Abstract:
A system for atraumatic removal of skin surface layers in a treatment to induce neocollagenesis in the dermis to reduce wrinkles and alter the architecture of the dermal layers. A preferred embodiment of the inventive system comprises (i) a hand-held instrument with a resilient floating skin interface that carries microscopic diamond fragments for abrading the skin surface in a controlled manner; (ii) a fluid source for supplying sterile fluids to the skin interface for cleaning skin debris from the skin interface; and (iii) a negative pressure source for pulling fluid to the skin interface and thereafter aspirating fluid and skin debris from a treatment site. The skin interface is formed of a resilient floating member (e.g., silicone) that allows the working surface to flex and atraumatically engage the topography of the skin surface as it is translated across a treatment site. The system allows substantially deep surface layer removal without significant pain.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]    This application is related to the following U.S. Patent Applications, provisional and otherwise: Ser. No. 09/______ (Docket No. S-ECI-007) filed concurrently herewith on Dec. 30, 1999 titled  Instruments and Techniques for Inducing Neocollagenesis in Skin Treatment,  Ser. No. 60/150,782 (Docket No. S-ECI-005) filed Aug. 26, 1999 titled  Instruments and Techniques for Controlled Removal of Epidermal Layers;  Ser. No. 60/150,781 (Docket No. S-ECI-004) filed Aug. 25, 1999 titled  Instruments and Techniques for Controlled Removal of Epidermal Layers;  Ser. No. 09/294,254 (Docket No. S-AQ-009) filed Apr. 19, 1999 titled  Instruments and Techniques for High - Velocity Fluid Abrasion of Epidermal Layers with Skin Cooling;  Ser. No. 09/271,610 (Docket No. S-AQ-002) filed Mar. 17, 1999 titled  Technique and System for Controlled Chemically - Mediated Removal of Skin Layers;  and U.S. patent application Ser. No. 09/210,293 (Docket No. S-DESC-010) filed Dec. 11, 1998 titled  Surgical Instrument for High Pressure Fluid Debridement of Epithelial Layers;  Ser. No. 60/125,369 (Docket No. S-AQ-004) filed Mar. 18, 1999 titled  Skin Resurfacing Technique and Instrument for Air - Assisted Chemical Etching of Dermal Layers;  and Ser. No. 60/125,399 (Docket No. S-AQ-007) filed Mar. 22, 1999 titled  High-Pressure Water Jet Abrasive Technique and Instrument for Skin Resurfacing.  All of the above listed applications are incorporated herein in their entirety by these references.  
     
    
     
       BACKGROUND OF THE INVENTION  
         [0002]    1. Field of the Invention  
           [0003]    The present invention relates to devices for dermatology and more particularly to a skin resurfacing system that utilizes (i) a skin interface having a diamond fragment abrading surface for removing skin surface layers as the working end is translated over a patient&#39;s skin, (ii) a source for delivery of a sterile fluids to the skin interface of the system, and (iii) an aspiration system for delivering fluids to and removing fluids and skin debris from the treatment site.  
           [0004]    2. Description of Background Art  
           [0005]    Dermatologists and plastic surgeons have used various methods for removing superficial skin layers to cause the growth of new skin layers (i.e., commonly described as skin resurfacing techniques) since the early 1900&#39;s. Early skin resurfacing treatments used an acid such as phenol to etch away surface layers of a patient&#39;s skin that exhibited damage which thereafter were replaced by new skin. (The term damage when referring to a skin disorder is herein defined as any cutaneous defect, e.g., including but not limited to rhytides, hyperpigmentation, acne scars, solar elastosis, other dyschromias, stria distensae, seborrheic dermatitus).  
           [0006]    Following the removal of surface skin layers at a particular depth, no matter the method of skin removal, the body&#39;s natural wound-healing response begins to regenerate the epidermis and underlying wounded skin layers. The new skin layer will then cytologically and architecturally resemble a younger and more normal skin. The range of resurfacing treatments can be divided generally into three categories based on the depth of the skin removal and wound: (i) superficial exfoliations or peels extending into the epidermis, (ii) medium-depth resurfacing treatments extending into the papillary dermis, and (iii) deep resurfacing treatments that remove tissue to the depth of the reticular dermis (see FIGS.  1 A- 1 B).  
