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WO2025090924A1 - Systèmes et procédés d'élimination de tissus et de raffermissement de la peau - Google Patents

Systèmes et procédés d'élimination de tissus et de raffermissement de la peau Download PDF

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Publication number
WO2025090924A1
WO2025090924A1 PCT/US2024/053049 US2024053049W WO2025090924A1 WO 2025090924 A1 WO2025090924 A1 WO 2025090924A1 US 2024053049 W US2024053049 W US 2024053049W WO 2025090924 A1 WO2025090924 A1 WO 2025090924A1
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WIPO (PCT)
Prior art keywords
columnar
skin
vacancy
vacancies
treatment area
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Pending
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PCT/US2024/053049
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English (en)
Inventor
Alexander MAKOWSKI
Daniel K. Negus
James L. Hobart
Jason POZNER
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Sciton Inc
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Sciton Inc
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Publication of WO2025090924A1 publication Critical patent/WO2025090924A1/fr
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Classifications

    • 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
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00017—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids with gas
    • 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
    • A61B2018/00458—Deeper parts of the skin, e.g. treatment of vascular disorders or port wine stains
    • 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
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • 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
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589—Coagulation

Definitions

  • the invention is generally related to systems and methods for the treatment of skin, and, more specifically, to systems and methods for skin removal, skin tightening, scar release, and/or skin healing.
  • Laser light is generated from a lasing medium (such as crystal rod, diode, or gas), and the beam shape generated can be a direct product of the shape of the lasing medium.
  • precise control of cross-sectional intensity profile, beam shape propagation, pulse dynamics, and laser thermal stability can all affect ablation of target tissue and avoidance of collateral thermal damage.
  • a method or system described herein can provide improved control of the shape and orientation of wounds, including in a manner that permits improved closure of the wound for tightening skin or otherwise treating skin, while minimizing or reducing scarring. It will also be appreciated that methods and systems described herein may, in some embodiments, provide generally improved wound recovery, such as improved time of recovery and/or reduced weeping of a wound.
  • a method or system described herein in some cases, can also permit a physician or surgeon to leverage their existing knowledge of medicine and human anatomy in real time during a treatment procedure or while planning a treatment in advance. Moreover, a method or system described herein, in some instances, can tighten skin or reduce scar tissue more efficiently and with better results compared to some other methods. It is to be further understood that methods and systems described herein can be used to treat any treatment area or portion of a patient and/or subject, without particular limitation. For instance, in some cases, the treatment area is located on the face of the patient or subject.
  • a method of removing skin of a patient described herein comprises performing a laser ablation in a treatment area of the skin of the patient, thereby removing a column of the skin and forming a columnar vacancy in the skin.
  • the columnar vacancy has a cross-section at the exterior surface of the skin.
  • the cross-section is non-circular.
  • the cross-section has a short axis, and the short axis is parallel to a pre-selected closure direction of the columnar vacancy.
  • a method described herein further comprises closing the columnar vacancy along the pre-selected closure direction.
  • closing a columnar vacancy comprises applying mechanical force along the short axis, such as may occur by, or in conjunction with, applying stitches, surgical tape, negative pressure, compressive bandages, and/or an adhesive to the columnar vacancy.
  • the cross-section of the columnar vacancy is a collapsible shape.
  • a collapsible shape can facilitate a closing step.
  • a “collapsible shape” is a shape whose area decreases continuously as the short axis is reduced to a length of zero, such as due to the application of force in the direction of the short axis, inwardly toward the middle of the shape or laterally across the short axis.
  • the collapsible shape is a diamond or ellipse. Examples of shapes that are not “collapsible” as described herein, for illustration purposes, are a circle and a square.
  • a columnar vacancy formed by a method described herein extends in a z-direction that is not orthogonal to the surface of the skin, as described further hereinbelow.
  • a columnar vacancy having such an angle relative to the exterior surface of the skin can in some cases provide additional advantages related to skin tightening, wound healing, and/or scar avoidance.
  • one or more of the foregoing features, alone or in combination can permit directional closure of the columnar vacancy with normal wound care methods, such as the use of surgical tape, stitches, and/or adhesive.
  • the pre-selected closure direction is aligned with a human body topology line of a patient or subject undergoing treatment.
  • a method described herein is not necessarily limited to the formation of only one columnar vacancy in the skin of a patient.
  • the laser ablation of a method described herein comprises fractional laser ablation, and a plurality of columns of skin is removed and a plurality of columnar vacancies is formed in the skin by the fractional laser ablation.
  • each of the columnar vacancies can have a cross-section, depth, angle in the z- direction or other property described hereinabove for a single columnar vacancy.
  • a method described herein comprises performing a fractional laser ablation in a treatment area of the skin of a patient or subject in need thereof, thereby removing n columns of the skin and forming n columnar vacancies in the skin, wherein the n columnar vacancies have n cross-sections (e g., n non-circular cross-sections) at the exterior surface of the skin (which cross-sections may be the same or different from one another in size and/or shape), and wherein the n cross-sections have n short axes (which short axes may be the same or different from one another in size and/or direction or orientation), and wherein the n short axes are parallel to n pre-selected closure directions of the n columnar vacancies (which closure directions may be the same or different from one another).
  • n cross-sections e g., n non-circular cross-sections
  • the n cross-sections have n short axes (which short axes may be the same or different
  • n can be an integer ranging from 1 to 100,000, 1 to 10,000, or from 1 to 1000 (or any subrange thereof).
  • a method described herein can form more than one group or set of columnar vacancies.
  • each group can comprise a plurality of columnar vacancies.
  • the plurality of columnar vacancies can all have one or more features in common.
  • a first group of columnar vacancies comprises a plurality of columnar vacancies that all have the same size and shape of cross-section, the same direction (or orientation) and size of short axis, and the same pre-selected closure direction.
  • such a method can in some cases also form a second group of columnar vacancies comprising a plurality of columnar vacancies that all, within the second group, have the same size and shape of cross-section, the same direction (or orientation) and size of short axis, and the same pre-selected closure direction.
  • the columnar vacancies of the first group (which share common features) can differ in at least one respect from the columnar vacancies of the second group (which likewise share common features with one another).
  • the short axis orientation and preselected closure direction of the first group differs from the short axis orientation and preselected closure direction of the second group.
  • a method described herein can comprise forming uniform or substantially uniform “blocks” of columnar vacancies that can be used in combination (e.g., “tiled” together to cover a treatment area in a modular way, such that a first region of the treatment area is covered by one of the “tiles,” while a second region of the treatment area is covered by a second “tile”).
  • such a system comprises a laser configured to fractionally ablate n columns of skin from a treatment area on the skin, thereby forming n columnar vacancies in the skin, the columnar vacancies each having a cross-section (e g., a non-circular cross-section) at the exterior surface of the skin. Additionally, the cross-section has a short axis, and the short axis is parallel to a pre-selected closure direction of the columnar vacancy.
  • the value of the integer n is not necessarily limited. For example, in some cases, n is an integer from 1 to 100,000.
  • a system described herein can also comprise one or more controllers operatively connected to the laser, the one or more controllers being configured to automatedly control the fractional laser ablation locations and the orientations of the short axis in the treatment area.
  • Other components may also be included in a system according to the present disclosure, as further described below.
  • FIG. 1 is a cross-sectional view of human skin showing the epidermal, dermal, and subcutaneous layers.
  • FIG. 2A is a cross-sectional view of human skin having a columnar vacancy extending through the epidermal and dermal layers into the subcutaneous layer.
  • FIG. 2B is a cross-sectional view of human skin having a columnar vacancy extending through the epidermal layer into the dermal layer.
  • FIG. 3A is a schematic illustration of a perspective view of an ablative laser treatment of skin.
  • FIG. 3C is a schematic illustration of a sectional view of an ablative laser treatment of skin.
  • FIG. 4A is a plan view of a treatment area having columnar vacancies.
  • FIG. 4B is a plan view of a treatment area having columnar vacancies relatively larger than the columnar vacancies of FIG. 4A.
  • FIG. 5 is a perspective view of a schematic illustration of laser beam having a diamond-shaped cross-section according to an embodiment described herein.
  • FIG. 6 is a perspective view of a schematic illustration of a laser beam having an ellipse-shaped cross-section according to an embodiment described herein.
  • FIG. 7A is a plan view of a plurality of columnar vacancies in a treatment area having a different cutting pattern according to an embodiment described herein.
  • FIG.7B is a plan view of a plurality of columnar vacancies in a treatment area having a different cutting pattern according to an embodiment described herein.
  • FIG. 8A illustrates a plan view of an array of columnar vacancies in a tissue phantom according to an embodiment described herein.
  • FIG. 8B illustrates a plan view of an array of columnar vacancies in a tissue phantom according to an embodiment described herein.
  • FIG. 8C illustrates a plan view of an array of columnar vacancies in a tissue phantom according to an embodiment described herein.
  • FIG. 9A illustrates a plan view of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is aligned with a human body topology line according to an embodiment described herein.
  • FIG. 9B illustrates a plan view of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is misaligned with a human body topology line according to an embodiment described herein.
  • FIG. 9C illustrates a plan view of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is misaligned with a short axis of the columnar vacancies according to an embodiment described herein.
  • FIG. 10 schematically illustrates a sectional view of skin having a columnar vacancy that extends through the epidermal and dermal layers, where the epidermal and dermal layers are brought together to close the columnar vacancy according to an embodiment described herein.
  • FIG. 11 schematically illustrates a sectional view of skin having a columnar vacancy that extends through the epidermal and dermal layers into the subcutaneous layer, where all three layers are brought together to close the columnar vacancy according to an embodiment described herein.
  • FIG. 12A is a photograph of a plurality of columnar vacancies in a treatment area in which the cross-section of the columnar vacancy is a square, on the day of treatment according to an embodiment described herein.
