Abstract:
The invention provides a system and method for achieving the cosmetically beneficial effects of shrinking collagen tissue in the dermis in an effective, non-invasive manner, which leaves the outer layer of skin intact and undamaged. One embodiment of the invention provides electromagnetic energy to the skin of a patient. The device includes a carrier and an array of electrodes on the carrier. A microporous pad on the carrier overlies the array of electrodes, forming an interior chamber to contain an electrically conductive material. The microporous pad is adapted to contact a patient&#39;s skin and ionically transport the applied electromagnetic energy to ohmically heat dermal tissue beneath the epidermal skin region. The shape of the carrier may differ to match different skin topographies and the electrodes may be sized to extend into tissue to heat a dermal skin region.

Description:
RELATED APPLICATION 
     This application is a continuation in part of copending U.S. Application Ser. No. 08/637,095, filed Apr. 29, 1996, entitled “Method and Apparatus for Controlled Contraction of Soft Tissue,” which is a continuation of application Ser. No. 08/389,924, filed Feb. 16, 1995 (now U.S. Pat. No. 5,569,242), which is a continuation of application Ser. No. 08/238,862, filed May 6, 1994 (now U.S. Pat. No. 5,458,596). 
    
    
     FIELD OF THE INVENTION 
     In a general sense, the invention is directed to systems and methods for treating cosmetic conditions in the human body. In a more particular sense, the invention is directed to systems and methods for treating cosmetic conditions affecting the skin of the face and neck, as evidenced by the appearance of lines and wrinkles in the face, or neck, or both. 
     BACKGROUND OF THE INVENTION 
     The skin is the principal seat of the sense of touch. The skin also provides protection against the physical forces of the environment, such as heat, cold, sun rays, friction, pressure, and chemicals. 
     Exposure of the skin to these environmental forces can, over time, cause the skin to sag or wrinkle. Hyperfunctional nervous disorders and normal contraction of facial and neck muscles, e.g. by frowning or squinting, can also over time form furrows or bands in the face and neck region. These and other effects of the normal aging process can present an aesthetically unpleasing cosmetic appearance. 
     Accordingly, there is a large demand for systems and methods which serve to “tighten” the skin to remove sags and wrinkles in the face and neck. 
     One prior method surgically resurfaces facial skin by ablating the outer layer of the skin (from 200 μm to 600 μm), using laser or chemicals. In time, a new skin surface develops. The laser and chemicals used to resurface the skin also irritate or heat collagen tissue, which is widely present in the dermis. When irritated or heated in prescribed ways, the collagen tissue partially dissociates and, in doing so, shrinks. The shrinkage of collagen also leads to a desirable “tightened” look. Still, laser or chemical resurfacing leads to prolonged redness of the skin, infection risk, increased or decreased pigmentation, and scarring. 
     Lax et al. U.S. Pat. No. 5,458,596 describes the use of radio frequency energy to shrink collagen tissue. This cosmetically beneficial effect can be achieved in facial and neck areas of the body in a minimally intrusive manner, without requiring the surgical removal of the outer layers of skin and the attendant problems just listed. 
     SUMMARY OF THE INVENTION 
     The invention provides improved systems and methods of systems and methods of achieving the cosmetically beneficial effects of shrinking collagen tissue in the dermis in an effective, non-invasive manner, which leaves the outer layer of skin intact and undamaged. 
     One aspect of the invention provides systems and methods for applying electromagnetic energy to skin. The systems and methods include a carrier and an array of electrodes on the carrier, which are connectable to a source of electromagnetic energy to apply the electromagnetic energy. According to this aspect of the invention, a microporous pad on the carrier overlays the array of electrodes, forming an interior chamber to contain an electrically conductive material. The microporous pad is adapted, in use, to contact an epidermal skin region and ionically transport the applied electromagnetic energy to ohmically heat dermal tissue beneath the epidermal skin region. 
     In one embodiment, the shape of the carrier can differ to match different skin region topographies. 
     Another aspect of the invention provides systems and methods for applying electromagnetic energy to skin, in which the array of electrodes on the carrier are sized so that, while the carrier contacts an epidermal skin region, the electrodes extend into tissue beneath the epidermal skin region to ohmically heat dermal tissue. 