           [0007]    Modern techniques for skin layer removal include: CO 2  laser resurfacing which falls into the category of a deep resurfacing treatment; Erbium laser resurfacing which generally is considered a medium-depth treatment; mechanical dermabrasion using high-speed abrasive wheels which results in a medium-depth or deep resurfacing treatment; and chemical peels which may range from a superficial to a deep resurfacing treatment, depending on the treatment parameters. A recent treatment, generally called micro-dermabrasion, has been developed that uses an air-pressure source to deliver abrasive particles directly against a patient&#39;s skin at high-velocities to abrade away skin layers. Such a micro-dermabrasion modality may be likened to sand-blasting albeit at velocities that do not cause excessive pain and discomfort to the patient. Micro-dermabrasion as currently practiced falls into the category of a superficial resurfacing treatment.  
           [0008]    A superficial exfoliation, peel or abrasion removes some or all of the epidermis (see FIGS.  1 A- 1 B) and thus is suited for treating very light rhytides. Such a superficial exfoliation is not effective in treating many forms of damage to skin. A medium-depth resurfacing treatment that extends into the papillary dermis (see FIG. 1B) can treat many types of damage to skin. Deep resurfacing treatments, such as CO 2  laser treatments, that extend well into the reticular dermis (see FIG. 1B) cause the most significant growth of new skin layers but carry the risk of scaring unless carefully controlled.  
           [0009]    It is useful to briefly explain the body&#39;s mechanism of actually resurfacing skin in response to the removal of a significant depth of dermal layers. Each of the above-listed depths of treatment disrupts the epidermal barrier, or a deeper dermal barrier (papillary or reticular), which initiates varied levels of the body&#39;s wound-healing response. A superficial skin layer removal typically causes a limited wound-healing response, including a transient inflammatory response and limited collagen synthesis within the dermis. In a medium-depth or a deep treatment, the initial inflammatory stage leads to hemostasis through an activated coagulation cascade. Chemotacic actors and fibrin lysis products cause neutrophils and monocytes to appear at the site of the wound. The neutrophils sterilize the wound site and the monocytes convert to macrophages and elaborate growth factors which initiate the next phase of the body&#39;s wound-healing response involving granular tissue formation. In this phase, fibroblasts generate a new extracellular matrix, particularly in the papillary and reticular dermis, which is sustained by angiogenesis and protected anteriorly by the reforming epithelial layer. The new extracellular matrix is largely composed of collagen fibers (particularly Types I and III) which are laid down in compact parallel arrays (see FIG. 1B). It is largely the collagen fibers that provide the structural integrity of the new skin—and contribute to the appearance of youthful skin.  
           [0010]    All of the prevalent types of skin damage (rhytides, solar elastosis effects, hyperpigmentation, acne scars, dyschromias, melasma, stria distensae) manifest common histologic and ultrastructural characteristics, which in particular include disorganized and thinner collagen aggregates, abnormalities in elastic fibers, and abnormal fibroblasts, melanocytes and keratinocytes that disrupt the normal architecture of the dermal layers. It is well recognized that there will be a clinical improvement in the condition and appearance of a patient&#39;s skin when a more normal architecture is regenerated by the body&#39;s wound-healing response. Of most significance to a clinical improvement is skin is the creation of more dense parallel collagen aggregates with decreased periodicity (spacing between fibrils). The body&#39;s wound-healing response is responsible for synthesis of these collagen aggregates. In addition to the body&#39;s natural wound healing response, adjunct pharmaceutical treatments that are administered concurrent with, or following, a skin exfoliations can enhance the development of collagen aggregates to provide a more normal dermal architecture in the skin—the result being a more youthful appearing skin.  