  • FIG. 12B is a photograph of a plurality of columnar vacancies in a treatment area in which the cross-section of the columnar vacancy is a square, on Day 1 after treatment according to an embodiment described herein.
  • FIG. 12C is a photograph of a plurality of columnar vacancies in a treatment area in which the cross-section of the columnar vacancy is a square, on Day 2 after treatment according to an embodiment described herein.
  • FIG. 12D is a photograph of a plurality of columnar vacancies in a treatment area in which the cross-section of the columnar vacancy is a square, on Day 3 after treatment according to an embodiment described herein.
  • FIG. 12E is a photograph of a plurality of columnar vacancies in a treatment area in which the cross-section of the columnar vacancy is a square, on Day 4 after treatment according to an embodiment described herein.
  • FIG. 13 A is a photograph of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is misaligned with a human body topology line of a patient, on the day of treatment according to an embodiment described herein.
  • FIG. 13B is a photograph of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is misaligned with a human body topology line of a patient, on Day 1 after treatment according to an embodiment described herein.
  • FIG. 13C is a photograph of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is misaligned with a human body topology line of a patient, on Day 5 after treatment according to an embodiment described herein.
  • FIG. 14A is a photograph of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is aligned with a human body topology line of a patient, on the day of treatment according to an embodiment described herein.
  • FIG. 14B is a photograph of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is aligned with a human body topology line of a patient, on Day 1 after treatment according to an embodiment described herein.
  • FIG. 14C is a photograph of a plurality of columnar vacancies in a treatment area in which the pre-selected closure direction is aligned with a human body topology line of a patient, on Day 5 after treatment according to an embodiment described herein.
  • FIG. 15 is a drawing of a negative pressure dressing on the neck of a patient according to an embodiment described herein.
  • FIG. 16A is a photograph of a plurality of columnar vacancies in a treatment area treated with a negative pressure dressing in which the pre-selected closure direction is aligned with a human body topology line of a patient, on the day of treatment according to an embodiment described herein.
  • FIG. 16B is a photograph of a plurality of columnar vacancies in a treatment area treated with a negative pressure dressing in which the pre-selected closure direction is aligned with a human body topology line of a patient, on Day 1 after treatment according to an embodiment described herein.
  • FIG. 16C is a photograph of a plurality of columnar vacancies in a treatment area treated with a negative pressure dressing in which the pre-selected closure direction is aligned with a human body topology line of a patient, on Day 4 after treatment according to an embodiment described herein.
  • FIG. 17A is a photograph of a plurality of columnar vacancies in a treatment area wherein the treatment area is not cooled during laser ablation immediately after treatment according to an embodiment described herein.
  • FIG. 17B is a photograph of a plurality of columnar vacancies in a treatment area wherein the treatment area is cooled during laser ablation immediately after treatment according to an embodiment described herein.
  • FIG. 17C is a photograph of a plurality of columnar vacancies in a treatment area wherein the treatment area is not cooled during laser ablation at one day after treatment according to an embodiment described herein.
  • FIG. 17D is a photograph of a plurality of columnar vacancies in a treatment area wherein the treatment area is cooled during laser ablation at one day after treatment according to an embodiment described herein.
  • FIG. 18 is a plot of the wound area quantified over a 5-day time course for Patient 1 having square columnar vacancies, Patient 2 having misaligned columnar vacancies, and Patient 4 having aligned columnar vacancies treated with negative pressure, according to some embodiments described herein.
  • FIG. 19 is a schematic of a system for skin tightening and/or removing skin according to an embodiment described herein.
  • the terms “substantially,” “approximately,” and “about” may be substituted with “within [a percentage] of’ what is specified, where the percentage could be 0.1, 1, 5, or 10 percent, unless the use of such a term in a given instance indicates otherwise.
  • methods of removing tissue such as skin
  • tightening skin reducing scarring, and/or otherwise treating skin
  • methods of treating the skin of a patient or subject in need thereof can tighten the skin of a subject by removing excess skin, such as “turkey neck” or “bat wing” skin, post weight loss skin, postpartum skin, brachioplasty skin, mastopexy skin, facelift skin, neck lift skin, abdominoplasty skin, post gastric bypass surgery skin, wrinkles, or other types of excess skin.
  • methods described herein can remove scar tissue, such as surgical scars, acne scars, atrophic scars, keloid scars, hypertrophic scars, stretch marks, or other types of scars.
  • closures can be oriented along human body topology lines in the skin.
  • combining wound shape and orientation using human body topology lines can provide improved closure, healing, or recovery and/or reduce partial reopening of the wound and wound tension upon movement. Scar avoidance can also be provided by some methods and systems described herein.
  • columnar vacancies or wounds in the skin
  • Such a shape in some cases, can be pulled shut or collapsed into a line without forming folds or wrinkles in the skin. Such a line can then be held shut by surgical closure while the skin heals.
  • a method described herein comprises performing a laser ablation in a treatment area of the skin of the patient, thereby removing a column of the skin and forming a columnar vacancy in the skin.
  • the columnar vacancy has a cross-section at the exterior surface of the skin.
  • the cross-section has a short axis, and the short axis is parallel to a pre-selected closure direction of the columnar vacancy.
  • the cross-section may have any shape not inconsistent with the technical objectives of the present disclosure.
  • the cross-section may be non-circular and/or non-square.
  • the cross-section may be circular or square.
  • a method described herein further comprises closing the columnar vacancy along the pre-selected closure direction.
  • closing a columnar vacancy comprises applying mechanical force along the short axis, such as may occur by, or in conjunction with, applying stitches, surgical tape, and/or an adhesive to the columnar vacancy, as described in further detail below.
  • the pre-selected closure direction is a human body topology line or parallel to a human body topology line, which the physician, surgeon, or other care provider may select and/or identify prior to beginning the treatment procedure or in real-time while carrying out the treatment procedure.
  • a closing step described herein can promote healing of the vacancy and of the treatment area more generally.
  • a method described herein can be used for tightening of skin (particularly in the direction of the short axis) and/or for the release of scars.
  • a “pre-selected” closure direction can simply be a direction selected by a user or care provider, such as a physician or surgeon, as a preferred or desired closure direction in the context of a specific treatment of a specific patient.
  • the term “pre-selected closure direction” as used herein can be simply a “closure direction.”
  • a method described herein is not necessarily limited to the formation of only one columnar vacancy in the skin of a patient.
  • the laser ablation of a method described herein comprises fractional laser ablation, and a plurality of columns of skin is removed and a plurality of columnar vacancies is formed in the skin by the fractional laser ablation.
  • each of the columnar vacancies can have a cross-section, depth, angle in the z- direction or other property described hereinabove for a single columnar vacancy.
  • a method described herein comprises performing a fractional laser ablation in a treatment area of the skin of a patient, thereby removing n columns of the skin and forming n columnar vacancies in the skin, wherein the n columnar vacancies have n crosssections at the exterior surface of the skin (which cross-sections may be the same or different from one another in size and/or shape), and wherein the n cross-sections have n short axes (which short axes may be the same or different from one another in size and/or direction or orientation), and wherein the n short axes are parallel to n pre-selected closure directions of the n columnar vacancies (which closure directions may be the same or different from one another).
  • n can be an integer ranging from 1 to 100,000, 1 to 10,000, or from 1 to 1000 (or any subrange thereof).
  • a method described herein can form more than one group or set of columnar vacancies.
  • each group can comprise a plurality of columnar vacancies.
  • the plurality of columnar vacancies can all have one or more features in common.
  • a first group of columnar vacancies comprises a plurality of columnar vacancies that all have the same size and shape of cross-section, the same direction (or orientation) and size of short axis, and the same pre-selected closure direction.
  • such a method can in some cases also form a second group of columnar vacancies comprising a plurality of columnar vacancies that all, within the second group, have the same size and shape of cross-section, the same direction (or orientation) and size of short axis, and the same pre-selected closure direction.
  • the columnar vacancies of the first group (which share common features) can differ in at least one respect from the columnar vacancies of the second group (which likewise share common features with one another).
  • the short axis orientation and preselected closure direction of the first group differs from the short axis orientation and preselected closure direction of the second group.
  • a method described herein can comprise forming uniform or substantially uniform “blocks” of columnar vacancies that can be used in combination (e g., “tiled” together to cover a treatment area in a modular way, such that a first region of the treatment area is covered by one of the “tiles,” while a second region of the treatment area is covered by a second “tile”).
  • a method comprises the step of removing one or more columns of the skin and forming one or more columnar vacancies in the skin.
  • a columnar vacancy has a perimeter defined by a first side and a second side opposite the first side.
  • the first side and the second side each comprise an epidermal layer, a dermal layer, a subcutaneous layer of skin, or any combination thereof.
  • the method further comprises contacting and/or connecting the first side of the columnar vacancy to the second side of the columnar vacancy, thereby closing the columnar vacancy.
  • FIG. 1 shows a cross-sectional view of the various layers of human skin, with the epidermal layer (101) being the outermost layer, the subcutaneous layer (103, i.e., “subcutis”) being the inner most layer, and the dermal layer (102) being a middle layer positioned between the epidermal and subcutaneous layers.
  • the columnar vacancy (10a) is a void in which a portion of one or more of the skin layers has been removed. As seen for example in FIG. 2A, in some instances, the columnar vacancy (10a) can extend through the epidermal layer (101) and dermal layer (102) into the subcutaneous layer (103). In other instances, as illustrated for example in FIG. 2B, the columnar vacancy (10b) can extend through the epidermal layer (101) into the dermal layer (102).
  • the epidermal layer, the dermal layer, and/or the subcutaneous layer of the first side of the columnar vacancy is aligned, respectively, with the epidermal layer, the dermal layer, and/or the subcutaneous layer of the second side of the columnar vacancy in a z-direction orthogonal to the surface of the skin.