     In one embodiment, the electrodes are sized to extend into dermal tissue. In another embodiment, the electrodes are sized to extend into subdermal tissue. 
     In one embodiment, the shape of the carrier can differ to match different skin region topographies. 
     Another aspect of the invention provides systems and methods for applying electromagnetic energy to a facelift flap. The systems and methods include a carrier and at least one electrode on the carrier connectable to a source of electromagnetic energy to apply the electromagnetic energy. The electrode is sized so that, while the carrier contacts a backside of the flap, the electrode ohmically heats the dermal tissue. 
     In one embodiment, the electrode, in use, rests on a surface on the backside of the flap. 
     In another embodiment, the electrode is sized to extend into dermal tissue within the flap. 
     Another aspect of the invention provides a family of devices for applying electromagnetic energy to skin. Each device comprising a carrier having a shape and an array of electrodes on the carrier connectable to a source of electromagnetic energy to apply the electromagnetic energy. According to this aspect of the invention, the shapes of the carriers differ to match different skin region topographies. 
     In one embodiment, the carrier is adapted, in use, to contact epidermal tissue. In this embodiment, the electrodes are sized to extend into tissue beneath the epidermal tissue. The electrodes can be sized to extend into dermal tissue. Alternatively, the electrodes are sized to extend into subdermal tissue. 
     Features and advantages of the inventions are set forth in the following Description and Drawings, as well as in the appended Claims. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a representative side section view of skin and underlying subcutaneous tissue; 
     FIG. 2 is a schematic view of a system that, in use, heats collagen tissue in the dermis for the purpose of treating cosmetic conditions affecting the skin; 
     FIG. 3 is an exploded perspective view of one category of an energy applicator, usable in association with the system shown in FIG. 2, to transmit energy into the dermis externally through the epidermis; 
     FIG. 4 is a side section view of the energy applicator shown in FIG. 3 in use to heat collagen tissue in the dermis; 
     FIG. 5 is a front view of the facial and neck region showing various energy applicator, like that shown in FIG. 3, specially shaped to match the topography of a skin region under the eye, below the ear, under the chin, around the lips, and on the forehead above the eyebrows; 
     FIG. 6 is an exploded perspective view of another category of an energy applicator, usable in association with the system shown in FIG. 2, to transmit energy internally directly into the dermis; 
     FIG. 7 is a side section view of the energy applicator shown in FIG. 6 in use to heat collagen tissue in the dermis; 
     FIG. 8 is an exploded perspective view, with portions in section, of another category of an energy applicator, usable in association with the system shown in FIG. 2, to transmit energy into the dermis internally through subcutaneous tissue; 
     FIG. 9 is a side section view of the energy applicator shown in FIG. 8 in use to heat collagen tissue in the dermis; 
     FIG. 10 is an exploded, perspective view of another category of an energy applicator, usable in association with the system shown in FIG. 2, to transmit energy into the dermis from the backside of a surgically created facelift flap. 
     FIG. 11 is a side section view of the energy applicator shown in FIG. 10 in use to heat collagen tissue in the dermis from the backside of a facelift flap; 
     FIG. 12 is a perspective view of an energy applicator of the type shown in FIG. 3, with associated probes for sensing temperature in the dermis; 
     FIG. 13 is a side section view of an energy applicator shown in FIG. 3, with the sensors deployed in the dermis to sense temperature conditions; 
     FIG. 14 is a side section view of an energy applicator of the type shown in FIG. 6, with associated sensors located in the dermis to sense temperature conditions; and 
     FIG. 15 is a side section view of a penetration tissue temperature sensing probe of the type shown in FIGS. 12 to  14 , with multiple sensors deployed in a stacked arrangement to sense a temperature gradient in the dermis. 
    
    
     The invention may be embodied in several forms without departing from its spirit or essential characteristics. The scope of the invention is defined in the appended claims, rather than in the specific description preceding them. All embodiments that fall within the meaning and range of equivalency of the claims are therefore intended to be embraced by the claims. 