           [0011]    The deeper skin resurfacing treatments, such as laser ablation, chemical peels and mechanical dermabrasion have drawbacks. The treatments are best used for treatments of a patient&#39;s face and may not be suited for treating other portions of a patient&#39;s body. For example, laser resurfacing of a patient&#39;s neck or décolletage may result in post-treatment pigmentation disorders. All the deep resurfacing treatments are expensive, require anesthetics, and must be performed in a clinical setting. The most significant disadvantage associated with deep resurfacing treatments relates to the post-treatment recovery period. It may require up to several weeks or even months to fully recover and to allow the skin the form a new epidermal layer. During a period ranging from a few weeks to several weeks after a deep resurfacing treatment, the patient typically must wear heavy make-up to cover redness thus making the treatment acceptable only to women.  
           [0012]    The superficial treatment offered by micro-dermabrasion has the advantage of being performed without anesthetics and requiring no extended post-treatment recovery period. However, microdermabrasion as currently practices also has several disadvantages. First, a microdermabrasion treatment is adapted only for a superficial exfoliation of a patient&#39;s epidermis which does not treat many forms of damage to skin. Further, the current micro-dermabrasion devices cause abrasive effects in a focused area of the skin that is very small, for example a few mm. 2 , since all current devices use a single pin-hole orifice that jets air and abrasives to strike the skin in a highly focused area. Such a focused treatment area is suitable for superficial exfoliations when the working end of the device is passed over the skin in overlapping paths. Further, such focused energy delivery is not well suited for deeper skin removal where repeated passes may be necessary. Still further, current micro-dermabrasion devices are not suited for deeper skin removal due to the pain associated with deep abrasions. Other disadvantages of the current micro-dermabrasion devices relate to the aluminum oxide abrasive particles that are typically used. Aluminum oxide can contaminate the working environment and create a health hazard for operators and patients alike. Inhalation of aluminum oxide particles over time can result in serious respiratory disorders.  
         SUMMARY OF THE INVENTION  
         [0013]    The present invention comprises a hand-held instrument adapted for pain-free removal of skin layers in a treatment to induce neocollagenesis in the dermis to reduce wrinkles and alter the architecture of the dermal layers. A preferred embodiment of the inventive system comprises (i) a hand-held instrument with a resilient working skin interface that carries microscopic diamond fragments for abrading the skin surface in a controlled manner; (ii) a fluid source for supplying sterile fluids to the skin interface for cleaning skin debris from the skin interface; and (iii) a negative (−) pressure source for pulling fluid to the skin interface and thereafter aspirating fluid and skin debris from a treatment site.  
           [0014]    More in particular, the working end that carries the resilient skin interface and sharp-edged diamond fragments is detachable from an intermediate instrument body and is inexpensive and disposable after being used for a single treatment. A preferred embodiment of hand-held instruments has a cartridge-type fluid reservoir that is detachable from the intermediate body section and is disposable. The working end defines a skin interface that engages and cuts or abrades the skin as it is translated across a treatment site. A preferred working end has a central channel and outflow aperture that communicates with a remote negative pressure source via a flexible tube. The skin interface is configured with a plurality of fluid inflow apertures generally about a perimeter of the skin interface. Preferably, the inflow apertures are located within a groove structure that allows substantial volume of fluid to be carried within the grooves and in contact with the treatment site. Intermediate to the arrangement of inflow and outflow apertures is a major portion of the skin interface that carries the diamond fragments, which range in diameter from about 10 μm to about 250 μm.  
           [0015]    Of particular interest, the skin interface is formed of a resilient material such as silicone to allow the working end to flex and atraumatically engage the skin surface as it is translated across a treatment site. Also of particular interest, the suspension of the diamond fragments in resilient silicone seems to allow a slight movement or adjustment of the diamond fragments as the diamond abrasive architecture is translated over skin. In other words, the diamond fragments float to a some extent as they cut the skin sur and patients report that skin layer removals to a significant depth can be accomplished substantially without pain.  
           [0016]    The aspiration source of the inventive system has multiple functions: (i) to draw the skin surface into a concave form of the skin interface and the diamond cutting architecture to perform the method of removing skin surface layers; (ii) to draw a sterile fluid across the diamond architecture to remove skin debris from the skin interface; and (iii) to further aspirate the skin debris and spent fluid volume to a remote collection reservoir.  