  • aligned layers in some cases, are not offset from one another in the z-direction by more than 15%, more than 10%, or more than 5% of the thickness of the respective layers in the z-direction.
  • two layers that are aligned with one another are offset in the z-direction by 0-10%, 0-8%, 0-5%, or 0-3%, based on the average thickness of the two layers in the z-direction.
  • the epidermal layers, the dermal layers, and the subcutaneous layers of the first and second sides of the columnar vacancy are aligned to form a substantially planar dermal -epi dermal junction and a substantially planar dermal-subcutaneous junction across the first and second sides of the columnar vacancy when the columnar vacancies are closed or connected.
  • a method described herein uses laser ablation to remove one or more columns of skin.
  • the laser ablation comprises fractional laser ablation.
  • fractional laser ablation refers to a laser ablation process in which an ablating laser beam is used to selectively ablate, vaporize, destroy, or remove columns of tissue, or “drill holes,” in a targeted area such as a treatment area of skin.
  • the step of removing a column of the skin and forming a columnar vacancy in the skin comprises performing a fractional laser ablation in a treatment area of the skin, thereby removing a column of the skin and forming a columnar vacancy in the skin.
  • fractional laser ablation “cuts” and removes columns of skin directly without the use of any other techniques, such as mechanical coring devices. That is, the columns of skin are removed by laser light alone.
  • a method described herein does not comprise or include removing a column of skin through mechanical coring.
  • FIG. 3A-C An exemplary fractional laser treatment process is illustrated in FIG. 3A-C, in which schematic illustrations of a subject’s skin tissue (200) both during and after an ablative laser treatment are shown.
  • a dose of fractionally ablative laser light (204) is applied to an external surface (202) of the subject’s skin (200) during an ablative laser treatment.
  • the laser light (204) may be orthogonally disposed relative to the surface (202) of the subject’s skin or angled relative to the surface (202) of the subject’s skin (200).
  • the laser light (204) forms one or more non-circular ablated columnar vacancies or channels (206) in the subject’s skin (200).
  • the shape of the columnar vacancy (206) formed in FIG. 3A-C is not necessarily limiting and is for illustration purposes only.
  • the cross-section of the columnar vacancy has a collapsible shape, such as a diamond or ellipse shape.
  • the cross-section of a columnar vacancy described herein can be equated to or considered to be the same as the nominal cross-sectional shape of the laser beam or laser spot that forms the columnar vacancy.
  • a laser or laser spot that has a specific cross-sectional shape can be considered to form a columnar vacancy having that same specific shape, even if the columnar vacancy when formed on the skin of a patient varies somewhat from the idealized shape (e.g., the columnar vacancy on the skin is not perfectly square, even if a square-shaped laser spot is used).
  • a shape may not be discernable or visibly discernable on the surface of the columnar vacancy. Not intending to be bound by theory, it is believed this may be due to any combination of the following natural biomechanical or biochemical responses to injury: skin elasticity, pliability, contraction, and/or coagulation.
  • a “dose” (or “exposure”) of laser light is generally not synonymous with a “pulse” of laser light, particularly not with respect to the “pulses” of laser light inherently produced by a pulsed laser (as opposed to a continuous wave laser).
  • a “dose” of laser light in the context of the present disclosure refers to light emitted by a laser during a single, discrete “on” time of the laser, during which the laser light is directed to a treatment area described herein (or to a single spot or location within the treatment area).
  • the “dose” of laser light can have a duration that is greater than the pulse duration of a pulsed laser (if a pulsed laser is used).
  • a single “dose” of laser light is at least 1 ms, at least 5 ms, at least 10 ms, at least 100 ms, at least 0.5 seconds, or at least 1 second in duration.
  • a “dose” of laser light described herein has a duration of 1 ms to 10 seconds, 1 ms to 5 seconds, 1 ms to 1 second, 100 ms to 10 seconds, 100 ms to 5 seconds, or 100 ms to 1 second.
  • a “dose” of laser light is temporally bounded on both sides by an “off’ period of time during which the laser light is not directed to or incident on the treatment area (or on the single spot or location within the treatment area). Further, this “off’ period of time is longer than (and different from) the time between pulses generated by a pulsed laser in continuous operation (if a pulsed laser is used).
  • FIG. 3B and 3C show respective dimensional and plan views of the skin tissue (200) after application of the ablative laser light (204).
  • the columnar vacancy (206) is shown in broken lines for illustration purposes only, so that the x-, y-, and z- directions are readily visible.
  • each columnar vacancy (206) that forms during an ablative laser treatment defines a three-dimensional structure having an overall length Yl, an overall width XI, and an overall depth Zl.
  • the overall length Yl and/or overall width XI of the columnar vacancy (206) can be symmetric or non-symmetric with respect to the z-axis in the z-direction.
  • the overall length Yl and/or overall width XI can vary in the z-direction in a continuous or discontinuous manner. In other embodiments, the overall length Y1 and/or overall width XI do not vary in the z-direction.
  • the columnar vacancy is polygonal, diamond-shaped, or ellipse-shaped when viewed orthogonally to the surface (202) of the skin along the z-direction. Moreover, in some cases, the cross-section of the columnar vacancy has a collapsible shape.
  • a columnar vacancy can have any overall length, overall width, and/or overall depth not inconsistent with the objectives of this disclosure.
  • the overall dimensions of the columnar vacancy can depend on the location of the treatment area of a subject.
  • the overall dimensions of the columnar vacancy (310a) can be relatively small (e.g., 2 mm overall length to 1 mm overall width), such as when the location of the treatment area (311) is in a region of the body where a higher density of relatively small columnar vacancies (310a) are needed.
  • a columnar vacancy having a 2 mm overall length and 1 mm overall width and an ellipse shape could be used to provide 10% tissue removal by using 6.4 vacancies per square centimeter of treatment area.
  • a 0.5 mm x 1 mm ellipse would have an area of 0.004 cm 2 and could provide 10% tissue removal by using 25.5 vacancies/cm 2 .
  • 10% tissue removal can be obtained using 51 vacancies/cm 2 .
  • 80-280 columnar vacancies per square centimeter of treatment area may be formed in the skin.
  • the surface area may be between 0.1 and 0.125 mm 2 .
  • an ellipse may be 250 pm x 500 pm or 400 pm x 900 pm.
  • the overall dimensions of the columnar vacancy (310b) can be relatively large (e.g., 10 mm overall length to 1 mm overall width), such as when the location of the treatment area (311) is in a region of the body where a lower density of larger columnar vacancies (310b) are needed for the same sized treatment area (311).
  • a 10 mm x 1 mm ellipse would have an area of 0.079 cm 2 and could provide 10% tissue removal by using 1.27 vacancies/cm 2 .
  • the columnar vacancy (or where a plurality of columnar vacancies is concerned, the average columnar vacancy) has an overall length that is 2.5 to 3.5 times greater than the overall width.
  • the ratio of overall length to overall width can be 1.5 to 1; 2 to 1; 3 to 1; 4 to 1; 5 to 1; 6 to 1; 7 to 1; 8 to 1; 9 to 1, 10 to 1; or >10 to 1.
  • columnar vacancies generally have a short axis (e g., a dimension in the x-direction) that is short compared to the size of the vacancy in another direction, such as an orthogonal direction (e.g., in the y-direction).
  • an ablation step removes at least 90%, at least 95%, at least 98%, or at least 99% of tissue in a column of a given width to a depth of up to 1000 pm or to a depth of up to 2000 pm.
  • an ablation step removes at least 90%, at least 95%, at least 98%, or at least 99% of tissue in the column to a depth of 50-20,000 pm, 50-10,000 pm, 50-5000 pm, 50-2000 pm, 50-1000 pm, 50-500 pm, 50-300 pm, 50-200 pm, 100-20,000 pm, 100-10,000 pm, 100-5000 pm, 100- 2000 pm, 100-1000 pm, 100-500 pm, 100-300 pm, 100-200 pm, 200-20,000 pm, 200-10,000 pm, 200-5000 pm, 200-2000 pm, 200-1000 pm, 200-500 pm, 400-20,000 pm, 400-10,000 pm, 400-5000 pm, 400-2000 pm, 400-1000 pm, 500-20,000 pm, 500-10,000 pm, 500-5000 pm, 500- 2000 pm, 500-1000 pm, 1000-20,000 pm, 1000-10,000 pm, 1000-5000 pm, 1000-2000 pm, or 2000-20,000 pm, 2000-10,000 pm, 2000-5000 pm, 5000-20,000 pm, 5000-10,000 pm, or 10,000-20,000 pm.
  • the fractional laser ablation generates columnar vacancies having an average length or width of 150-500 pm, 150-450 pm, 150-400 pm, 200-600 pm, 200-500 pm, 200-450 pm, 200-400 pm, 250-600 pm, 250-500 pm, 250-450 pm, 250-400 pm, 300-600 pm, 300-500 pm, 300-450 pm, 300-400 pm, 400-600 pm, 400-500 pm, or 450-600 pm, and a depth of 0.3-2.5 mm, 0.3-2 mm, 0.3-1.5 mm, 0.3-1 mm, 0.5-2.5 mm, 0.5-2 mm, 0.5- 1.5 mm, 0.5-1 mm, 1-2.5 mm, or 1-2 mm.
  • a “laser” can refer to a single lasing device that produces a single beam of laser light from a single lasing medium.
  • the laser described herein can be a pulsed laser or a continuous wave (CW) laser.
  • the laser can produce time-modulated pulses of the laser beam.
  • the laser beam comprises an ablative laser beam and the laser produces time-modulated pulses of the ablative laser beam.
  • a laser or laser beam described herein can have any power and any peak or average emission wavelength not inconsistent with the objectives of this disclosure.
  • a laser or laser beam of a device described herein has a peak or average emission wavelength in the infrared (IR) region of the electromagnetic spectrum.