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     The invention provides systems and methods of treating cosmetic conditions affecting the skin. The system and methods are applicable for use throughout the body. However, the systems and methods are particularly well suited for treating cosmetic conditions in the facial or neck area of the body. For this reason, the systems and methods will be described in this context. 
     I. Anatomy of the Skin 
     As FIG. 1 shows, the skin  10  overlies and protects subcutaneous tissue  12  and muscle tissue  14  of the body. In the face and neck areas, the skin  10  measures about 2mm in cross section. 
     The skin  10  includes an external, non-vascular covering of epithelial cells, called the epidermis  16 . In the face and neck regions, the epidermis measures about 100 μm in cross section. 
     The skin  10  also includes a layer of vascular tissue, named the dermis  18 . In the face and neck regions, the dermis  18  measures about 1900 μm in cross section. 
     The dermis  18  is tough, flexible, and highly elastic. It is divided into a papillary (upper) layer  20  and a reticular (lower) layer  22 . The most numerous fibers in the papillary and reticular layers  20  and  22  are collagen fibers, which in large part account for the strength and physical properties of the dermis  18 . Hair bulbs, sweat ducts, and other glands also occupy the reticular layer  22 . 
     The fibrous structure of collagen tissue is observed to dissociate and contract along its length when heated to a defined temperature condition, i.e., about 65° C. The contraction of collagen tissue causes the dermis  18  to reduce in size, which has an observable tightening effect. As collagen contacts, wrinkles and sag lines in the skin are ameliorated. As a result, the outward cosmetic appearance of the skin  10  improves. 
     The temperature conditions conducive to the beneficial results of collagen shrinkage lay well above the temperature conditions at which irreversible thermal damage to epithelial cells begins to occur, i.e., above about 47° C. 
     II. Systems for Renovating the Dermis 
     A. System Overview 
     FIG. 2 shows a system  24  for renovating and reconstituting the dermis. The system  24  applies energy to the dermis to elevate and maintain its temperature at a predetermined temperature condition, at or about 65° C., without increasing the temperature of the epidermis beyond 47° C. In this way, the system applies energy to the dermis in a targeted, selective fashion, to dissociate and contract collagen tissue, while preserving and protecting epithelial cells against thermal damage. 
     The system  24  includes a treatment device  26 . The device  26  includes a handle  28  made, e.g., from molded plastic. The handle  28  carries at its distal end a treatment energy applicator  30 , which, in use, contacts the epidermis. The handle  28  is sized to be conveniently grasped like a pencil or paint brush by a physician, to thereby manipulate the applicator  30  on the epidermis  16 . 
     The system  24  further includes a device  32  to generate treatment energy. In the illustrated embodiment, the generator  32  generates radio frequency energy, e.g., having a frequency in the range of about 400 kHz to about 10 mHz. 
     A cable  34  extending from the proximal end of the handle  28  terminates with an electrical connector  36 . The cable  34  is electrically coupled to the applicator  30 , e.g., by wires that extend through the interior of the handle  28 . When connector  36  plugs into the generator  32 , to convey the generated energy to the applicator  30  for transmission to the skin. 
     The system  24  also includes certain auxiliary processing equipment  38  and  40 . In the illustrated embodiment, the processing equipment  38  comprises an external fluid delivery apparatus, and the processing equipment  40  comprises an external aspirating apparatus. 
     The handle  28  of the treatment device  26  includes one or more interior lumens  42 . The lumens terminate in fittings  44  and  46 , located at the proximal end of the handle  28 . One fitting  44  connects to the fluid delivery apparatus  38 , to convey processing fluid to the distal end of the handle  28  for discharge. The other fitting  46  connects to the aspirating apparatus  40 , to convey aspirated material from the distal end of the handle  28  for discharge. 
     The system  24  also includes a controller  48 . The controller  48 , which preferably includes a central processing unit (CPU), is linked to the generator  32 , the fluid delivery apparatus  38 , and the aspirating apparatus  40 . The controller  48  governs the power levels, cycles, and duration that the radio frequency energy is distributed to the applicator  30 , to achieve and maintain power levels appropriate to achieve the desired treatment objectives. In tandem, the controller  48  also governs the delivery of processing fluid to the applicator  30  and the removal of aspirated material from the applicator  30 . 
