction or denaturization of collagen involves the application of an energy source which results in the breaking of the heat labile bonds of the triple helix. As a result the longitudinal axis of the molecule contracts. This is essentially an immediate extracellular 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. These cells differentiate into contractile myofibroblasts and 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. Subsequent contraction can then be achieved by the molecular denaturization of collagen.
  • tissue shrinkage with the denaturization of collagen occurs in second degree burns and is typically applied as a standard thermal gradient that is hotter on the surface and cooler in the underlying dermis.
  • tissue shrinkage with the denaturization of collagen occurs in second degree burns and is typically applied as a standard thermal gradient that is hotter on the surface and cooler in the underlying dermis.
  • cellular contraction and partial denaturization of dermal collagen results in a tightening effect on the skin.
  • the present invention provides a means to apply a reverse thermal gradient in which the skin's underlying collagen-containing layers are heated instead of the epidermis. Contraction of the skin and underlying soft tissue is possible without ablation or a second degree burn with its inherent blistering and pigmentary irregularities.
  • a reverse thermal gradient can also be described as a reverse gradient of collagen contraction in which collagen is preferentially contracted within a target tissue regardless of its relationship to a surface structure. Unwanted thermal effects and collagen contraction on adjacent soft tissue structures are avoided. Because collagen is found in tendon, bone, cartilage and all other connective tissue throughout the body, reverse thermal gradient contraction of collagen tissue can have many applications.
  • the selective induction of the basic wound healing process serves as the basis for the second major application of the present invention.
  • 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 then produce scar collagen that functions as the main structural support of a healed wound.
  • the deposition and subsequent remodeling of this nascent scar matrix provides the means to alter the consistency and geometry of soft tissue for both aesthetic and reconstructive purposes.
  • an object of the invention is to provide a method for tightening skin by the use of RF or other energy sources, including ultrasound, to promote a thermal conduction rather than ablation of collagen containing tissue.
  • Another object of the invention is to provide a method for tightening skin using multiple port focusing separately or combined with other energy sources
  • a further object of the invention is to provide a method for tightening skin through the management of conduction/convection energy losses in the soft tissue system.
  • Still a further object of the invention is to provide a method for tightening skin by altering tissue impedance achieved through surface hydration to increase conductance, injection of conducting and resisting
  • Skin resurfacing techniques that secondarily tighten excess skin (such as laser and chemical peels) employ a "standard thermal gradient" that requires burning off the superficial skin as a second degree burn.
  • the thermal effects of collagen contraction in the deeper dermis occur, but require a painful healing phase due to the second degree burn.
  • These modalities depend upon re-epithelialization with cell migration from the skin appendages. This process of re- epithelialization is similar to the healing of any thermal burn and is more likely to cause pigmentary irregularities due to the destruction of melanocytes in the epidermis.
  • RF energy radio frequency
  • a high frequency alternating current usually 100,000 to 500,000 Hz
  • Ionic agitation is produced in the tissue around the electrode as the ions attempt to follow the changes of direction of the alternating current. This agitation results in frictional heating so that the tissue, rather than the electrode itself, is the primary source of
  • Another object of the present invention is to provide a method for tightening skin by decreasing the shrinkage temperature of collagen by chemically altering molecular and fiber stability.
  • Yet another object of the present invention is to provide a method for tightening skin by modifying the thermal insulation characteristics of the skin to be more of a thermal conductor.
  • a thermal conductivity of the skin is modified to achieve skin tightening.
  • FIG. 1 is a perspective view of an apparatus for applying electromagnetic energy through the skin in order to cause a partial denaturization of collagen tissue, resulting in a tightening of the skin.
  • Figure 2 is a cross-sectional view of the skin and underlying tissue.
  • Figure 3 is a schematic representation of the collagen network.
  • Fig. 4 is a schematic diagram of an apparatus for applying electromagnetic energy to underlying subcutaneous layers or deeper soft tissue layers to create a desired contour effect by partially denaturing collagen tissue, and without substantially modifying melanocytes and other epithelial cells in the epidermis.
  • FIG. 5 is a block diagram of an RF system which can be utilized with the present invention.
  • FIG. 6 is a block diagram of processing circuit of one embodiment of the invention.
  • Scar Collagen Deposition A non-ablative neosynthetic process of collagen deposition as a reaction to inflammation induced by thermal injury.
  • the resulting collagen is frequently referred to as nascent, as opposed to pre-existing.
  • Reverse Thermal Gradient A non-ablative remodeling effect upon either pre-existing or nascent scar collagen.
  • Reverse Gradient of Collagen Contraction A tissue environment in which collagen is preferentially contracted within a target tissue regardless of its relationship to adjacent or surface structures.
  • Tissue Impedance The resistance in tissue to the flow of energy or current.
  • Tissue Conductance The transmission of energy or current through tissue.
  • Fibroblast The connective tissue cell that produces collagen and is the source of cellular contraction.
  • Radiofrequency (RF) Energy The segment of the electromagnetic spectrum (wavelengths 10 -3 to 105 meters) that is released as thermal energy in tissue when ions are agitated by a high frequency alternating current.
  • the present invention provides for the thermal shrinkage, or tightening of skin without the destruction of the overlying epidermis.