  • the laser or laser beam has a peak or average emission wavelength in the range of 1-4 pm, 1-3 pm, 2-4 pm, 2-3 pm, 8-12 pm, or 9-11 pm.
  • the laser or laser beam comprises an erbium-doped yttrium aluminum garnet (ErYAG) laser or laser beam or a neodymium-doped YAG (Nd:YAG) laser or laser beam having a peak or average emission wavelength of 2940 nm or 1064 nm.
  • the laser or laser beam comprises a carbon dioxide laser or laser beam.
  • a laser beam described herein can also have a peak or average emission wavelength in the visible region of the electromagnetic spectrum. Non-limiting examples of peak or average emission wavelengths suitable for use in some embodiments described herein include 532 nm, 695 nm, 755 nm, 1064 nm, and 1470 nm, or 2940 nm.
  • a laser or laser beam of a device described herein has an average power of 50 to 200 W or 5 to 200 W.
  • the spot size of a laser beam produced by a laser described herein may also vary. Any spot size not inconsistent with the objectives of the disclosure may be used. In some cases, for instance, the spot size is 0.1-10 mm, 0.1-1 mm, 0.1-0.5 mm, 0.5-5 mm, 1-10 mm, or 1- 5 mm. Other spot sizes may also be used.
  • the laser beam can have any cross-sectional shape not inconsistent with the technical objectives of this disclosure.
  • the cross-sectional shape of the laser beam is not limited.
  • the laser beam has a shape corresponding to the shape (or nominal shape) of a columnar vacancy described herein.
  • the cross-section of the laser beam may have a circular shape.
  • the laser beam may have a shape having a short axis (meaning a relatively short axis, as compared to another axis of the shape, which is relatively long as a “long axis”).
  • the crosssection of the laser may also be a collapsible shape.
  • the laser beam has a diamond-shaped or ellipse-shaped cross-section. In the instance shown in FIG. 5, a laser beam having a diamond-shaped cross-section is shown, and in the instance shown in FIG.
  • a laser beam having an ellipse-shaped cross-section is shown.
  • a laser beam with a non-collapsible shape may also be used to form a columnar vacancy with a crosssection that is a collapsible shape in the skin.
  • drilling a plurality of smaller columnar vacancies that are stacked or packed together may be used to form or create a columnar vacancy with a cross-section that is a collapsible shape.
  • a method described herein further comprises removing a plurality of columns of skin (as opposed to only a single column of skin) from a treatment area and forming a plurality of columnar vacancies (as opposed to a single vacancy) in the treatment area.
  • a plurality of columns of skin may be removed using a fractional laser ablation.
  • the dimensions of each individual column of skin removed can be substantially equal to each other in some instances, such as is shown in FIG. 7A and 7B. In other instances, the dimensions of the individual column of skin removed can be different from each other.
  • each columnar vacancy, or any given columnar vacancy, of the plurality of columnar vacancies can have a size and/or shape described hereinabove for a single columnar vacancy.
  • the plurality of columnar vacancies can be removed from the treatment area in a pattern. Any pattern not inconsistent with the objectives of this disclosure.
  • a grid-like pattern of columns and rows can be formed by the columnar vacancies 10 within the treatment area (311).
  • the columnar vacancies (10) in adjacent columns are staggered such that the columnar vacancies (10) in adjacent columns are in different rows, and columnar vacancies (10) in every other column are in the same rows.
  • FIG. 7A and 7B a grid-like pattern of columns and rows can be formed by the columnar vacancies 10 within the treatment area (311).
  • the columnar vacancies (10) in adjacent columns are staggered such that the columnar vacancies (10) in adjacent columns are in different rows, and columnar vacancies (10) in every other column are in the same rows.
  • the columnar vacancies (10) in adjacent columns can be positioned within their respective columns without substantially overlapping into their respective adjacent column, and every other row within a column.
  • the columnar vacancies 10 in every other row overlap into the adjacent column.
  • the columnar vacancies (10) within a treatment area can comprise a single column, or, in other embodiments (not shown), a single row within a treatment area, where the number of columnar vacancies within the treatment area are relatively low compared to the patterns in FIG. 7A and 7B, with each columnar vacancy being relatively large.
  • FIG. 8A-C illustrate additional embodiments.
  • Each of FIG. 8A-C illustrate an array of columnar vacancies in a tissue phantom (600), demonstrating even coverage and control of size and spacing.
  • the closure direction (and, in the case of tightening, the tightening direction) is along or parallel to the short axis of the diamond or ellipse.
  • FIG. 8A illustrates diamond shaped holes/vacancies (610a) in an array.
  • FIG. 8B illustrates elliptical holes/vacancies (610b) having a wave pattern, in which the short axes change orientation within the array.
  • 8C illustrates the use of two orientations of ellipse-shaped holes (610c, 610d; with reference to the short axes) from one group or set as compared to another group or set, where each group or set can be used as a tile as described herein.
  • the treatment area is located on the face of a subject or a patient.
  • the treatment area is located on the neck, chest, back, or legs of a subject or a patient.
  • the treatment area can be any size not inconsistent with the goals of this disclosure.
  • the treatment area can have an area of 10 mm 2 to 1,000 cm 2 ; 20 mm 2 to 1,000 cm 2 ; 30 mm 2 to 1,000 cm 2 ; 40 mm 2 to 1,000 cm 2 ; 40 mm 2 to 1,000 cm 2 ; 50 mm 2 to 1,000 cm 2 ; 60 mm 2 to 1,000 cm 2 ; 70 mm 2 to 1,000 cm 2 ; 80 mm 2 to 1,000 cm 2 ; 90 mm 2 to 1,000 cm 2 ; 100 mm 2 to 1,000 cm 2 ; 200 mm 2 to 1,000 cm 2 ; 300 mm 2 to 1,000 cm 2 ; 400 mm 2 to 1,000 cm 2 ; 500 mm 2 to 1,000 cm 2 ; 600 mm 2 to 1,000 cm 2 ; 700 mm 2 to 1,000 cm 2 ; 800 mm 2 to 1,000 cm 2 ; 900 mm 2 to 1,000 cm 2 ; or 1 cm 2 to 1,000 cm 2 .
  • the pre-selected closure direction is aligned with a human body topology line of a patient.
  • a human body topology line may comprise, be formed from, or be a Langer’s line.
  • Langer’s lines are lines that indicate the natural orientation of collagen fibers in the skin.
  • Langer’s lines comprise cleavage lines or wrinkle lines.
  • a human body topology line may comprise, be formed from, or be a Kraissl’s line.
  • Kraissl’s lines are anatomical skin lines that are oriented perpendicular to the action of the underlying muscle.
  • a human body topology line may comprise, be formed from, or be a relaxed skin tension line.
  • relaxed skin tension lines are those lines produced in living patients or subjects by positioning the body so that the skin is relaxed and then gently pinching the skin to reveal a crease.
  • human body topology lines may vary or generally do vary among patients. That is, in some cases, human body topology lines can be patient-dependent, based upon patient characteristics including but not limited to weight, height, body composition, and build.
  • human body topology lines are selected and/or identified by a physician, surgeon, or other care provider prior to beginning a treatment procedure or in real-time while carrying out a treatment procedure.
  • a method further comprises selecting a human body topology line prior to beginning a treatment procedure or in real-time while carrying out a treatment procedure. Selecting a human body topology line may be carried out in any manner not inconsistent with the technical objectives of the present disclosure.
  • the pre-selected closure direction being aligned with a human body topology line of a patient or a subject comprises being parallel or substantially parallel with a human body topology line of a patient or a subject.
  • an angle (0) between the pre-selected closure direction of a patient or a subject and the relevant human body topology line may be less than or equal to 30 degrees, less than or equal to 25 degrees, less than or equal to 20 degrees, less than or equal to 15 degrees, less than or equal to 10 degrees, or less than or equal to 5 degrees. It is to be understood that an angle (0) between the human body topology line and the pre-selected closure direction of 0 degrees indicates that the human body topology line and the pre-selected closure direction are exactly parallel.
  • the pre-selected closure direction can be aligned with the short axis of a columnar vacancy (e.g., a non-circular columnar vacancy, such as a diamond or ellipse).
  • a columnar vacancy e.g., a non-circular columnar vacancy, such as a diamond or ellipse.
  • alignment of the pre-closure direction and the short axis of a columnar vacancy comprises the direction and axis being parallel or substantially parallel to one another.
  • an angle ( ⁇ p) between the pre-selected closure direction of a patient or a subject and the short axis of a columnar vacancy may be less than or equal to 30 degrees, less than or equal to 25 degrees, less than or equal to 20 degrees, less than or equal to 15 degrees, less than or equal to 10 degrees, or less than or equal to 5 degrees. It is to be understood that an angle (cp) of zero degrees between the short axis and the pre-selected closure direction indicates that the short axis and the pre-selected closure direction are exactly parallel.
  • FIG. 9A illustrates an embodiment in which the pre-selected direction is aligned with a human body topology line.
  • a plurality of columnar vacancies (410) is formed, each with a short axis (420).
  • the cross-section of the columnar vacancies (410) is an ellipse.
  • the block arrow indicates the pre-selected closure direction (430).
  • the double ended arrow indicates the human body topology line (440).
  • the human body topology line (440) may comprise a Langer’s line, a Kraissl line, or a relaxed skin tension line.
  • other human body topology lines are contemplated and may also be used, without particular limitation.
  • the pre-selected closure direction (430) and the human body topology line (440) are parallel.
  • FIG. 9B illustrates an embodiment in which the pre-selected closure direction is misaligned with a human body topology line.
  • a plurality of columnar vacancies (410) are formed, each with a short axis (420).
  • the cross-section of the columnar vacancies (410) is an ellipse.
  • the block arrow indicates the pre-selected closure direction (430), and the double ended arrow indicates the human body topology line (440).