     The controller  48  includes an input/output (I/O) device  50 . The I/O device  50  allows the physician to input control and processing variables, to enable the controller  48  to generate appropriate command signals. The I/O device  50  also receives real time processing feedback information from one or more sensors  52  associated with the applicator, for processing by the controller  48 , e.g., to govern the application of energy and the delivery of processing fluid. The I/O device  50  also includes a display  54 , to graphically present processing information to the physician for viewing or analysis. 
     B. The Treatment Device 
     The structure of the treatment device  26  and associated electrical energy applicator  30  can vary. 
     The illustrated embodiments describe and show four representative categories of energy applicators  30 , as follows: 
     (i) a first category applicator  30 (1) (shown in FIGS. 3 and 4) transmits energy into the dermis externally through the epidermis. 
     (ii) a second category applicator  30 (2) (shown in FIGS. 6 and 7) transmits energy internally directly into the dermis. 
     (iii) a third category applicator  30 (3) (shown in FIGS. 8 and 9) transmits energy into the dermis internally through subcutaneous tissue. 
     (iv) a fourth category applicator  30 (4) (shown in FIGS. 10 and 11) transmits energy into the dermis from the backside of a surgically created facelift flap. 
     The various categories of energy applicators  30 (1),  30 (2),  30 (3), and  30 (4) will now be discussed in greater detail. 
     (i) EPIDERMAL ENERGY APPLICATOR 
     In this category, as shown in FIG. 3, the energy applicator  30 (1) includes a carrier grid  56 , which is mounted on the distal end of the handle  28 . The carrier grid  56  is made from an electrically non-conducting material, e.g., plastic or ceramic. 
     The carrier grid  56  carries a pattern of multiple, spaced apart electrodes  58 . Each electrode  58  comprises a discrete transmission source of radio frequency energy. The electrodes  58  can be made, e.g., from stainless steel, platinum, and other noble metals, or combinations thereof. The electrodes  58  may be fastened to the grid by various means, e.g., by adhesives, by painting, or by other coating or deposition techniques. 
     In the illustrated embodiment, the carrier grid  56  is formed by an outside frame  60  with crossing interior spacers  62 . Together, the frame  60  and spacers  62  define an open lattice of cells  64 . In the illustrated embodiment, the grid  56  defines sixteen cells  64 . It should be appreciated that the cells  64  could number more or less than sixteen. 
     In the illustrated embodiment, the electrodes  58  are located on the grid  56  at the four corners of each cell  64 . This arrangement provides a symmetric pattern of twenty-five electrodes  58  on the grid  56 . Still, it should be appreciated that the electrodes  58  could be arranged in other symmetric or nonsymmetric patterns in the grid. 
     In the embodiment shown in FIG. 3, the energy applicator  30 (1) includes an external pad  66 , which is attached peripherally about the carrier grid  56 . The pad  66  is made from a resilient microporous membrane. As FIG. 4 shows, the pad  66 , in use, makes surface contact with the epidermis  16 . The resilience of the pad  66  makes it well suited to conform to a variable surface topography of the epidermis  16 . 
     The attachment of the pad about the carrier grid  56  creates an interior chamber  68 , which encloses the grid  56 . The applicator  30 (1) further includes a fluid manifold  70  inside the chamber  68 . The fluid manifold  70  communicates with the fluid delivery apparatus  38 , via the handle lumens  42 . The manifold  70  uniformly introduces processing fluid through the grid  56  and into the interior chamber  68 . 
     In this arrangement, the processing fluid comprises an electrically conductive liquid, such as saline (about 0.9% to 3.0%). The apparatus  38  includes a pump  72  to convey the electrically conductive liquid through the manifold  70  at a prescribed rate. 