  • Skin tightening with a reverse thermal gradient (hereafter "RTG") contraction of collagen can correct areas such as the thighs, knees, arms, back and hips without unsightly scarring of standard techniques. Areas previously corrected by surgical procedures, such as face and neck lifts, could also be corrected without requiring surgery or the typical incisions around the ear. Elastosis, or stretching of the abdominal skin from pregnancy, could be corrected without the long scar commonly associated with an abdominoplasty. Breast uplifts (mastopexies) would no longer require extensive incisions. It is believed that RTG contraction of collagen could be an effective, non-invasive alternative for the aesthetic treatment of these areas. RTG contraction of collagen could also be employed in areas not effectively treated by standard surgical techniques. Treatment of "cellulite" of the thighs and hips is one example.
  • the achievement of a RTG is the selective non-ablative contraction of collagen without thermal damage to surface and adjacent conducting tissues.
  • Various modalities are available, (i) RF or other energy sources (ultrasound) that promote thermal conduction rather than ablation, (ii) multiple port focusing separately or combined with other energy sources, (iii) management of conduction/convection energy losses in the soft tissue system, (iv) alterations of tissue impedance (physical manipulation, surface hydration to increase conductance, injection of conducting and resisting fluids, invoking the inflammatory stage of the wound healing sequence to increase conduction, mampulation of collagen deposition and maturation, (v) decreasing the shrinkage temperature (Ts) of collagen by chemically altering molecular and fiber stability, and/or providing a mechanism to make the skin more of a thermal conductor than a thermal insulator.
  • Ts shrinkage temperature
  • the subcutaneous fat layers have loculations from fibrous septae that contain collagen. These fibrous septae can be contracted to tighten the soft tissue in areas such as the hips and thighs.
  • fibrous septae can be contracted to tighten the soft tissue in areas such as the hips and thighs.
  • intracellular effects upon the fat cell, or lipocyte by thermal induction will cause a net reduction of fat from the lipocyte which will achieve a net reduction in volume of the treated area.
  • a second device such as ultrasound focused at the appropriate level on the subcutaneous tissue
  • the RTG RF device
  • a second broad application of RTG contraction of collagen involves the induction of scar collagen deposition.
  • Thermal induction can incite the wound healing sequence of fibroblast proliferation with nascent scar deposition in soft tissues normally devoid or deficient of collagen.
  • RTG Reliable to breath apnea
  • the soft palate in the back of the throat collapses and interferes with or obstructs breathing in sleeping individuals.
  • Current treatments involve the surgical shortening of this structure, or laser treatments which employ a standard thermal gradient which bums the mucosa.
  • the soft palate contains a minimal amount of collagen. Thermal induction of scar collagen deposition on the soft palate followed by contraction to shorten the palate could relieve the functional airway obstruction.
  • burning of the mucosa is avoided by employing a RTG instead of a standard thermal gradient.
  • RTG contraction of collagen could include the treatment of unstable joints due to collateral ligament laxity.
  • the thermal induction and deposition of scar collagen with subsequent contraction will reduce the hypermobility of these joints.
  • this technology can be applied in the treatment of unstable spinal column disorders, such as lumbar or cervical compression syndromes, and scoliosis that is often encountered in younger women.
  • thermal induction of scar collagen deposition would be initiated in precise locations along the spine. Additional treatments would then contract the scar collagen to counter the vectors of spinal deviation and increase the stability of the spine.
  • the thermal induction of osteoblasts in the periosteum will result in callus (calcium matrix) formation. As callus contains a higher percentage of collagen than mature bone, subsequent remodeling with thermal contraction is possible. Maturation of the remodeled callus with calcium matrix deposition will result in a stable bony fusion of treated areas.
  • treatment of wrinkles could be accomplished by combining a RTG contraction of dermal collagen with the induction of scar collagen deposition.
  • Improved skin turgor is accomplished by first replenishing the collagen matrix that has been lost with aging. Following the induction and deposition of nascent scar collagen in the dermis, contraction of collagen with a RTG would correct wrinkling of the skin without resorting to "resurfacing" techniques that require the application of a standard thermal gradient bum to the skin. Prolonged healing and pigmentary irregularities would be avoided.
  • the superficial papillary dermis is the treatment zone for this application.
  • a derivation of Ohm's law provides a means to alter and discriminate the biophysical properties of soft tissue.
  • I E/R, where I is intensity of the current (measured in amperes), E is the energy potential (measured in volts), and R is the resistance (measured in ohms).
  • I intensity of the current (measured in amperes)
  • E the energy potential (measured in volts)
  • R the resistance (measured in ohms).
  • I intensity of the current (measured in amperes)
  • E the energy potential (measured in volts)
  • R the resistance (measured in ohms).
  • TI tissue impedance
  • Modulation of RF frequency may provide additional delineation of the impedance characteristics of tissues. More specifically, an increase in the frequency may correlate to a greater thermal release in higher impedance tissues. In a "series" system, an increase in RF frequency will equate to an increase in the thermal content of target tissues that are resistors. In a parallel system, target tissues may be configured differently to augment current density in a low impedance environment. Different frequency parameters may be required.
  • Raising the extracellular fluid (ECF) content of soft tissue results in a reduction in tissue impedance, which increases current density and thermal delivery to target tissues that have a relatively higher impedance.
  • Target tissues can also be physically manipulated to lower ECF content and further raise their local tissue impedance as resistors.
  • the thermal energy released at a target tissue is expressed as joules, or the heat dissipated in an electrical system.
  • the thermal energy released at the target tissue is directly related to the tissue impedance and is exponentially related to the current density.
  • tissue impedance in reference to the different phases of the wound healing sequence is critical in predicting thermal remodeling effects upon collagen.