           [0017]    In practicing a method of the invention, the following steps are performed, the system operator (i) places the skin interface carrying the abrasive architecture against the patient&#39;s skin in a treatment site; (ii) actuates a negative pressurization source in fluid communication an arrangement of apertures in the skin interface to draw the skin into a concavity of the skin interface and against the abrasive architecture; (iii) translates the abrasive architecture across the treatment site to cut or abrade a skin surface layer; and (iv) contemporaneous with the cutting step, flowing a fluid (e.g., sterile water) generally about and across the abrasive architecture between the arrangement of inflow and outflow apertures in the skin interface under the negative pressures forces to (A) remove the skin debris and clean abrasive architecture; (B) to hydrate the skin to facilitate surface layer cutting, and (C) to cool the skin to make the skin treatment more pain-free.  
           [0018]    In general, the invention provides a system and techniques for removing skin surface layers in a controlled manner.  
           [0019]    The invention advantageously provides a technique to induce neocollageneis in a patient&#39;s skin.  
           [0020]    The invention advantageously provides a technique and system for rejuvenating a patient&#39;s skin by surface layer removal to thereby induce the body&#39;s wound healing response to cause noecollagenesis in the dermis of the treatment area.  
           [0021]    The invention provides a system with a resilient skin interface that carries exposed sharp-edged diamond fragments for controlled cutting or abrasion of the skin surface.  
           [0022]    The invention advantageously provides a system with a resilient skin interface that flexes to conform to the skin surface as it is translated across a skin treatment site.  
           [0023]    The invention provides a working end in which sharp-edged diamond fragments are resiliently suspended in a flexible silicone.  
           [0024]    The invention advantageously provides a fluid source for supplying a fluid to a perimeter of the skin interface to cool the skin, hydrate the skin and remove skin debris from the skin interface during use.  
           [0025]    The invention advantageously provides an aspiration source communicating with a central aperture in the skin interface for drawing fluid across the skin interface to remove skin debris and aspirate such skin debris to a remote collection source.  
           [0026]    The invention advantageously provides an instrument handle with a cartridge-type fluid reservoir that is removable and disposable.  
           [0027]    The invention advantageously provides an injection-molded working end that carries diamond fragments that is inexpensive and disposable. 
       
    
    
       [0028]    Other objects and advantages of the invention will be apparent from the following description, the accompanying drawings and the appended claims. Additional advantages and features of the invention appear in the following description in which several embodiments are set forth.  
       BRIEF DESCRIPTION OF THE DRAWINGS  
       [0029]    FIGS.  1 A- 1 B are sectional illustrations of a patient&#39;s skin showing dermal layers.  
         [0030]    [0030]FIG. 2A is a perspective view of an exemplary Type “A” body and working end of the instrument of the invention.  
         [0031]    [0031]FIG. 2B is an exploded perspective view of components of the exemplary body and working end of FIG. 2A.  
         [0032]    [0032]FIG. 3 is an enlarged perspective view of the working end of the instrument of FIGS.  2 A- 2 B.  
         [0033]    [0033]FIG. 4 is a sectional view of the exemplary working end of FIG. 3 taken along line  4 - 4  of FIG. 3.  
         [0034]    [0034]FIG. 5 is a greatly enlarged sectional view of a skin interface portion of the exemplary working end of FIG. 3 showing diamond particles carried therein taken along line  5 - 5  of FIG. 4.  
         [0035]    [0035]FIG. 6 is a sectional view of an alternative working end that is similar to the working end of FIG. 3.  
         [0036]    [0036]FIG. 7 is a sectional view of another alternative working end that is similar to the working end of FIG. 3.  
         [0037]    [0037]FIG. 8A is a greatly enlarged sectional view of a working end surface shown engaging a patient&#39;s skin in a method of the invention.  
         [0038]    [0038]FIG. 8B is a sectional view of the working end surface of FIG. 9A showing a radial groove.  
         [0039]    [0039]FIG. 9 is a perspective view of an alternative working end similar to that of FIG. 3 with an alternative plan shape.  
         [0040]    [0040]FIG. 10A is a sectional view of Type “B” system having a flex-surface working end that is shown in a first repose position.  