  • the pre-selected closure direction (430) and the human body topology line (440) are misaligned, with the angle (0) between them being greater than 30 degrees.
  • the angle (0) between them is greater than 45 degrees, greater than 60 degrees, greater than 75 degrees, between 30 degrees and 90 degrees, or between 45 degrees and 90 degrees.
  • FIG. 9C illustrates an embodiment in which the pre-selected closure direction is misaligned with the short axis of the columnar vacancy.
  • the treatment area (400) a plurality of columnar vacancies (410) are formed, each with a short axis (420).
  • the cross-section of the columnar vacancies (410) is an ellipse.
  • the block arrow indicates the preselected closure direction (430), and the double ended arrow indicates the human body topology line (440).
  • the pre-selected closure direction (430) and the short axis (420) are misaligned, with the angle ( ⁇ p) between them being greater than 30 degrees. In this particular non-limiting Example, the angle is 90 degrees.
  • the angle (0) between them is greater than 45 degrees, greater than 60 degrees, greater than 75 degrees, between 30 degrees and 90 degrees, or between 45 degrees and 90 degrees.
  • performing a laser ablation in a treatment area of the skin of a patient may cause an increase in the temperature of the remaining tissue in treatment area.
  • the temperature of the treatment area may increase to between 40°C and 250°C, 50°C and 250°C, 60°C and 250°C, 70°C and 250°C, 80°C and 250°C, 90°C and 250°C, 100°C and 250°C, 110°C and 250°C, 120°C and 250°C, 130°C and 250°C, 140°C and 250°C, 150°C and 250°C, 160°C and 250°C, 170°C and 250°C, 180°C and 250°C, 190°C and 250°C, 200°C and 250°C, 40°C and 200°C, 50°C and 200°C, 60°C and 200°C, 70°C and 200°C, 80°C and 200°C, 90°C and 200°C, 100
  • methods described herein may further comprise cooling the treatment area. That is, in some cases, cooling the treatment area may partially or fully counteract the increase in temperature caused by performing the laser ablation. In some embodiments, cooling the treatment area may cool the treatment area during laser ablation by 3°C-50°C, 5°C-5O°C, 7°C-50°C, 10°C-50°C, 15°C-50°C, 20°C-50°C, 25°C-50°C, 30°C-50°C, 35°C-50°C, 40°C-50°C, 45°C-50°C, 3°C-45°C, 5°C-45°C, 7°C-45°C, 10°C-45°C, 15°C-45°C, 20°C-45°C, 25°C-45°C, 30°C-45°C, 35°C-45°C, 40°C-45°C, 3°C-40°C, 5°C-40°C, 7°C-40°C, 10°C-40°C, 15
  • Cooling the treatment area may be carried out in any manner not inconsistent with the technical objectives of the present disclosure.
  • cooling the treatment area may comprise applying air to the treatment area.
  • the air blown on the treatment air to cool the treatment air may have a relative humidity in the range of 50%-60%, 50%-70%, 50%-80%, 50%-90%, 50%-100%, 60%-70%, 60%-80%, 60%-90%, 60%-100%, 70%-80%, 70%-90%, 70%-100%, 80%-90%, 80%-100%, or 90%-100%.
  • the air blown on the treatment air to cool the treatment air may be in the temperature range of -30°C -30°C, -30°C -20°C, -30°C -10°C, -30°C -0°C, -30°C -10°C, -30°C -20°C, -20°C -30°C, -20°C -20°C, -20°C -10°C, -20°C -0°C, -20°C -10°C, -10°C -30°C, -10°C -20°C, -10°C -10°C, -10°C -0°C, 0°C -30°C, 0°C -20°C, 0°C -10°C, 10°C -30°C, 10°C -20°C, or 20°C -30°C.
  • a columnar vacancy may be closed by contacting or connecting the first side of the columnar vacancy to the second side of the columnar vacancy.
  • the columnar vacancy can be closed by bringing together one or more of the epidermal, dermal, and subcutaneous layers.
  • the epidermal and dermal layers can be brought together, such as is shown in FIG. 10.
  • the dotted line indicates a line normal to the short axis, wherein the epidermal and dermal layers are brought together.
  • all three layers can be brought together.
  • the alignment and closing illustrated in FIG. 11 is achieved.
  • the columnar vacancy may be closed in any manner not inconsistent with the objectives of the present disclosure.
  • the first and second sides are brought together manually by squeezing or compressing the skin on the first and second sides together using one’s fingers.
  • the first and second sides can alternatively be brought together using mechanical devices to close the columnar vacancy.
  • the force used to close the columnar vacancies can be applied parallel or substantially parallel to the short axis of the columnar vacancy.
  • the first and second sides can be brought together by a pair of forces pulling in the direction of the long axis of the columnar vacancies.
  • such application of force causes the columnar vacancy to collapse to form a line, as described further herein.
  • the columnar vacancy is completely closed. In some other embodiments, after the application of the force to close the columnar vacancy, the columnar vacancy is only partially closed.
  • methods described herein can further comprise applying a dressing to the skin of a subject over the columnar vacancy.
  • a dressing when a dressing is applied, the first and second sides of the columnar vacancy may be first brought together manually by squeezing or compressing the skin on the first and second sides together using one’s fingers, and then a dressing may be applied.
  • the first and second sides can alternatively be brought together by applying a dressing adjacent to one side of a columnar vacancy and pulling the skin along the closure direction to close the columnar vacancy.
  • the columnar vacancy may be closed or partially closed using any method not inconsistent with the technical objectives of the present disclosure, and a dressing may be applied on top of the closed or partially closed columnar vacancy.
  • the dressing can comprise a compressive dressing, an adhesive dressing, or a combination thereof.
  • a compressive dressing comprises a dressing that provides pressure or compression to the particular area at which the dressing is applied.
  • compressive dressings include but are not limited to compressive bandages, compression stockings, or adhesive dressings that also apply compression (e.g., TEGADERM®, available from 3M or DuoDermTM, available from ConvaTech).
  • TEGADERM® available from 3M or DuoDermTM, available from ConvaTech
  • the adhesive dressing can be any biologically compatible adhesive known to those of ordinary skill in the art that is not inconsistent with the objectives of this disclosure.
  • the adhesive can be a urethane polymer-based adhesive, such as the commercial product TEGADERM® (available from 3M).
  • TEGADERM® commercial product
  • TEGADERM ® different sizes and shapes can be fashioned to facilitate placement on various regions of the body.
  • the compressive adhesive dressing can be manually stretched prior to application on the skin over the columnar vacancy, or can be pre-stretched using an applicator device. The pre-stretched compressive adhesive dressing can then be positioned over the columnar vacancy and adhered to the skin.
  • the compressive adhesive dressing can then be allowed to relax (e.g., through contraction), thus applying a compressive force to the closed columnar vacancy, allowing the columnar vacancy to remain closed during the healing process.
  • the adhesive can be a cyanoacrylate polymer-based adhesive, such as the commercial product DERMABOND® (available from Ethicon).
  • an adhesive is a bioadhesive or a biomimicry adhesive, such as a gelatin or L-DOPA adhesive.
  • exemplary adhesives that may be used in a method described herein include polyphenolic protein adhesives and polysaccharides.
  • absorbable sutures or staples can be used to assist the adhesive in holding the columnar vacancy closed.
  • absorbable fish barb sutures/staples can be inserted into the skin to provide mechanical support to the chemical bonding of the adhesive.
  • the absorbable sutures can be inserted at any therapeutically useful depth, such as 0.5 mm, 1 mm, 1.5 mm, or 2 mm.
  • the force used to close the columnar vacancies can be particularly applied parallel to the short axis of the columnar vacancy.
  • adhesives described herein can be transparent to light or substantially transparent to light. More particularly, in some preferred embodiments, the adhesive is transparent or substantially transparent to light having a wavelength that can be used to non-ablatively irradiate a closed columnar vacancy underlying the adhesive.
  • a method described herein can further comprise the step of irradiating the closed columnar vacancy with a non-ablative laser or broad band light (“BBL”) beam or source through the applied adhesive.
  • BBL broad band light
  • the adhesive is transparent or optically transparent in the infrared region of the electromagnetic spectrum or the visible region of the spectrum or in some other region of the spectrum corresponding to or overlapping with the peak wavelength or average wavelength of, respectively, the non-ablative laser beam or BBL beam.
  • the adhesive has an optical transparency of at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%, or at least 95% in a desired region of the spectrum, where the transparency is based on percent transmission of incident light within the desired region.
  • the desired region generally includes the peak wavelength or average wavelength of the non-ablative laser light or BBL.
  • the adhesive has a transparency recited above (e.g., at least 60% transmission) within one or more of the following spectral windows: 350-750 nm, 450-750 nm, 450-700 nm, 500-750 nm, 500-700 nm, 550-750 nm, 600-750 nm, 800-1400 nm, 800-1200 nm, and 800-1100 nm.
  • the step of irradiating the closed columnar vacancy as described herein can have a therapeutic effect on the columnar vacancy and/or provide one or more therapeutically beneficial effects to the subject.
  • the step of irradiating can cause or contribute to hemostasis, coagulation, or both of the closed columnar vacancy.
  • the step of irradiating triggers a “heat shock” response in and/or around the closed columnar vacancy wound, triggering the body to produce a variety of heat shock proteins (“HSP”) that reduce inflammation and scarring, and accelerate wound healing time.
  • HSP heat shock proteins
  • the accelerated wound healing achieved by a method described herein can permit bandages or other dressings applied to the treatment area (e.g., on the face) of the patient to be removed after a shorter period of time than otherwise possible.
  • dressings in particular can be removed after a shorter period of time.