  • conductors such as inflammatory edema or normal saline will increase the extracellular fluid. Transfer of RF energy through tissue without thermal release is facilitated. Injection of glucose containing solutions or conditions that reduce the ECF will act as resistors that will target tissue for thermal release and the remodeling of collagen.
  • the initial stage involves the creation of inflammatory edema that raises ECF and conductance.
  • the second phase of fibroplasia involves the multiplication and migration of fibroblasts to the wound.
  • the deposition of scar collagen will increase tissue impedance even though (ECF) ground substance content is high.
  • the final phase of scar collagen maturation begins at two weeks and continues for several weeks. During this phase, the collagen becomes progressively more insoluble due to the loss of ground substance with a concomitant increase in intermolecular and interfiber cross linkage. Concurrent with this change is a gradual increase in tissue impedance. Preexisting or native collagen is even more insoluble and will exhibit the highest tissue impedance.
  • the ability of energy to do work in this soft tissue system corresponds to the contraction of collagen by the disruption of crosslinks in the triple helix of the molecule.
  • An accurate measure of energy delivery to the tissue is required. Temperature is not a measure of heat content or energy delivery to tissue. Rather, it is a momentary snapshot of the energy level of the tissue. It is the delivery of energy over time as the heat content (joules/second) that is the most accurate measure of energy available for the contracture of collagen.
  • Another factor that affects the heat content of tissue is the thermal dissipation that occurs through thermal conduction away from the target tissue and the thermal convection from vascular and surface structures. Control of multiple factors is required to create the optimal RF tissue environment for the non-ablative contraction of collagen.
  • heat is required as a precursor of the "RF effect.
  • This may be supplied from a variety of sources, such as ultrasound.
  • the thermal energy acts as an amplifier of the RF electrode rather than a direct agent to cleave the molecular crosslinks.
  • This beginning thermal sequence provides the ionic agitation required for the magnetic induction by the RF electrode.
  • the magnetocaloric effects predicts the thermal requirement for the magnetic
  • RF electrode produces an alternating magnetic moment that cleaves the collagen crosslinks with an "in phase" alternating ionic motion.
  • the magnetocaloric effect increases the induced magnetic moment within the tissue. Additional thermal energy beyond this effect will only damage tissue and should be avoided.
  • FM frequency modulation
  • tissue impedance of the skin surface and soft tissue serves either as a conduit or as a target resistor.
  • current density can be increased with the injection of a conductor (decrease TI) such as normal saline, which allows the subcutaneous plane to act as a conduit to the target tissue.
  • Conducting fluid that increases current density to the target tissue will increase thermal release in a logarithmic fashion.
  • saline injection into target tissues enlarges the effective surface area of the RF electrode. A more uniform inductive effect is provided by the saline tissue interface.
  • Increasing the TI of adjacent structures by stretching skin over rollers will have a similar effect by funneling the current to the conduit tissue.
  • Injection of a resistor fluid, such as glucose, into a target tissue will increase the TI and thermal release in a linear fashion.
  • Current density of conduit tissues and thermal release at target tissues is greatly enhanced by combining the injection of conducting (saline) and resisting (glucose) fluids.
  • soft tissue injection functions as a tissue impedance "lens" that focuses thermal energy in target tissues while reducing collateral damage to adjacent structures. This approach is mainly used for deeper soft tissue applications.
  • the manipulation of the impedance characteristics of target tissues with either conductors or resistors will create the optimal RF environment that has the appropriate amount of heat and current density for the magnetic induction of that tissue.
  • an understanding of dermal impedance is required. Reduction in the thermal load at the skin entry port subjacent to the RF electrode may be accomplished by reducing the tissue impedance of the skin with hydration, i.e. a hydrogel applied under the electrode strip is used to increase ECF and conductivity of the skin entry point. A more selective (time-dependent) hydration of the epidermis and papillary dermis under the electrode will conduct current through the superficial skin and target the deeper dermis as a resistor.
  • This pre-determined period of hydration is selected for the specific dermal level of the target tissue.
  • the target tissue interface is positioned between the overlying hydrated conducting skin and the subjacent non-hydrated dermis that acts as a resistor.
  • a RTG for dermal and subdermal contraction of skin is achieved when the current is released as thermal energy in the deeper dermal tissue.
  • hydration of the skin is achieved by initially applying an anesthetic gel that has an aqueous penetrant formulation. The treatment area is then submerged in a bath for a variable period of time, as dictated by the dermal target level. This specific methodology would have cutaneous applications for scar collagen deposition and contraction to correct wrinkling and aging of the skin.
  • Wrinkling of the skin is treated by targeting a more superficial dermal level and is achieved by reducing the duration and depth of skin hydration. Deeper dermal effects for skin contraction would be achieved by longer periods of skin hydration.
  • the deeper dermal and subdermal target tissues can be discriminated further from the conducting superficial skin with the injection of a fluid resistor such as glucose. Heating of the glucose prior to injection in the target tissue may additionally serve to lower the RF power requirement for contraction of collagen.
  • the "tumescent" technique used for liposuction could be used as a familiar technique of injection.
  • Another approach to alter TI is to invoke the inflammatory stage of the wound healing sequence. Similar to the induction of scar collagen deposition, the wound healing sequence can be initiated to alter the TI and current density of soft tissue.
  • the initial inflammatory stage of the wound healing sequence involves creation of edema fluid within the extracellular spaces.
  • the ECF will be increased as edema fluid and will allow tissue to act as a conductor/conduit.