         [0041]    [0041]FIG. 10B is a sectional view of the flex-surface working end of FIG. 10A in a second flexed position showing the practice of its method of use in engaging a skin surface. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0042]    1. Type “A” Skin Treatment System. FIGS.  2 A- 2 B illustrate an exemplary instrument system  5  that is designed for atraumatic removal of skin layers in a skin resurfacing or rejuvenation treatment. This embodiment of instrument system  5  comprises (i) a hand-held instrument  18  with a removable working end portion  20 ; (ii) a fluid source or reservoir  30  for supplying fluids to the working end  20 ; and (iii) a negative (−) pressure source (or aspiration source) indicated at  40  that aspirates fluid and ski debris from a treatment site TS on the patient&#39;s skin.  
         [0043]    [0043]FIG. 2A shows that the working end  20  is carried by, and preferably but optionally detachable from, an intermediate body section indicated at  42 . This embodiment has fluid reservoir indicated at  30  that also is detachably coupled to body section  42 . This instrument body  18  is adapted to use a detachable ergonomic handle portion  43  that has mating ribs  44   a  that cooperate with notches  44   b  in body section  42 . In this preferred embodiment, the reservoir  30  carrying a fluid F is a disposable cartridge that may be fitted to body section  42  with a breakable seal  46  and male and female fittings  47   a  and  47   b  as are known in the art (see FIG. 2B). The working end  20  described below also is detachable, inexpensive and disposable.  
         [0044]    More in particular, referring to FIG. 3, the working end  20  defines a skin interface surface portion indicated at  45  that is adapted to engage the skin surface as the working end is translated across a patient&#39;s skin. In this embodiment, the skin interface  45  comprises the distal-acing surface region of the working end that is within the concave form  48  of working end  20 . In this exemplary embodiment, the skin interface  45  transitions into an opening portion  50  generally centrally located in the working end. The opening  50  communicates with an interior passageway  51  that extends through body section  42  and further communicate with flexible tubing  52  that extends to the remote negative (−) pressure source  40  (see FIG. 2B). In this embodiment, there are a plurality of inflow apertures  54  generally about a perimeter of the skin interface that are in fluid communication with the fluid reservoir  30  as will be described further below.  
         [0045]    Of particular interest, referring to FIG. 3, the skin interface  45  and optionally the entire working end  20  is formed of any suitable resilient material to allow the working end and skin interface  45  to flex and bend to atraumatically engage the skin surface as the working end is translated across a treatment site. It has been found that silicone is an ideal material that flexes desirably as described below in a method of the invention.  
         [0046]    Also of particular interest to the invention, referring to FIGS. 4 and 5, the skin interface  45  carries a diamond dust, fragment or particulate composition indicated at  55 . A natural diamond fragment composition  55  has been found to have very sharp projecting points, edges and apices  57  that create an abrasive architecture that is well adapted to remove skin surface layers as the interface  45  carrying the diamond fragments is moved across a treatment site. Further, it has been found that spaces indicated at  58  between the diamond apices  57  will not tend to collect skin detritus when a fluid F (e.g., sterile water) generally flows across and about the skin interface  45  under the force of negative pressure from the aspiration source  40 . It is believed that such removed skin particles or skin detritus do not adhere about the abrasive architecture of the skin interface  45  due to the fact that (i) the facets  59  of the diamond particles are very smooth and resist tissue adherence, and (ii) that the resilient material carrying the diamond fragments (e.g., silicone) is naturally lubricious and non-stick thus resisting any clogging of the spaces in the architecture of the skin interface  45 . The ability of the fluid flow across the skin interface to remove skin detritus to the interior opening  50  for aspiration to a collection reservoir is very important for performing the method of the invention. As will be described below, the working end is passed over patient&#39;s skin in numerous paths, and the skin interface  45  must be continually free of detritus to allow a predictable level of skin surface removal during each portion of the working end&#39;s translation over a treatment site. It has been found that diamond fragments ranging in size from about 10 μm to about 250 μm in maximum cross-sectional dimension may be used in the skin interface to remove tissue. The different sizes of fragments cause very different characteristics in skin surface removal, and it has been found that different skin types and different desired depths of skin surface removal can be optimized by using a selected size of diamond fragment. For a thin, sensitive skin and a thin layer removal, preferably, the diamond crystals are from about 10 μm to about 50 μm in maximum cross-sectional dimension. For a thicker skin, or oily skin, and for a deeper layer removal, preferably, the diamond crystals are from about 30 μm to about 100 μin maximum cross-sectional dimension.  