  • BBL source and BBL beam can refer to a source and beam, respectively, of intense, broad-spectrum pulses of light, including as defined and approved by the U.S. Food and Drug Administration. More particularly, a BBL beam produced by a BBL source can comprise pulses of non-coherent or non-laser light having a wavelength from 500 nm to 1200 nm, as described, for instance, in Raulin et al., “IPL technology: a review,” Lasers Surg. Med. 2003, 32:78-87. Any laser, BBL source, laser beam, or BBL beam not inconsistent with the objectives of this disclosure can be used.
  • the choice of laser, BBL source, or laser or BBL beam can be based on a desired effect of the laser or BBL beam and/or on a desired target of the laser or BBL beam, such as a specific adhesive and/or columnar vacancy.
  • a BBL source described herein generally produces a pulsed light output.
  • the BBL source comprises a xenon gas-filled chamber.
  • the BBL source can produce a BBL beam by the application of bursts or pulses of electrical current through the xenon-containing chamber.
  • the irradiating beam is substantially non-ablative, and is therefore used for different purposes than the ablative fractional laser beam previously described herein that removes columns of skin.
  • the non-ablative irradiating beam can be coagulative, where a “coagulative” beam is understood to cause coagulation of tissue in and/or around the closed columnar vacancy.
  • the non-ablative irradiating beam can be hemostatic, where a “hemostatic” beam is understood to slow, reduce, or stop bleeding from the closed columnar vacancy.
  • the laser previously described herein can comprise a hybrid laser operable to produce laser beams having a plurality of differing wavelengths.
  • the hybrid laser is operable to selectively produce an ablative laser beam and a non-ablative laser beam. It is also possible to use both a BBL source and a laser integrated into the same device.
  • a single device described herein can be used to produce and deliver one or more beams (e.g., one or more laser beams, or one or more laser beams in combination with a BBL beam) having a range of properties, as needed for a specific treatment or other application of the device.
  • negative pressure may be applied during and/or after forming the columnar vacancies in the skin to close the columnar vacancies. In some instances, applying negative pressure may completely close the columnar vacancy. In some cases, applying negative pressure may partially close the columnar vacancy. In some implementations, negative pressure may be applied through the application of negative pressure dressings. Any negative pressure dressing not inconsistent with the technical objectives of the present disclosure may be used. Non-limiting examples include the PICO family of negative pressure wound therapy systems by Smith+Nephew or the 3MTM PrevenaTM System.
  • any negative pressure not inconsistent with the technical objectives of the present disclosure may be applied during and/or after forming the columnar vacancies in the skin.
  • the negative pressure is in the range from -40 mmHg to -200 mmHg, -40 mmHg to -180 mmHg, -40 mmHg to -160 mmHg, -40 mmHg to -140 mmHg, -40 mmHg to -120 mmHg, -40 mmHg to -100 mmHg, -40 mmHg to -80 mmHg, -40 mmHg to -60 mmHg, -60 mmHg to -200 mmHg, -60 mmHg to -180 mmHg, -60 mmHg to -160 mmHg, -60 mmHg to -140 mmHg, -60 mmHg to -120 mmHg, -60 mmHg to -100 mmH
  • the duration of the application of the negative pressure may vary.
  • the negative pressure is applied in the range of 1 hour to 6 hours, 6 hours to 12 hours, 12 hours to 24 hours, 24 hours to 48 hours, 48 hours to 3 days, 3 days to 1 week, 1 week to 2 weeks, 2 weeks to 4 weeks, 4 weeks to 6 weeks, or 6 weeks to 8 weeks.
  • the application of the negative pressure may be continuous. That is, in some instances, the negative pressure may be applied without the removal of the negative pressure or the removal of the wound dressing system. However, in some embodiments, the application of the negative pressure may be discontinuous.
  • the negative pressure dressing may be removed to change the dressing material that is in the negative pressure dressing system.
  • the dressing material may be changed on a schedule, such as once daily, every three days, every five days, or every seven days.
  • the negative pressure dressing system may be reapplied to continue the application of negative pressure without restarting the timeline of the application of the negative pressure.
  • the application of negative pressure may also be applied as a series of applications of negative pressure, with breaks in the treatment period. That is, in some cases, the application of negative pressure may be completed in cycles. Any cycle of the application of negative pressure not inconsistent with the technical objectives of the present disclosure may be used.
  • the negative pressure may be applied for 5 minutes to 12 hours on, and 2 minutes to 12 hours off over the course of 1 hour to 6 hours, 6 hours to 12 hours, 12 hours to 24 hours, 24 hours to 48 hours, 48 hours to 3 days, 3 days to 1 week, 1 week to 2 weeks, 2 weeks to 4 weeks, 4 weeks to 6 weeks, or 6 weeks to 8 weeks.
  • a method of treating skin can comprise applying negative pressure in a manner described herein, without necessarily carrying out certain other steps in certain other ways.
  • a method described herein comprises applying negative pressure to close a wound (or columnar vacancy) and/or to assist with healing of a wound (or columnar vacancy), even if the wound (or columnar vacancy) does not have a non-circular cross-section or short axis, or does not have a collapsible shape, or if the wound (or columnar vacancy) has a short axis and/or collapsible shape but is not aligned with a human body topology line as described herein.
  • applying negative pressure in a manner described herein can provide one or more advantages even if applying such negative pressure is not combined with certain other features of the present disclosure.
  • applying negative pressure is combined with other features described herein, such as a collapsible shape and/or alignment of a columnar vacancy.
  • methods described herein may increase skin tightness.
  • the degree of skin tightening or overall skin tightening achieved by certain of the methods described herein is generally related to a total area of the columns of skin removed.
  • the degree of skin tightening is approximately 1 to 0.5, where removal of 1% of the skin within the treatment area correspondingly results in a 0.5% reduction in the total area of the treatment area.
  • the degree of skin tightening is approximately 1 to 1, where removal of 1% of the skin within the treatment area correspondingly results in a 1% reduction in the total area of the treatment area.
  • the degree of skin tightening is approximately 1 to 1.5, where removal of 1% of the skin within the treatment area correspondingly results in a 1.5% reduction in the total area of the treatment area.
  • methods of skin tightening described herein may have a visual, detectable, and/or quantifiable reduction of tissue volume, skin surface area, and/or skin laxity that leads to skin tightness.
  • methods of skin tightening described herein may have a visual, detectable, and/or quantifiable increase in tissue volume and/or skin surface area that leads to skin tightness.
  • methods described herein may also reduce wrinkles.
  • the effect of a method described herein, in some cases, can be quantified by a point reduction of the Lemperle Assessment Scale, as described for example in Lemperle G, et al., A classification of facial wrinkles. Plast Reconstr Surg. 2001;
  • the methods described herein result in a quantifiable reduction of the degree of wrinkling by 1- to 3-point reduction on the Lemperle Scale. In other embodiments, the methods result in a 1- to 2-point reduction or a 1 -point reduction on the Lemperle Scale.
  • any beneficial area or volumetric fraction of skin can be removed from a treatment area.
  • up to 30% of the skin area in a treatment area can be removed.
  • between 1% and 25% of the skin area in a treatment area can be removed.
  • between 5% and 20% of the skin area can be removed.
  • between 10% and 20% or between 10% and 15% of the skin area can be removed.
  • between 15% and 30%, between 15% and 25%, or between 20% and 30% of the skin area can be removed.
  • methods described herein may provide improved wound recovery. In some cases, methods described herein may yield shortened recovery and/or skin healing times. In some implementations, methods described herein may reduce discomfort caused by wounds during recovery. Moreover, in some instances, methods described herein may reduce the weeping of wounds. Stated differently, in some cases, methods described herein may reduce the drainage of wounds.
  • systems for treating tissue are described herein.
  • such systems are capable of performing the methods previously described herein in Section I.
  • the various components and elements discussed in Section I correspond to the various components and elements described below, such as, for example, the lasers, adhesives, computers and controllers, and the like, and their accompanying descriptions in Section I are incorporated by reference in their entirety herein below.
  • such a system comprises a laser configured to fractionally ablate n columns of skin from a treatment area on the skin, thereby forming n columnar vacancies in the skin, the columnar vacancies each having a cross-section at the exterior surface of the skin.
  • the cross-section has a short axis, and the short axis is parallel to a pre-selected closure direction of the columnar vacancy.
  • the shape of the cross-section is not limited. In some instances, the cross-section is non-circular. In such cases, the value of the integer n is not necessarily limited. For example, in some cases, n is an integer from 1 to 100,000 or 1 to 10,000.
  • a system described herein can also comprise one or more controllers operatively connected to the laser, the one or more controllers being configured to automatedly control the fractional laser ablation locations and the orientations of the short axis in the treatment area.
  • a controller may further comprise a control unit.
  • a control unit may comprise a controller. Any controller and/or control unit not inconsistent with the technical objectives of the present disclosure may be used.
  • a controller and/or control unit comprises hardware and/or software for coordinating, automating, or controlling the operation of additional parts of the system (e.g., the handpiece and/or cooling system). Any such hardware and/or software not inconsistent with the objectives of the present disclosure may be used.
  • various suitable hardware and software components will be readily apparent to those of ordinary skill in the art.
  • a system described herein comprises a handpiece that delivers laser light as described herein.
  • the handpiece is configured to permit the manual rotation and manipulation of the handpiece.
  • the orientation of handpiece is able to be freely controlled (i.e., rotated and manipulated) by the user.
  • the handpiece is configured to permit rotation of the both the handpiece itself and/or the short axis of the laser beam spot (or columnar vacancy formed thereby), from one group or set of columnar vacancies to another group or set of columnar vacancies, or between individual columnar vacancies or spots.
  • a system described herein may further comprise a cooling system.