  • This fluid is a conductor whose osmolarity is similar to normal saline and is formed by the extravasation of serum from the capillary bed or post capillary venules. Changes in endothelial permeability as mediated by histamine and bradykinin will appear morphologically as erythema of the skin.
  • the collagen shrinkage temperature (Ts) is an indication of molecular stability as is determined by the amount of crosslinkage.
  • Ground substance such as chondroitin sulfuric acid (CSA) increases molecular stability by promoting salt-like crosslinks between collagen fibers.
  • Reagents such as hyaluronidase (Wydase) that enzymatically remove CSA will reduce fiber stability and the shrinkage temperature (Ts).
  • a reduction of 10 °C in the Ts is obtained by the injection of this reagent. As a result, power requirements and thermal damage to conducting and target tissues would be reduced.
  • Wydase may be combined with a resistor fluid such as glucose to augment thermal release while lowering the temperature required for contraction.
  • a resistor fluid such as glucose
  • the solution would be combined with a dilute local anesthetic and injected into target tissues with the "tumescent" technique.
  • Pharmacological methods to alter the solubility of collagen may also be an effective way to alter the relative conductance and resistance of soft tissue.
  • Anti-inflammatory medications such as steroids will reduce conductance and edema fluid of target tissues.
  • Other agents such as vitamin E will also reduce conductance by promoting the scar maturation process. During this process, the decrease in collagen solubility is due to loss of ground substance and an increase in molecular cross linkage.
  • Reversing the maturation process involves increasing the solubility of collagen with various lathrogenic agents (such as beta aminoproprionitrile, d-penacillinamine and colchicine). Cross linkage is retarded and the tissue will exhibit a higher conductance due to the increase in ground substance.
  • lathrogenic agents such as beta aminoproprionitrile, d-penacillinamine and colchicine.
  • a surface convection cooling pad should cool tissues but provide enough thermal energy required by the magnetocaloric effect for the magnetic induction and cleavage of molecular collagen crosslinks.
  • Additional device modalities are available to physically manipulate tissue and decrease ECF, i.e. the manipulated tissue behaves like a resistor.
  • These devices may be applied in tandem or as part of the RF electrode. They include rollers, suction cups or a combination of both.
  • Simple mechanical trauma such as rolling the skin will initially increase the TI, but may subsequently augment conductance of the skin with the formation of inflammatory edema at the current entry area of skin under the electrode.
  • the skin surface will avoid thermal damage and allow more efficient delivery of energy to target tissues.
  • Target tissues will also respond in a similar fashion with the formation of inflammatory extracellular fluid.
  • an initial drop in TI will be observed, the solubility and conductance will decrease with the deposition of scar collagen within 72 hours after initial injury. Subsequent treatment may be timed to take advantage of the increasing resistance of the target tissue to provide a greater release of thermal energy.
  • Additional scar maturation with increased cross linkage may make the collagen more susceptible to contraction from both a TI and a chemical bonding perspective, even though the shrinkage temperature (Ts) is raised.
  • collagen maturation with additional cross-linkage will increase the potential for contraction.
  • Mature or native collagen should exhibit a greater thermal release (TI increase) and molecular contraction than more soluble and immature scar collagen.
  • the present invention involves application of a RTG to heat the underlying dermal collagen, while protecting the superficial epidermal skin.
  • the device used to achieve this effect is similar to a heating pad. It employs radio frequency (RF) energy that is precisely focused on the underlying dermal collagen of treatment areas.
  • RF radio frequency
  • this energy source can be employed in tandem with other energy sources.
  • Ultrasound can be used as a non-inductive source can provide the initial energy of ionic agitation required for the magnetic RF induction of collagen containing tissue.
  • the heating pad is designed to provide the appropriate vectors of contraction. Areas of application are not confined by requirements to hide surgical incisions or to transition chemical peels or laser resurfacing into aesthetic boundaries. And since scarring and pigmentary irregularities are avoided, skin tightening can now occur in areas previously considered “off-limits" to standard methods of correction.
  • the medical devices and procedures that are designed specifically for skin contraction will have the following components: initially, the skin is hydrated to a specific dermal level before the RF heating pad is applied.
  • ultrasound transducers are incorporated with mechanical rollers that are applied as a separate device over the RF heating pad. The rollers manipulate tissue impedance and the ultrasound transducers are aligned as parallel opposing ports that are focused with an overlapping energy pattern at the target dermal level. By simultaneously heating the target tissue with ultrasound, power requirements are reduced for the RF heating pad.
  • the initial evaluation is begun with a digitized image of the patient Each potential treatment area is captured for analysis.
  • a cursor is used to determine the appropriate boundary of each treatment area for either a minimally invasive or non-invasive approach.
  • a vector analysis is performed to orient the parallel electrode array on the patient's skin.
  • an intraoperative infrared image is captured and referenced to the preoperative digital evaluation.
  • the peak infrared emission pattern for each area is captured and digitally incorporated into an entire mosaic of the treatment area. This peak emission mosaic is compared to the preoperative digital evaluation for the position, boundary and appropriate vectors of contraction in addition to the recommended infrared emission levels.
  • a treatment sequence for clients desiring skin contraction involves a variety of modalities.
  • a topical agent such as Retin A or alpha hydroxy acid is applied to the skin to produce an inflammatory edema. Conductance of RF energy through the superficial skin will be facilitated.