         [0047]    Since each range of dimensions of the diamond fragments produces a differing ability to cut skin surface layers, another feature of the invention is to provide color coding to different working ends  20  that carry different dimensions of diamond fragments. It is believed that thee to six colors may be appropriate for different ranges of cutting ability. In this embodiment, the molded silicone of the ski interface can be colored. A preferred method has been developed for partially embedding the diamond fragments  55  in the skin interface which comprises distributing a very thin, dispersed layer of the fragments in an injection mold and thereafter introducing silicone into the mold. By using a selected viscosity of introduced silicone and a selected dispersion of the fragments in the mold, the silicone will form and set about the fragments  55  as generally indicated in FIG. 5.  
         [0048]    As shown in FIGS.  3 - 4 , in this embodiment, the skin interface  45  defines an x-axis (X) and a y-axis (Y) wherein the direction of movement of the working end across a treatment site is generally in a direction along the x-axis as the operator sweeps the skin interface over the treatment site. The skin interface  45  has an overall transverse or x-axis dimension is from about 5.0 mm. to about 40.0 mm. with a larger dimensioned end being adapted for treating a larger ski area (e.g., arms, back legs and décolletage). A typical x-axis dimension is from about 5.0 mm. to 15.0 mm. for a skin treatment site area TS around a patient&#39;s face. The dimension across the y-axis of the skin interface  45  may also be from about 5.0 mm. to about 40.0 mm. with the relation between the y-axis and x-axis being from 1:1 to about 3:1. In a preferred embodiment, the ratio y-axis/x-axis ratio is from about 1:1 (as is a round working end) to about 2:1 as shown in the plan shape of FIG. 3 or in an oval plan shape. The surface area of the skin interface  45  (e.g., in mm. 2 ) about opening  50  may be from about 5.0 mm. 2  to about 100.0 mm. 2  to remove skin surface layers efficiently. It has been found that the shape of the concave form  48  of the working end is very important for the practice of the method and the depth C of the concavity may range from about 0.5 mm. to about 10.0 mm. depending on the overall dimensions across the working end (see FIG. 4).  
         [0049]    As can be seen in FIGS.  3 - 4 , in this embodiment, the fluid inflow apertures  54  are located in one or more generally circumferential recessed portions or grooves  60   a - 60   n  in the skin interface  45  generally around opening  50 . As can be understood easily, the negative pressure source  40  will draw fluid F into the concave form  48  of the working end when a perimeter  62  of the working end is pressed against a skin surface. It is desirable to have a suitable flow of fluid F generally across the opposing sides of the skin interface and into opening  50 . It has been found that recesses or grooves  60   a - 60   n  of a selected dimension desirably maintain a ready amount of fluid F therein as the skin interface is moved over the skin. FIG. 6 shows a slightly different embodiment configured with two recesses or grooves  60   a  and  60   b.  FIG. 7 shows another slightly different embodiment with a plurality of inflow apertures  63   a  about a perimeter  62  of the working end without any substantial recesses or grooves but the apertures widening at their open distal termination indicated at  63   b.  It should be appreciated that the working end may be configured with micro-porosities (not shown) about the skin interface to serve as fluid inflow apertures  54  and fall within the scope of the invention. The optional grooves  60   a - 60   n  shown in FIGS.  3 - 4  are deep enough (having dimension D 1  in FIGS. 4 &amp; 8A) so that the skin surface  66  can not be drawn entirely into the recess thus allowing the recess to be maintained with fluid therein during a treatment. It also has been found that generally radial recessed portions  64   a - 64   n  are useful for directing the flow of fluid F toward opening  50 . The radial recessed portions or grooves  64   a - 64   n  have a depth D 2  shown in FIGS.  8 A- 8 B that is generally shallower than the depth of grooves  60   a - 60   n.  By the term radial, it is meant that the recessed portions may extend directly toward opening  50  or at an angle relative to opening  50  and collectively, some of such grooves will generally be angled relative to the direction of translation of the workin. As shown in FIG. 8B, it is believed that the skin surface  66  will be slightly pulled into a groove  64   a  as the skin interface moves across skin and the fluid F within and about the groove will assist in removing sin detritus SD from the treatment site and be aspirated into central opening  50 . The radial recessed portions or grooves  64   a - 64   n  may extend partly toward to central recess and opening  50  as shown in FIG. 3 or entirely to the central opening as shown in the alternative working end embodiment of FIG. 9.  