     The flow of the electrically conductive liquid into the through the grid  56  and into interior chamber  68  contacts the interior surface of the microporous membrane of the pad  66 . As FIG. 4 shows, the microporous membrane of the pad  66  has pores  74  sized to permit passage of the electrically conductive fluid in the chamber  68  through the membrane and into contact with the epidermis  16  the membrane contacts. 
     The diffusion of electrically conductive liquid through the membrane pores  74  serves two purposes. First, it creates conductive cooling at the interface between the membrane pad  66  and the epidermis  16 . Second, it serves to ionically transport radio frequency energy transmitted by the grid electrodes  58  through the membrane pores  74 , for return (in a unipolar arrangement) through exterior patch electrode  76  coupled to patient ground. 
     The ionically conducted radio frequency energy transported through the membrane pore  74  will, in turn, cause localized ohmic heating of skin tissue. The application of radio frequency energy by ionic transport to the epidermis surface, simultaneously combined with the conductive surface cooling effects that the ionic transport also provides, places the tissue region where maximum temperature conditions exist (designated TMAX in FIG. 4) at a location below the epidermis  16 , into the papillary dermis  20  and, preferably, into the reticular dermis  22  as well. 
     The applicator  30 (1) thereby makes possible selective heating of the interior dermis  18  to a maximum tissue temperature TMAX of about 65° C., while maintaining the temperature of the epidermis  16  at or about 20° C. to 30° C., thereby avoiding thermal damage to the epidermis  16 . 
     Alternatively, an electrically conductive jelly can occupy the interior chamber  68 . The jelly causes ionic transport of radio frequency energy through the membrane pores  74 . In this arrangement, a manifold  78  distributes fluid about the periphery of the pad  66 , but not into the chamber  68  itself, to nevertheless cause convective surface cooling effects. In this arrangement, the fluid distributed by the manifold  78  need not be electrically conductive, but it can be to provide uniform distribution of the radio frequency energy at the pad  66 . 
     In use, the physician places the pad  66  upon a targeted region of tissue. The controller  48  governs the application of radio frequency energy to the electrodes  58  in concert with the delivery of fluid to the manifold  70  (or  78 ), to control the desired epidermal and dermal tissue temperature conditions. The controller  48  can also govern the withdrawal of fluid from the vicinity of the pad  66  through the aspirating apparatus  40  for this purpose. The controller  48  can alter the distribution of the radio frequency energy among selected sets or subsets of one or more grid electrodes  58 . In this way, the controller  48  can focus the application of radio frequency in selected patterns. 
     In maintaining control of the process, the controller  48  can depend upon empirically determined or modeled relationships among selected processing variables, including, e.g., tissue temperature, time, power, and fluid delivery rate, without actual temperature sensing. Preferably, however, localized tissue temperature conditions are sensed to provide direct feedback control, as will be described in greater detail later. 
     In the illustrated embodiment, the handle  28  and grid  56  can comprise reusable components. In this arrangement, the energy applicator pad  66  can comprise a single use component that is temporarily fastened to the handle  28  at time of use, e.g., by a conventional snap-fit, and then removed after use for disposal. 
     The pad  66  need not be sized to cover a targeted facial or neck region in its entirety. Instead, the physician can locate the pad  66  in contact with a localized area of epidermal tissue within a targeted region. After applying the desired amount of radio frequency energy, the physician can relocate the pad  66  to an adjacent tissue area in the targeted region and again apply radio frequency energy. The physician can repeat this successive process, until the entire targeted region has been subject to treatment by exposure to radio frequency energy. 
     The energy applicator pads  66  can be specially shaped and contoured to provide different geometries, selected to match the topography of the targeted facial or neck region, e.g., under the eye (as pad  66 (1) in FIG. 5 shows); or below the ear (as pad  66 (2) in FIG. 5 shows); or under the chin (as pad  66 (3) in FIG. 5 shows); or around the lips (as pad  66 (4) in FIG. 5 shows); or on the forehead above the eyebrows (as pad  66 (5) in FIG. 5 shows). 