  • the client begins her treatment session with the application of an aqueous penetrant gel which contains a concentrated local anesthetic. The gel is massaged into the specifically marked treatment areas for 30 minutes. These areas are preferentially hydrated by having the client bathe for approximately one hour with water temperature approximately
  • the next stage of the treatment sequence involves the application of the RF heating pad that has been specifically configured from the treatment area. Incorporated into the RF heating pad is a cooling channel that will cycle dermal heating and surface convection cooling. A second device that employs mechanical rollers and ultrasound transducers to focus additional thermal energy in the skin may also be used.
  • Minimally invasive techniques are possible that involve the percutaneous insertion of a medical device through the skin that can achieve a RTG for the contraction of skin.
  • the device can be used in tandem with an endoscope to provide hemostasis and aid the dissection of the subcutaneous plane.
  • the device consists of a multiple purpose canula that is used for subcutaneous dissection and liposuction in addition to collagen contraction.
  • a spatula shaped canula has a light source on the dorsal surface which trans illuminates the skin and creates a focused light pattern on the skin to determine depth and uniformity of the subcutaneous plane of dissection.
  • a liposuction portal is placed on the ventral aspect of the device and allows aesthetic modification of the subcutaneous fat.
  • a separate energy source is also mounted on the dorsal aspect of the canula and is used to "paint" the subdermal and dermal tissues for the contraction of collagen.
  • This device may either be a separate canula with the transilluminator or combined as a single combined device with the subcutaneous dissection/suction canula.
  • an RF electrode is utilized as the primary energy source.
  • Other energy sources may include an ultrasound transducer or a coherent C0 2 light source with a diffuser.
  • a facelift procedure would typically involve the initial injection of a tumescent solution that contains a dilute xylocaine/epinephrine mixture with added Wydase. Anesthesia and vasoconstriction with lowering of the collagen shrinkage temperature (Ts) is provided with this solution.
  • Ts collagen shrinkage temperature
  • the subcutaneous dissection/ liposuction canula is inserted.
  • an endoscope may be inserted for direct visualization and hemostasis. After development of a uniform superficial subcutaneous plane of dissection, liposculpture of the underlying subcutaneous tissue is achieved.
  • a separate or combined canula skin contraction is achieved in a uniform fashion by sweeping the energy source in the superficial subdermal plane of dissection. Accurate surface and depth orientation is provided by the transillumination pattern of the skin.
  • Another example of a minimally invasive procedure is the correction of the post partum ptosis of the breast.
  • large anchor shaped incisions are employed to achieve a mastopexy or breast uplift.
  • uplifting and tightening of the breast envelope can be achieved through small periareolar incisions with the minimally invasive methodology of The present invention. Achievement of a three- dimensional enhancement rather than a two-dimensional uplifting is provided by preoperatively dete ⁇ nining the appropriate vectors of contraction with digital capture software, i.e.
  • a radial pattern of sweeping will result in a longitudinal shortening of the breast envelope, whereas a circular sweeping pattern around the circumference of the breast will increase projection by tightening the base perimeter dimension.
  • a variety of esthetic procedures is also possible for the abdomen, thighs and arms.
  • the present invention provides the esthetic surgeon with the opportunity to achieve a more immediate result in a minimally invasive fashion.
  • the larger incisions of typical esthetic procedures is eliminated. Contour irregularities and skin looseness that is typical of suction lipectomy procedures is avoided.
  • tissue impedance for collagen contraction
  • TI tissue impedance
  • Power requirements for cancer management can be reduced further by altering intracellular metabolism rather than ablating tumor cells. If remission or homeostasis is defined as a state in which net tumor growth has ceased, then the creation of a state can be achieved by increasing cell death (ablation) or decreasing cell growth by suppression of mitosis with intracellular thermal induction. Most oncologic treatment modalities focus upon various ablation strategies that place little emphasis on reducing mitotic activity. Suppression of cancer cell mitosis with intracellular thermal induction has significant potential in reestablishing homeostasis at lower power requirements. The patient care algorithm would consist of a continuing sequence of treatments to maintain the balance between cell death and cell growth while eliminating damage to adjacent tissue.
  • the thermal induction of homeostasis will also provide a continuing opportunity for a competent immune response by the patient.
  • a balance between ablation and thermal induction of homeostasis is also promoted by selectively altering the tissue impedance of target and conducting tissues. Power or dose requirements for ablation can be further reduced by modifying the cellular kinetics of the tumor. Thermal induction will place cells in phase during the mitotic cycle, rendering the tumor more susceptible to ablation. Cycles of treatment with thermal induction will stagger phases of cell multiplication to predictable periods that can be timed with the patient's oncologic treatment (i.e. chemotherapy and/or radiation therapy). By increasing the specificity of thermal ablation, sequential management of metastatic disease may be possible.
  • Thermal ablation of normal tissue can be used for aesthetic liposculpture. By altering TI and conductance with these methods, ablation of subcutaneous fat can be achieved with a greater degree of precision.
  • the current use of "tumescent" injection of an impedance altering solution integrates easily with the present invention.
  • Non-ablative thermal modification of intracellular metabolism is another potential application with this technology. If a low grade injury pattem is sustained during exercise, thermal injury should incite the same sequence of extracellular and intracellular inflammation that leads to hypertrophy of a muscle cell. This method can be applied for disuse atrophy of muscle in patients who are paraplegic or who are in catabolic stress for any reason. Disuse atrophy sustained in zero gravity environments may be avoided with intracellular thermal induction of muscle.
  • thermal inductive effects should be different for intracellular suppression of collagen synthesis than scar collagen formation as provided by the wound healing sequence.