  • the cooling system may cool the treatment area during laser ablation by 3°C-50°C, 5°C-50°C, 7°C-50°C, 10°C-50°C, 15°C-50°C, 20°C-50°C, 25°C-50°C, 30°C-50°C, 35°C-50°C, 40°C-50°C, 45°C-50°C, 3°C-45°C, 5°C-45°C, 7°C-45°C, 10°C-45°C, 15°C-45°C, 20°C-45°C, 25°C-45°C, 30°C-45°C, 35°C-45°C, 40°C-45°C, 3°C-40°C, 5°C-40°C, 7°C-40°C, 10°C-40°C, 15°C-40°C, 20°C-40°C, 25°C-40°C, 30°C-40°C,
  • a cooling system may apply air to the treatment area.
  • the air of the cooling system may have a relative humidity in the range of 50%-60%, 50%-70%, 50%-80%, 50%-90%, 50%-100%, 60%-70%, 60%-80%, 60%-90%, 60%-100%, 70%-80%, 70%-90%, 70%-100%, 80%-90%, 80%-100%, or 90%-100%.
  • the air of the cooling system may be in the temperature range of -30°C -30°C, -30°C -20°C, -30°C - 10°C, -30°C -0°C, -30°C -10°C, -30°C -20°C, -20°C -30°C, -20°C -20°C, -20°C -10°C, -20°C -0°C, -20°C -10°C, -10°C -30°C, -10°C -20°C, -10°C -10°C, -10°C -0°C, 0°C -30°C, 0°C -30°C, 0°C - 20°C, 0°C -10°C, 10°C -30°C, 10°C -20°C, or 20°C -30°C.
  • an imaging device comprises a camera. Any camera not inconsistent with the technical objectives of the present disclosure may be used.
  • a camera comprises a visual camera.
  • a visual camera includes a camera that collects images in the visible spectrum. Many suitable visual cameras will be readily apparent to those of ordinary skill in the art. Non-limiting examples of a visual camera include but are not limited to RGB cameras, monocular cameras, stereo cameras, and fish eye cameras.
  • a camera comprises an infrared camera or a thermal camera.
  • Systems described herein, in some embodiments, may further comprise one or more lenses, mirrors, actuators, or other hardware or software for directing the laser beam to a desired location. Any lenses, mirrors, actuators, or other hardware or software not inconsistent with the objectives of the present disclosure may be used. Many suitable lenses, mirrors, actuators, or other hardware or software will be readily apparent to those of ordinary skill in the art.
  • a system or device described herein can include any combination of components or features described above.
  • any laser (or combination of lasers) described above can be used in combination with any additional hardware and/or software described herein.
  • a laser ablation was performed on a treatment area of skin to remove a plurality of columns to form columnar vacancies in the skin on Patient 1.
  • the cross-section of the columnar vacancies was a non-collapsible shape.
  • the cross-section of the columnar vacancies was a square with the approximate length dimensions 350-400 pm per side.
  • the square shape of the cross-section of the columnar vacancies may not be as visibly discernable on the surface on the columnar vacancy because of the nature of skin after injury (i.e., skin elasticity changes, pliability changes, contraction, and/or coagulation).
  • the columnar vacancies were formed using a square-shaped laser spot.
  • FIG. 12A is a photograph of a plurality of the columnar vacancies (410) on the day of treatment in a treatment area (400).
  • the overlaid squares in FIG. 12A indicate the shape of the cross-section, as a guide to the eye.
  • FIG. 12B is a photograph of a plurality of columnar vacancies (410) from the same patient one day after treatment (“Day 1”). As shown by these images, the square cross-sections are highly visible after treatment, “filling in” with new tissue and/or skin during healing in a “secondary intention” manner, instead of closing.
  • the filling in is due to the lack of collapsible shape for the cross-sections of the columnar vacancies and the inability of the shape of cross-sections to properly align with human body topology lines, despite the use of the compression bandaging.
  • FIG. 12C shows a photograph of a plurality of columnar vacancies (410) from the same patient two days after treatment (“Day 2”).
  • FIG. 12D shows a photograph of a plurality of columnar vacancies (410) at Day 3 after treatment
  • FIG. 12E shows a photograph of the columnar vacancies (410) at Day 4 after treatment.
  • the columnar vacancies with square cross-sections continued to remain highly visible during healing, growing “shut” with scabbing and new tissue and/or skin instead of closing.
  • a laser ablation was performed on the treatment areas of two patients to remove a plurality of columns on the skin to form columnar vacancies in the skin according to some embodiments described herein.
  • the treatment area was on the anterior neck for both patients. Photographs were taken with the skin under tension due to mild cervical extension.
  • the cross-section shape of the columnar vacancies for each patient was an ellipse, a collapsible shape. That is, in both instances, the columnar vacancies were formed using an ellipse-shaped laser spot.
  • the short axis of the ellipse was misaligned with the pre-selected closure direction and a human body topology line (see FIG. 13), and in Patient 3, the short axis of the ellipse was aligned with the pre-selected closure direction and a human body topology line (see FIG. 14).
  • FIG. 13 A a photograph of a plurality of columnar vacancies (410) on the day of treatment in a treatment area (400) of Patient 2 is shown.
  • the overlaid ellipses shown in FIG. 13A indicate the shape of the cross-section of the columnar vacancies at the exterior surface, as a guide to the eye, particularly since the cervical extension created some tension in the up-down direction in the plane of the page of FIG. 13 A, somewhat distorting the apparent shape of the vacancies (410), away from a perfect ellipse and toward a round shape.
  • the bold, thick arrow in FIG. 13A indicates the pre-selected closure direction.
  • the dashed double arrow indicates the human body topology line.
  • this human body topology line comprises a Langer’s line.
  • the pre-selected closure direction and the Langer’s line are parallel to one another.
  • the short axis of the columnar vacancy is approximately perpendicular to the pre-selected closure direction (analogous to FIG. 9C), indicating misalignment for Patient 2.
  • TEGADERM compression bandaging was used to close the columnar vacancies along the pre-selected closure direction.
  • FIG. 13B and FIG. 13C show the treatment area (400) at Days 1 and 5 after treatment, respectively.
  • the misalignment described above contributes to the visible shape discrepancy between the elliptical columnar vacancy, and the visualized round holes.
  • the misalignment diminishes the effect of closure on healing, such that columnar vacancies are widened and filled with scabs and tissue regrowth.
  • Results for Patient 3 are shown in FIG. 14. Specifically, in FIG. 14A, a photograph of a plurality of columnar vacancies (410) on the day of treatment in a treatment area (400) of Patient 3 is shown.
  • the overlaid ellipses indicate the shape of the cross-section of the columnar vacancies at the exterior surface, as a guide to the eye.
  • the bold, thick arrow indicates the preselected closure direction.
  • the dashed double arrow indicates the human body topology line. In this patient, the human body topology line is a Langer’s line.
  • the pre-selected closure direction, the short axis of the columnar vacancy (marked with a dashed line bisecting the relevant overlaid ellipse), and the Langer’s line are approximately parallel to one another, indicating an angle of approximately zero degrees between the short axis of the cross-section of the columnar vacancy and the pre-selected closure direction, and between the short axis and the Langer’s line, and between the closure direction and the Langer’s line.
  • TEGADERM compression bandaging was used to close the columnar vacancies along the pre-selected closure direction.
  • FIG. 14B and FIG. 14C show the treatment area (400) at Days 1 and 5 after treatment, respectively. Not intending to be bound by theory, it is believed that alignment as described above contributes to the visible shape discrepancy between the elliptical columnar vacancy, and the slit like elliptical holes of a higher aspect ratio. Additionally, it is believed that, in this non-limiting Example, alignment facilitates the closure of the columnar vacancies by compression bandage.
  • this non-limiting Example demonstrates advantages of the collapsible shape of the cross-section of the columnar vacancy and aligning the short axis of the collapsible shape, the pre-selected closure direction, and a human body topology line.
  • a laser ablation was performed on the treatment area of a patient, Patient 4, in combination with treatment with a negative pressure dressing.
  • Negative pressure therapy can assist in wound edge apposition and prevent fluid accumulation that may otherwise inhibit timely closure of columnar vacancies.
  • FIG. 16A a photograph of a plurality of columnar vacancies (410) on the day of treatment in a treatment area (400) of the patient is shown.
  • the overlaid ellipses shown in FIG. 16A indicate the shape of the cross-section of the columnar vacancy at the exterior surface, as a guide to the eye.
  • the bold, thick arrow indicates the pre-selected closure direction.
  • the dashed double arrow indicates the human body topology line.
  • the human body topology line is a Langer’s line.
  • the pre-selected closure direction, the short axis of the columnar vacancies, and the Langer’s line are approximately parallel to one another, indicating an angle of approximately 0 degrees among the short axis, the pre-selected closure direction, and the Langer’s line.
  • FIG. 16B and FIG. 16C show the treatment area (400) at Days 1 and 5 after treatment, respectively.
  • this non-limiting Example demonstrates advantages of the collapsible shape of the cross-section of the columnar vacancies, aligning the pre-selected closure direction of the columnar vacancies with a human body topology line, and applying negative pressure to the treatment area after forming the columnar vacancies in the skin.
  • a laser ablation was performed without cooling a treatment area during the ablation.
  • a laser ablation was performed with cooling of a treatment area during a similar ablation.
  • FIG. 17A illustrates a photograph of the columnar vacancies (410) formed in the treatment area (400) during the laser ablation, without cooling.
  • a substantial rim of desiccated skin (480) formed, indicating secondary (unintended) thermal damage to skin at the surface of the columnar vacancies.
  • FIG. 17B illustrates a photograph of columnar vacancies (410) formed during laser ablation, while cooling the treatment area (400).
  • there is little or no rim of desiccated skin indicating less unintended or undesired thermal damage caused by the heat generated by forming the columnar vacancies in the skin through the laser ablation.