     (ii) INTRADERMAL ENERGY APPLICATOR 
     As shown in FIG. 6, the second category of energy applicator  30 (2) includes a carrier  80  on the distal end of the handle  28 . The carrier  80  supports an array of spaced-apart needle electrodes  82 . The electrodes  82  are metallic, being made, e.g., from stainless steel, platinum, other noble metals, or combinations thereof. Each electrode  82  comprises a discrete transmission source of radio frequency energy, which the controller  48  governs. 
     The carrier  80  can provide physical connections between control wires and each electrode  82 , e.g., by solder or adhesive. Alternatively, the carrier  80  can have painted, coated, or otherwise deposited solid state circuitry to provide the electrical paths. The solid state circuitry can include a fuse element that interrupts electrical contact after a specified period of use, to thereby discourage reuse of the carrier  80 . 
     In use (as FIG. 7 shows), the electrodes  82  are intended to be inserted as a unit on the carrier  80  through the epidermis  16  and into the dermis  18 . After insertion, the controller  48  conditions the electrodes  82  for operation in a unipolar mode. In this mode, energy transmitted by one or more of the electrodes  82  is returned by an indifferent patch electrode  84 , which is coupled to patient ground. 
     Alternatively, the controller  48  can condition pairs of electrodes  82  to operate in a bipolar mode, with one electrode serving to transmit radio frequency energy, and the other electrode serving as the return path. 
     The size and spacing of the electrodes  82  shown in FIGS. 10 and 11 are purposely set to penetrate the skin to a depth sufficient to pass entirely through the epidermis  16  and penetrate the papillary and, preferable, extend into the reticular dermis (e.g., about 200 μm to 300 μm). When used for this purpose, the electrodes  82  each possesses a total length of about 0.5 to about 3.0 mm. The electrodes are mutually spaced apart by about 0.5 mm to 10.0 mm. 
     An electrical insulating material  86  surrounds the proximal end of each electrode  82  by at least 0.5 mm. This leaves an exposed, non-insulated length at the distal end of about 0.5 mm to 2.5 mm. The insulating material  82  insulates the epidermis  16  and a portion of the dermis  18  from direct exposure to radio frequency energy transmitted by the exposed distal end. 
     The ratio between exposed and insulated regions on the electrodes  82  affects the impedance of the electrodes  82  during use. Generally speaking, the larger the exposed region is compared to the insulated region, a larger impedance value can be expected. 
     In use, the physician places the carrier  80  upon a desired region of tissue. The physician applies light pressure on the handle  28  to insert the needle electrodes  82  through the epidermis  16  and into the dermis  18 . The controller  48  governs the application of radio frequency energy to the electrodes  82  to ohmically heat adjacent dermal tissue. The electrodes  82  can be operated individually or in groups to form defined energy application patterns. As before described, the controller  48  can depend upon the empirically determined or modeled relationships among processing variables to affect process control, with or without actual temperature sensing. 
     In this arrangement, the handle  28  can comprise a reusable component, and the carrier  80  with electrodes  82  can comprise a single use component, which is temporarily fastened to the distal end of the handle  28  for use and then removed after use for disposal. 
     As with the pad  66 , the carrier  80  need not be sized to cover a targeted facial or neck region in its entirety. Instead, the physician can successive locate the carrier  80  in a localized areas within a targeted region, and apply radio frequency energy to each localized area. 
     Like the pad  66 , the carrier  80  can also be specially shaped and contoured to provide different geometries, selected to match the topography of the targeted facial or neck region, as shown in FIG.  5 . 
     (iii) SUBDERMAL ENERGY APPLICATOR 
     As shown in FIG. 8, the third category of energy applicator  30 (3) includes a carrier  88  mounted on the distal end of the handle  28 . Like the carrier  80  shown in FIG. 6, the carrier  88  shown in FIG. 8 holds an array of spaced-apart, metallic needle electrodes  90 . Each electrode  90  comprises a discrete transmission source of radio frequency energy, which the controller  48  governs. 
     As before explained, the carrier  88  can provide physical connections between control wires and each electrode  90 , or carry painted, coated, or otherwise deposited solid state circuitry to provide the electrical paths. 