  • a direct application of intracellular thermal suppression of collagen synthesis and fibroblast mitosis is the reduction of hypertrophic scarring in surgical incisions.
  • Bony callus formation and formation by the osteoblast may also be modulated by the selective balance between intracellular and extracellular thermal inductive effects.
  • the healing by regeneration instead of scarring may be influenced by the selective thermal induction of intracellular and extracellular processes.
  • Regeneration of soft tissue structures may occur more readily in a conducting milieu than in an impedance environment which would promote the deposition of scar collagen.
  • Peripheral nerve regeneration should be aided by selectively suppressing scar formation at the proximal stump of a transacted nerve, and the demyelination of nerve fibers could be prevented with this modality. Determining the impedance/conductance conditions and electromagnetic field pattem of fetal development should provide necessary information to promote healing by regeneration.
  • the intracellular degeneration and cell membrane dissolution of the cerebral cortex may be prevented by maintaining the appropriate magnetic field around these structures.
  • Standard Thermal Gradient is the application of electromagnetic energy The soft tissue without modification of surface angle incidents or tissue parameters that change energy transmission and release in that tissue.
  • Contraction of Collagen Containing Tissue is the contraction of that tissue without modification of surface energy angle incidents or tissue parameters that change energy transmission and release within that tissue.
  • a Standard Gradient of Energy Delivery is the delivery of energy into tissue without modification of surface incidents or tissue parameters that change energy transmission and release within that tissue.
  • a Standard Gradient of Tissue Interaction is the interaction of tissue with energy without modification of surface angle incidents or tissue parameters that would change the pattern of tissue interaction with energy.
  • a Reverse Thermal Gradient is defined by its relationship to a Standard
  • a Reverse Thermal Gradient is cooler on the surface or in adjacent tissues when compared to a Standard Thermal Gradient that has a target tissue with the same heat content.
  • a Reverse Thermal Gradient can also be expressed as:
  • a Reverse Gradient of Collagen Contraction results in the preferential contraction of a target tissue that is greater in comparison to a Standard Gradient of Collagen Contraction of target and surface/adjacent tissues
  • a Reverse Gradient of Collagen Contraction can also be expressed as
  • a Reverse, Gradient of Energy Delivery is defined by its relationship to a
  • a Reverse Gradient of Energy Delivery is the preferential delivery of energy to a target tissue that is greater in comparison to a Standard of Gradient of energy delivery regardless of the energy content of surface and adjacent tissues.
  • a Reverse Gradient of Energy Delivery can also be expressed as:
  • Reverse Gradient of Tissue Interaction is defined by its relationship to a Standard Gradient of tissue interaction.
  • a Reverse Gradient of Tissue Interaction is the achievement of a desired soft tissue effect on a target tissue with a reduced soft tissue effect to surface or adjacent structures in comparison to a Standard Gradient of interaction.
  • a Reverse Gradient of Tissue Interaction can also be expressed as:
  • Component Cells i.e., the adiposcyte, myocyte, fibroblast, fibrocyte, epidermal cell, melanocyte, osteoblast, osteocyte, neuron, skin adnexal cells - hair follicle, sebaceous gland, sweat gland.
  • Component Cells i.e., the adiposcyte, myocyte, fibroblast, fibrocyte, epidermal cell, melanocyte, osteoblast, osteocyte, neuron, skin adnexal cells - hair follicle, sebaceous gland, sweat gland.
  • SUBST1TUTE SHEET (RULE 26) 1. Manipulation of Electromagnetic Energy to Achieve the Most Efficient Cleavage of Collagen Bonds for Contraction with the Smallest Amount of Thermal Damage to Surface and Adjacent Tissues.
  • Tissue Parameters 1. Tissue Impedance by Altering the ECF.
  • ICF Intracellular
  • ICF Intracellular
  • Nonviable and Viable Cellular Components of the Epidermis Occurs by the Uptake of Water in These Keratin Containing Cells.
  • the Stratum Corneum is Changed into a Thermal Conductor Instead of Typically Functioning as a Thermal Insulator. More Specifically, Keratin is a Poor Thermal and Electrical Conductor.
  • Intracellular Keratin is a Better Thermal and Electrical Conductor that Promotes Heat Transfer to Underlying Collagen Containing Tissues and Reduces Intracellular Tissue Impedance.
  • the Improved Transfer of Heat, Through the epidermis facilitates the creation of a transcutaneous reverse thermal gradient.

Abstract

L'invention porte sur un procédé de raffermissement de la peau par modification de l'impédance d'un tissu. Un dispositif de sortie d'énergie électromagnétique a une surface de sortie d'énergie dont au moins une partie est placée sur une surface de la peau. De l'énergie électromagnétique appliquée par l'intermédiaire de la surface de sortie d'énergie traverse la surface de la peau et pénètre jusqu'à un tissu sous-jacent contenant du collagène. Une impédance d'au moins une partie de la peau ou du tissu sous-jacent contenant du collagène est modifiée. Au moins une partie du tissu sous-jacent contenant du collagène se contracte et la surface de la peau est raffermie.