         [0050]    Referring again to FIG. 4, it can be seen that working end  20  is detachable from body  42  by means of a male and female fitting. Working end  20  has a female or recessed portion  67  that sealably mates with the projecting portion  68  of body portion  42 . Since working end  20  is of resilient material, the wall portion  69  of the working end  20  can be stretched and lip portion  72   a  locks into annular groove  73  of the body  42  to form a fluid-tight seal. The opening  50  of the working end  20  is then in alignment with interior passageway  51  of body  42 . Likewise, the apertures  54  transition into an system of interior fluid flow channels  74   a  in the working end  20  that align with similar channels  74   b  in body  42  that communicate with fluid reservoir  30 .  
         [0051]    In the exemplary system, the aspiration source  40  thus has multiple simultaneous functions: (i) to draw the skin surface into the concave form  48  of working end  20  and more particularly against the skin interface  45  and diamond abrasive architecture to perform the method of removing skin surface layers; (ii) to draw a fluid F across the skin interface  45  diamond abrasive architecture  55  to remove and clean skin debris from the skin interface; and (iii) to further aspirate the skin debris and fluid volume F to a remote collection reservoir  75 . Besides these functions, it has been found that patients find the fluid F to have a desirable cooling and hydrating effect (when compared to prior art high-velocity air-driven particle skin abrasion methods). The aspiration source or negative (−) pressurization source  40  may be any suitable vacuum source known in the art. Between the aspiration source  40  and the remote collection reservoir  75  is a filter  76  subsystem that is known in the art for collecting aspirated skin debris and fluid. The collection reservoir  75  and filter  76  are preferably of inexpensive plastic and other materials that are disposable.  
         [0052]    The aspiration source  40  is preferably provided with a controller  80  and adjustable valve means  82  for adjusting the pressure level setting to any suitable range. The system operator will learn from experience how to balance the pressure level to attain the desired level of suction against the patient&#39;s so A trigger or switch component  78  is provided as a foot-switch (FIG. 2A) but any suitable finger switch in body  18  also may be used.  
         [0053]    2. Practice of the Method of the Invention. Turning again to FIGS.  8 A- 8 B, a sectional view of working end  20  shows the technique of the present invention in abrasive removal of skin surface layers. FIG. 8A shows the working end  20  after actuation of the negative (−) pressure source  40  with the skin surface  66  initially being drawn into the concave form  48  of the working end. The operating negative pressures may be in any suitable range that is determined by investigation. The flexibility of the resilient material of the working end allows the perimeter  62  of the working end to flex slightly to conform to the skin surface. It has been found by experimentation that optimal pressure levels vary greatly depending on (i) the type of skin targeted for treatment, (ii) the dimensions across the working end, and (iii) the dimensions of opening  50 .  
         [0054]    Next, the operator moves the skin interface  45  across a treatment site TS which is a path on the patient&#39;s skin while still actuating the trigger  78  thereby maintaining the negative pressure environment in the concavity  48  and opening  50 . The sideways or generally lateral movement of the skin interface  45  allows the diamond architecture  55  to abrade the surface layers. Referring to FIG. 8B, the shallow radial groove  64   a  generally has a flow of fluid F (in the direction of arrows) therethrough which carries skin debris SD and fluid F to the opening  50  for aspiration to the collection reservoir  75 . The translation of the skin interface  45  over the treatment site TS allows an abrasion and removal of the skin surface in a controllable manner.  