     As FIG. 9 best shows, the needle electrodes  90  shown in FIG. 8 differ from the electrode  82  in FIG. 6 in that they are longer than the needle electrodes  82 . The longer electrodes  90  are intended to be inserted as a unit through both the epidermis  16  and the dermis  18 , and extend into the subcutaneous tissue region  12  a short distance beyond the reticular dermis  22 . 
     For this purpose, the electrodes  90  each possesses a total length of about 3.0 mm to 10.0 mm. The electrodes  90  are mutually spaced apart by about 0.5 mm to 3.0 mm. An electrical insulating material  92  surrounds the proximal end of each electrode  90  by at least 2.0 mm. This leaves an exposed, non-insulated length at the distal end of each electrode  90  of about 3.0 mm to 4.0 mm. The insulating material  92  insulates the epidermis  16  and dermis  18  from direct exposure to radio frequency energy transmitted by the exposed distal ends of the electrodes  90 . 
     In the illustrated embodiment, at least some, and preferably all, of the needle electrodes  90  include interior fluid passages  94  (see FIG.  8 ). A manifold  96  couples a select number of the passages  94  in communication with the fluid delivery apparatus  38 . This way, processing fluid can be introduced through the electrodes  90  and into the subcutaneous tissue surrounding the distal ends of the electrodes  90 . The manifold  96  couples other passages  94  in communication with the aspirating device  40 , to evacuate material through the distal ends of the electrodes  90 . 
     In this embodiment, the processing fluid comprises an electrically conductive liquid, such as saline. The apparatus  38  includes a pump  72  (see FIG. 1) to convey the electrically conductive liquid to the manifold  96  at a prescribed rate. The manifold  96  disperses the electrically conductive liquid through the selected passages  94 . 
     The controller conditions the electrodes  90  to operate in a unipolar mode. Energy transmitted by one or more of the electrodes  90  is returned by an indifferent patch electrode  100 , which is coupled to patient ground (see FIG.  9 ). At the same time, electrically conductive liquid flows through the selected passages  94  into the surrounding subcutaneous tissue region  12  (shown by arrows  122  in FIG.  9 ), while liquid and other material is evacuated through the other passages  94  by the aspirating device  40  (as shown by arrows  124  in FIG.  9 ). 
     The radio frequency energy transmitted by the exposed, distal ends of the electrodes  90  will cause localized ohmic heating of subcutaneous tissue. The conduction of the electrically conductive fluid ionically distributes the radio frequency energy in a uniform manner, while also providing a localized cooling effect. The cooling effect places the tissue region where maximum temperature conditions exist at a location (designated TMAX in FIG. 9) spaced from the distal ends of the electrodes  90 , which includes the reticular dermis  22 . 
     The localized heating effects will all cause fat tissue  102  in the subcutaneous tissue  12  to flow (see FIG.  9 ). Suction applied by the aspirating device  40  through the passages  94  can be used to evacuate flowing fat tissue from subcutaneous tissue  12  (as arrows  124  in FIG. 9 show). This provides localized liposuction effects in the subcutaneous region  12 , in tandem with collagen heating effects in the dermis  18 . 
     In use, the physician places the carrier  88  upon a desired region of tissue. The physician applies light pressure on the handle  18  to insert the needle electrodes  90  through the epidermis  16  and dermis  18  and into a subcutaneous tissue region  12 . The controller  48  governs the application of radio frequency energy to the electrodes  90 , which can be operated individually or in defined patterns. 
     The carrier  88  need not be sized to cover an entire targeted region. The physician can locate the carrier  88  in successive local areas within a targeted region, and apply radio frequency energy to each localized area. Like the pad  66 , the carrier  88  can also be specially shaped and contoured to provide different geometries, selected to match the topography of the targeted facial or neck region, as shown in FIG.  5 . 
     As before described, the controller  48  can depend upon the empirically determined or modeled relationships among processing variables to affect process control, with or without actual temperature sensing. 
     In this embodiment, as in the preceding embodiment, the handle  28  can comprise a reusable component, and the carrier  88  and needle electrodes  90  can comprise a single use component that is temporarily fastened to the handle  28  for use and then removed after use for disposal. 