PCT/US1997/013608 1996-08-06 1997-08-04 Procede de raffermissement de la peau WO1998005380A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU38250/97A AU3825097A (en) 1996-08-06 1997-08-04 Method for tightening skin
PCT/US1997/013608 WO1998005380A1 (fr) 1996-08-06 1997-08-04 Procede de raffermissement de la peau

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US60/023,377 1996-08-05
US2337796P 1996-08-06 1996-08-06
PCT/US1997/013608 WO1998005380A1 (fr) 1996-08-06 1997-08-04 Procede de raffermissement de la peau

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US6081749A (en) * 1997-08-13 2000-06-27 Surx, Inc. Noninvasive devices, methods, and systems for shrinking of tissues
US6156060A (en) * 1998-07-31 2000-12-05 Surx, Inc. Static devices and methods to shrink tissues for incontinence
EP1066086A1 (fr) * 1998-03-27 2001-01-10 The General Hospital Corporation Procede et appareil de ciblage selectif de tissus riches en graisse
US6216704B1 (en) 1997-08-13 2001-04-17 Surx, Inc. Noninvasive devices, methods, and systems for shrinking of tissues
EP1608225A2 (fr) * 2003-03-26 2005-12-28 The Regents of the University of Minnesota Interventions chirurgicales thermiques et compositions associees
WO2008068749A1 (fr) * 2006-12-04 2008-06-12 Syneron Medical Ltd. Procédé et dispositif pour traitement cutané utilisant l'énergie optique et les radiofréquences
US7758621B2 (en) 1997-05-15 2010-07-20 Palomar Medical Technologies, Inc. Method and apparatus for therapeutic EMR treatment on the skin
US7763016B2 (en) 1997-05-15 2010-07-27 Palomar Medical Technologies, Inc. Light energy delivery head
US7942915B2 (en) 2002-05-23 2011-05-17 Palomar Medical Technologies, Inc. Phototreatment device for use with coolants
US8328794B2 (en) 1996-12-02 2012-12-11 Palomar Medical Technologies, Inc. System for electromagnetic radiation dermatology and head for use therewith
EP2564895A1 (fr) 2011-09-05 2013-03-06 Venus Concept Ltd Dispositif esthétique amélioré pour embellir la peau et procédés correspondants
US8915948B2 (en) 2002-06-19 2014-12-23 Palomar Medical Technologies, Llc Method and apparatus for photothermal treatment of tissue at depth
US8968284B2 (en) 2000-10-02 2015-03-03 Verathon Inc. Apparatus and methods for treating female urinary incontinence
US8979727B2 (en) 2008-06-29 2015-03-17 Venus Concept Ltd. Esthetic apparatus useful for increasing skin rejuvenation and methods thereof
US9023031B2 (en) 1997-08-13 2015-05-05 Verathon Inc. Noninvasive devices, methods, and systems for modifying tissues
US9028536B2 (en) 2006-08-02 2015-05-12 Cynosure, Inc. Picosecond laser apparatus and methods for its operation and use
US9780518B2 (en) 2012-04-18 2017-10-03 Cynosure, Inc. Picosecond laser apparatus and methods for treating target tissues with same
WO2018008023A1 (fr) 2016-07-07 2018-01-11 Venus Concept Ltd. Appareil à usage esthétique utile pour accroître la régénération de la peau et procédés associés
US9919168B2 (en) 2009-07-23 2018-03-20 Palomar Medical Technologies, Inc. Method for improvement of cellulite appearance
US9981143B2 (en) 2008-06-29 2018-05-29 Venus Concept Ltd. Esthetic apparatus useful for increasing skin rejuvenation and methods thereof
US10245107B2 (en) 2013-03-15 2019-04-02 Cynosure, Inc. Picosecond optical radiation systems and methods of use
US10434324B2 (en) 2005-04-22 2019-10-08 Cynosure, Llc Methods and systems for laser treatment using non-uniform output beam
WO2020086552A1 (fr) 2018-10-23 2020-04-30 Aesthetics Biomedical, Inc. Procédés, dispositifs et systèmes pour induire une régénération de collagène
US11418000B2 (en) 2018-02-26 2022-08-16 Cynosure, Llc Q-switched cavity dumped sub-nanosecond laser

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US8328794B2 (en) 1996-12-02 2012-12-11 Palomar Medical Technologies, Inc. System for electromagnetic radiation dermatology and head for use therewith
US7758621B2 (en) 1997-05-15 2010-07-20 Palomar Medical Technologies, Inc. Method and apparatus for therapeutic EMR treatment on the skin
US8328796B2 (en) 1997-05-15 2012-12-11 Palomar Medical Technologies, Inc. Light energy delivery head
US8002768B1 (en) 1997-05-15 2011-08-23 Palomar Medical Technologies, Inc. Light energy delivery head
US7763016B2 (en) 1997-05-15 2010-07-27 Palomar Medical Technologies, Inc. Light energy delivery head
US6081749A (en) * 1997-08-13 2000-06-27 Surx, Inc. Noninvasive devices, methods, and systems for shrinking of tissues
US6216704B1 (en) 1997-08-13 2001-04-17 Surx, Inc. Noninvasive devices, methods, and systems for shrinking of tissues
US9023031B2 (en) 1997-08-13 2015-05-05 Verathon Inc. Noninvasive devices, methods, and systems for modifying tissues
EP1066086A4 (fr) * 1998-03-27 2007-08-15 Gen Hospital Corp Procede et appareil de ciblage selectif de tissus riches en graisse
EP2263749A3 (fr) * 1998-03-27 2012-09-26 The General Hospital Corporation Procédé et appareil pour le ciblage sélectif des tissus riches en lipides
EP1066086A1 (fr) * 1998-03-27 2001-01-10 The General Hospital Corporation Procede et appareil de ciblage selectif de tissus riches en graisse