         [0055]    It has been discovered that patients find the skin surface removal techniques disclosed herein to be substantially painless for limited depth surface removal. It has further been found that deeper skin surface removal procedures with the resilient working end  20  is substantially pain-free, particularly when compared to prior at skin removal methods for a similar depth treatment. It is believed that an important novel aspect of the invention is the suspension of the diamond fragments  55  in a resilient substrate such as silicone. It is postulated that the slight movement or adjustment of individual diamond fragments  55  of the diamond abrasive architecture in the resilient substrate as the skin interface  45  is translated over skin allows the diamonds to float to a slight extent and cut the skin surface in an atraumatic manner.  
         [0056]    The negative pressure environment within the working end causes the fluid F and skin debris SD to be entrained in an air volume to be drawn through passageway  51  to the collection reservoir  75 . After translating the working end over a treatment site, the operator may release trigger  78  to easily lit the working end from the patient&#39;s skin or simply reverse the movement of the device. The treated path can be easily seen and the operator then can remove skin layers in another slightly overlapping or adjacent path by repeating the above steps until surface removal is completed over the targeted treatment area. Following a treatment, of preferably a series of treatments over time, new skin surface layers including increased collagen aggregation in the papillary dermis will occur to provide a rejuvenated skin texture.  
         [0057]    3. Type “B” Skin Treatment System. FIGS.  10 A- 10 B illustrate an exemplary instrument system  105  that operates on a similar manner as the previously described Type “A” system except that the skin interface  145  is designed to further optimize the atraumatic aspects of the skin layer abrasion methods. Elements of the new Type “B” system that are functionally similar to elements of the previous embodiment have the same reference numerals+100; elements of the Type “B” system that are identical to those previously described have the previous reference numeral.  
         [0058]    Referring now to FIG. 10A, a sectional view is shown of a Type “B” working end  120  which is adapted to be fitted to a body  42  as described previously. In this embodiment, the fluid source  30  again is in fluid communication with a plurality of apertures  154  in small intermittent recesses or grooves  160  about the periphery  62  of the working end  120 . The skin interface portion  145  is fabricated of a resilient material such as silicone and carries diamond fragments  55  as described above.  
         [0059]    Of particular interest, FIG. 10A shows that the skin interface  145  is defined by the distal surface of a flexible or floating web-like portion  165  of the resilient working end  120 . That is, the skin interface  145  and floating annular web portion  165  of is adapted to float, move and flex to conform to the topography of the skin surface as the abrasive architecture  55  is translated over a treatment site. As can be seen by comparing FIGS. 10A and 10B, the floating annular web member defines an opening  150  therein that communicates with passageway  51  in the body  42 . An optional flexible thin wall indicated at  166  extends between opening  150  and a proximal section  168  of the working end. A volume of air indicated at  170  is captured in chamber  172  proximal to the floating web portion  165 , which may be vented to the exterior by bore  174  to facilitate flexing of the web. Thus, the skin interface  145  has a first repose position shown in FIG. 10A which is slightly concave or substantially flat. The skin interface  145  is capable of moving to a range of second flexed positions as shown in FIG. 10B which results from actuation of the negative (−) pressure source  40  against a skin surface engaged by the working end  120 .  
         [0060]    It is believed that such a floating skin interface  145  will conform to irregularities in the skin as well as maintain very close contact with the skin no matter the level of negative pressure in the system. It has been found that negative pressure against the skin can change rapidly during use due to various factors and a floating skin interface serves as a means for controlling the pressure levels.  
         [0061]    In the views of FIGS.  10 A- 10 B, the floating skin interface  145  floats on a chamber  172  filled with air. It should be appreciated that the skin interface could be flexible and float on an underlying volume of a compressible foam or other spongy material and fall within the scope of the invention (not shown).  
         [0062]    Specific features of the invention may be shown in some figures and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention. While the principles of the invention have been made clear in the exemplary embodiments, it will be obvious to those skilled in the art that modifications of the structure, arrangement, proportions, elements, and materials may be utilized in the practice of the invention, and otherwise, which are particularly adapted to specific environments and operative requirements without departing from the principles of the invention. The appended claims are intended to cover and embrace any and all such modifications, with the limits only of the true purview, spirit and scope of the invention.