     (iv) FACELIFT FLAP ENERGY APPLICATOR 
     As shown in FIG. 10, the fourth category of energy applicator  30 (4) likewise includes a carrier  104  on the distal end of the handle  28 . The carrier  104  holds a pair of bipolar metallic electrodes  106 . In use, energy transmitted by one of the electrodes  106  is returned by the other electrode  106  to patient ground. Alternatively, the carrier  104  can hold an array of several needle electrodes, which are operated in either a bipolar or unipolar mode. 
     In use (see FIG.  11 ), the physician surgically creates a facelift flap  108  in the targeted tissue region. The flap  108  extends well into the dermis  18  (e.g., 200 μm to 300 μm). The physician inserts the needle electrodes  106  into the backside of the flap  108  and applies radio frequency energy. 
     The size and spacing of the electrodes  106  are purposely set to penetrate into the backside of the skin flap  108  to a depth sufficient to locate the distal ends of the electrodes  106  in dermal tissue. 
     When used for this purpose, the electrodes  106  each possesses a total length of about 3.0 mm to 8.0 mm. The electrodes  106  are mutually spaced apart by about 0.5 mm to 10.0 mm. 
     Alternatively, in this embodiment, the applicator  30 (4) can comprise an array of surface electrodes  106  that do not penetrate the skin flap  108 , but which rest on the surface of the backside of the skin flap. 
     As before described, the controller  48  governs application of radio frequency energy to achieve the desired tissue effects. 
     In this embodiment, as in preceding embodiments, the handle  28  can comprise a reusable component, and the carrier  104  and electrodes  106  can comprise a single use component that is temporarily fastened to the handle for use and then removed after use for disposal. 
     C. Dermal Temperature Sensing 
     In all of the preceding embodiments, the controller  48  preferable relies upon sensing tissue temperature conditions as a form of active process feedback control. 
     For this purpose, the energy applicator carries at least one sensor  112  (see FIG.  12 ), which senses tissue temperature conditions. In the illustrated embodiment, the at least one sensor  112  is located beneath the epidermis  16  and into the dermis  18  (see FIG.  13 ), to sense actual tissue temperature conditions in the dermis  18 . 
     When used in association with the applicator pad  66  of the category (i) applicator  30 (1)(as FIG. 12 shows), an array of probes  114  is arranged in a spaced-apart relationship along the periphery of the pad  66 . Each probe  114  carries at least one temperature sensor  112 . In use, the probes  114  extend through the epidermis  16  and into the dermis  18 , as FIG. 13 shows. 
     When use in association with a penetrating needle electrode  82 ,  90 , or  106 , (see FIG. 14) each needle electrode  82 ,  90 , or  106  can carry at least one temperature sensor  112 . Alternatively, of course, probes could be used to carry the sensors  112 , in the manner shown in FIGS. 12 and 13. In any event, the sensors  112  are located so that, in use, they are positioned in the region of the dermis  118  where radio frequency heating is targeted, as FIG. 14 shows. 
     In the embodiment shown in FIG. 15, a tissue penetrating probe  116  (or needle electrode, as the case may be) may support a vertically stacked array  118  of temperature sensors  120 . The temperature sensors  120  are arranged at known, fixed intervals along the probe  116 . The stacked sensors  120  sense a dermal tissue temperature gradient along the length of the probe  116 . 
     The sensing of a temperature gradient within dermal tissue targeted for radio frequency heating permits the controller  48  to identify along the gradient the location of the maximum tissue temperature region TMAX. For control purposes, the controller  48  can include an algorithm that selects the maximum tissue temperature TMAX and also identifies the depth D(TMAX) at which the maximum tissue temperature occurs. By varying the power of radio frequency energy applied and the rate of surface cooling (when appropriate), the controller  48  can adjust the maximum tissue temperature TMAX to achieve the desired control point temperature, which for collagen shrinkage is 65° C. The controller  48  can also establish and maintain a control depth (D(TMAX) at which the desired control point temperature occurs, e.g., at a skin depth of 200 μm to 300 μm (pre-set or set by the physician), to achieve optimal collagen shrinkage. 
     Various features of the invention are set forth in the following claims.