US7470271B2 (en) 1998-07-31 2008-12-30 Ams Research Corporation Static devices and methods to shrink tissues for incontinence
US6776779B1 (en) 1998-07-31 2004-08-17 Solarant Medical, Inc. Static devices and methods to shrink tissues for incontinence
US6156060A (en) * 1998-07-31 2000-12-05 Surx, Inc. Static devices and methods to shrink tissues for incontinence
US8968284B2 (en) 2000-10-02 2015-03-03 Verathon Inc. Apparatus and methods for treating female urinary incontinence
US7942915B2 (en) 2002-05-23 2011-05-17 Palomar Medical Technologies, Inc. Phototreatment device for use with coolants
US8915948B2 (en) 2002-06-19 2014-12-23 Palomar Medical Technologies, Llc Method and apparatus for photothermal treatment of tissue at depth
US10556123B2 (en) 2002-06-19 2020-02-11 Palomar Medical Technologies, Llc Method and apparatus for treatment of cutaneous and subcutaneous conditions
US10500413B2 (en) 2002-06-19 2019-12-10 Palomar Medical Technologies, Llc Method and apparatus for treatment of cutaneous and subcutaneous conditions
US7344531B2 (en) 2003-03-26 2008-03-18 Regents Of The University Of Minnesota Thermal surgical procedures and compositions
EP1608225A2 (fr) * 2003-03-26 2005-12-28 The Regents of the University of Minnesota Interventions chirurgicales thermiques et compositions associees
EP1608225A4 (fr) * 2003-03-26 2007-07-04 Univ Minnesota Interventions chirurgicales thermiques et compositions associees
US7344530B2 (en) 2003-03-26 2008-03-18 Regents Of The University Of Minnesota Thermal surgical procedures and compositions
US10434324B2 (en) 2005-04-22 2019-10-08 Cynosure, Llc Methods and systems for laser treatment using non-uniform output beam
US10966785B2 (en) 2006-08-02 2021-04-06 Cynosure, Llc Picosecond laser apparatus and methods for its operation and use
US9028536B2 (en) 2006-08-02 2015-05-12 Cynosure, Inc. Picosecond laser apparatus and methods for its operation and use
US11712299B2 (en) 2006-08-02 2023-08-01 Cynosure, LLC. Picosecond laser apparatus and methods for its operation and use
US10849687B2 (en) 2006-08-02 2020-12-01 Cynosure, Llc Picosecond laser apparatus and methods for its operation and use
WO2008068749A1 (fr) * 2006-12-04 2008-06-12 Syneron Medical Ltd. Procédé et dispositif pour traitement cutané utilisant l'énergie optique et les radiofréquences
US9814897B2 (en) 2008-06-29 2017-11-14 Venus Concept Ltd. Esthetic apparatus useful for increasing skin rejuvenation and methods thereof
US9901743B2 (en) 2008-06-29 2018-02-27 Venus Concept Ltd. Esthetic apparatus useful for increasing skin rejuvenation and methods thereof
US9981143B2 (en) 2008-06-29 2018-05-29 Venus Concept Ltd. Esthetic apparatus useful for increasing skin rejuvenation and methods thereof
US11547866B2 (en) 2008-06-29 2023-01-10 Venus Concept Ltd. Esthetic apparatus useful for increasing skin rejuvenation and methods thereof
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US9694194B2 (en) 2008-06-29 2017-07-04 Venus Concept Ltd Esthetic apparatus useful for increasing skin rejuvenation and methods thereof
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US8979727B2 (en) 2008-06-29 2015-03-17 Venus Concept Ltd. Esthetic apparatus useful for increasing skin rejuvenation and methods thereof
US9919168B2 (en) 2009-07-23 2018-03-20 Palomar Medical Technologies, Inc. Method for improvement of cellulite appearance
US9532832B2 (en) 2011-09-05 2017-01-03 Venus Concept Ltd. Esthetic device for beautifying skin and methods thereof
EP2564895A1 (fr) 2011-09-05 2013-03-06 Venus Concept Ltd Dispositif esthétique amélioré pour embellir la peau et procédés correspondants
US11664637B2 (en) 2012-04-18 2023-05-30 Cynosure, Llc Picosecond laser apparatus and methods for treating target tissues with same
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US10305244B2 (en) 2012-04-18 2019-05-28 Cynosure, Llc Picosecond laser apparatus and methods for treating target tissues with same
US9780518B2 (en) 2012-04-18 2017-10-03 Cynosure, Inc. Picosecond laser apparatus and methods for treating target tissues with same
US11095087B2 (en) 2012-04-18 2021-08-17 Cynosure, Llc Picosecond laser apparatus and methods for treating target tissues with same
US10245107B2 (en) 2013-03-15 2019-04-02 Cynosure, Inc. Picosecond optical radiation systems and methods of use
US11446086B2 (en) 2013-03-15 2022-09-20 Cynosure, Llc Picosecond optical radiation systems and methods of use
US10285757B2 (en) 2013-03-15 2019-05-14 Cynosure, Llc Picosecond optical radiation systems and methods of use
US10765478B2 (en) 2013-03-15 2020-09-08 Cynosurce, Llc Picosecond optical radiation systems and methods of use
WO2018008023A1 (fr) 2016-07-07 2018-01-11 Venus Concept Ltd. Appareil à usage esthétique utile pour accroître la régénération de la peau et procédés associés
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US11791603B2 (en) 2018-02-26 2023-10-17 Cynosure, LLC. Q-switched cavity dumped sub-nanosecond laser
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