  • FIG. 17C illustrates a photograph of the columnar vacancies (410) formed in the treatment area (400) during the laser ablation, without cooling, displaying the same treatment as FIG. 17A after one day of healing. Compared to FIG.17A, the vacancies are still open, showing evidence of fluid pooling and rounding of the shape.
  • FIG. 17D illustrates a photograph of the columnar vacancies (410) formed in the treatment area (400) during the laser ablation, with cooling, displaying the same treatment as FIG. 17B after one day of healing.
  • the vacancies in FIG. 17D retain their elliptical shape, as evident by the closure of the columnar vacancies by filling as well as novel skin tension lines that can be seen developing between neighboring ellipses.
  • FIG. 17C Day 1, no cooling
  • FIG. 17D Day 1, cooling
  • shows cooling helps reduce thermal damage that can inhibit the closure of columnar vacancies.
  • this non-limiting Example demonstrates advantages of cooling the treatment area during performing the laser ablation to form columnar vacancies in the skin.
  • the system (500) comprises an ablative laser (501).
  • the wavelength of the ablative laser (501) is selected based upon the tissue type being treated.
  • the wavelength of the ablative laser (501) is a wavelength absorbed by water in the skin.
  • an ablative laser (501) may comprise one or more laser beams.
  • an ablative laser (501) may comprise an ablative laser beam for the purpose of ablation and an additional visible beam that is coaxially aligned for the purpose of aligning the ablative laser beam.
  • the system (500) comprises a collimated delivery device (502) for the ablative laser (501).
  • a collimated delivery device (502) further comprises a laser articulating arm.
  • a collimated delivery device (502) further comprises a fiber laser and a collimator.
  • beam walk from the laser articulating arm may be avoided using the fiber laser or a smaller laser.
  • an aperture may be used with the ablative laser (501) to modify the shape of the ablative laser (501) into the desired laser beam shape.
  • an aperture may be used to modified the shape of the ablative laser (501) to produce a diamond shape or an ellipse shape.
  • an aperture may be a physical aperture.
  • the system (500) comprises beam shaping optics (503) for the ablative laser (501).
  • beam shaping optics (503) may be toric or spherical cylindrical optics.
  • the beam shaping optics (503) may be spaced appropriately for beam imaging and demagnification.
  • beam shaping optics (503) may further comprise an axicon or anamorphic prism pairs, which may, in some cases, help achieve the desired beam shape.
  • the system (500) comprises a rotation mechanism (504) for the ablative laser (501).
  • a rotation mechanism (504) comprises an indexed hollow tube center along the optical axis of the ablative laser (501).
  • a rotation mechanism (504) may have discrete positions or a detent mechanism.
  • a rotation mechanism (504) may allow axial orientation of a collapsible shape along a desired position or a human body topology line. Further, in some instances a rotation mechanism (504) may also be manual or motorized with position sensing.
  • the system (500) comprises a demagnification mechanism (505) for the ablative laser (501).
  • a demagnification mechanism (505) takes a shaped beam for the ablative laser (501) and changes the magnification of the beam to achieve the desired spot size.
  • the system (500) comprises motorized scanners and telecentration optics (506).
  • a pair of mirrors are mounted on the motorized scanners (506), one for each axis to allow for the placement of multiple spots of the ablative laser on the target tissue (501) with even spacing.
  • galvanometers drive the mirrors to their various orientations.
  • motorized scanners and telecentration optics (506) may allow for the patterning of the shape (e.g., close packed) of the ablative laser (501) while maintaining beam shape and orientation of each spot.
  • the system (500) comprises a physical standoff whose shape and size enforces the alignment of the target tissue at the optimum optical focal plane of the laser beam (“standoff at focus”) (507).
  • the standoff at focus (507) helps to maintains the beam shape of the ablative laser (501).
  • Embodiment 1 A method of removing skin of a patient, comprising: performing a laser ablation in a treatment area of the skin of the patient, thereby removing a column of the skin and forming a columnar vacancy in the skin, wherein the columnar vacancy has a non-circular cross-section at the exterior surface of the skin, wherein the non-circular cross-section has a short axis, and wherein the short axis is parallel to a pre-selected closure direction of the columnar vacancy.
  • Embodiment 2 The method of Embodiment 1 further comprising closing the columnar vacancy along the pre-selected closure direction.
  • Embodiment 3 The method of Embodiment 1 or Embodiment 2, wherein the crosssection is a collapsible shape.
  • Embodiment 4 The method of Embodiment 3, wherein the collapsible shape is an ellipse.
  • Embodiment 5 The method of Embodiment 3, wherein the collapsible shape is a diamond.
  • Embodiment 6 The method of any of Embodiments 1-5, wherein the columnar vacancy extends in a z-direction that is not orthogonal to the surface of the skin.
  • Embodiment 7 The method of any of Embodiments 1-6, wherein the cross-section has an area of 0.01 to 25 mm 2 .
  • Embodiment 8 The method of any of Embodiments 1-7, wherein the pre-selected closure direction is aligned with a human body topology line of the patient.
  • Embodiment 9 The method of Embodiment 8, wherein the human body topology line is a Langer’s line.
  • Embodiment 10 The method of Embodiment 8, wherein the human body topology line is a Kraissl line.
  • Embodiment 11 The method of Embodiment 8, wherein the human body topology line is a relaxed skin tension line.
  • Embodiment 12 The method of any of Embodiments 1-11, wherein: the laser ablation comprises fractional laser ablation; and a plurality of columns of skin is removed and a plurality of columnar vacancies is formed in the skin by the fractional laser ablation.
  • Embodiment 13 The method of any of Embodiments 1-12, wherein the treatment area is located on the face of the patient.
  • Embodiment 14 The method of Embodiment 2, wherein closing the columnar vacancy along the pre-selected closure direction comprises applying an adhesive dressing, a compressive dressing, or a combination thereof.
  • Embodiment 15 The method of Embodiment 2, wherein closing the columnar vacancy along the pre-selected closure direction comprises applying negative pressure.
  • Embodiment 16 The method of any of Embodiments 1-15 further comprising cooling the treatment area.
  • Embodiment 17 A system for skin removal, comprising: a laser configured to fractionally ablate n columns of skin from a treatment area on the skin, thereby forming n columnar vacancies in the skin, the columnar vacancies each having a noncircular cross-section at the exterior surface of the skin, wherein the non-circular cross-section has a short axis, wherein the short axis is parallel to a pre-selected closure direction of the columnar vacancy, and wherein n is an integer from 1 to 100,000; and one or more controllers operatively connected to the laser, the one or more controllers being configured to automatedly control the fractional laser ablation locations and the orientations of the short axis in the treatment area.
  • Embodiment 18 The system of Embodiment 17, wherein the non-circular crosssection is a collapsible shape.
  • Embodiment 19 The system of Embodiment 18, wherein the collapsible shape is an ellipse.
  • Embodiment 20 The system of Embodiment 18, wherein the collapsible shape is a diamond.
  • Embodiment 21 The system of any of Embodiments 17-20 further comprising a handpiece.
  • Embodiment 22 The system of any of Embodiments 17-21 further comprising a cooling system.
  • Embodiment 23 A method of treating skin of a patient, the method comprising: performing an ablation in a treatment area of the skin of the patient with a laser, thereby removing a column of the skin and forming a columnar vacancy in the skin, wherein the columnar vacancy has a cross-section at the exterior surface of the skin, wherein the cross-section has a short axis, and wherein the short axis is parallel to a pre-selected closure direction of the columnar vacancy; and applying negative pressure during and/or after forming the columnar vacancy in the skin.
  • Embodiment 24 The method of Embodiment 23, wherein applying negative pressure during and/or after forming the columnar vacancy in the skin at least partially closes the columnar vacancy in the skin.
  • Embodiment 25 The method of Embodiment 23 or Embodiment 24, wherein the cross-section is non-circular.
  • Embodiment 26 The method of Embodiment 25, wherein the non-circular crosssection is a collapsible shape.
  • Embodiment 27 The method of Embodiment 26, wherein the collapsible shape is an ellipse.
  • Embodiment 28 The method of Embodiment 26, wherein the collapsible shape is a diamond.
  • Embodiment 29 The method of any of Embodiments 23-28 further comprising cooling the treatment area.

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Abstract

Selon un aspect, l'invention concerne des méthodes de traitement d'un tissu tel que la peau. Dans certains modes de réalisation, un tel procédé comprend la réalisation d'une ablation laser dans une zone de traitement de la peau d'un patient, ce qui permet d'éliminer une colonne de la peau et de former un espace colonnaire dans la peau. En outre, dans certains cas, l'espace colonnaire a une section transversale non circulaire au niveau de la surface extérieure de la peau. De plus, la section transversale non circulaire a un axe court, et l'axe court est parallèle à une direction de fermeture présélectionnée de l'espace colonnaire. En outre, dans certains cas, un procédé décrit ici comprend en outre la fermeture de l'espace colonnaire le long de la direction de fermeture présélectionnée.
PCT/US2024/053049 2023-10-27 2024-10-25 Systèmes et procédés d'élimination de tissus et de raffermissement de la peau Pending WO2025090924A1 (fr)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20130053931A1 (en) * 2007-02-23 2013-02-28 Reliant Technologies, Inc. Method and device for tightening tissue using electromagnetic radiation
US20210282855A1 (en) * 2017-05-19 2021-09-16 Sciton. Inc System and methods for treating skin
US20210401453A1 (en) * 2018-11-07 2021-12-30 Cytrellis Biosystems, Inc. Systems and methods for skin treatment

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20130053931A1 (en) * 2007-02-23 2013-02-28 Reliant Technologies, Inc. Method and device for tightening tissue using electromagnetic radiation
US20210282855A1 (en) * 2017-05-19 2021-09-16 Sciton. Inc System and methods for treating skin
US20210401453A1 (en) * 2018-11-07 2021-12-30 Cytrellis Biosystems, Inc. Systems and methods for skin treatment

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