Abstract:
Skin tissue is subjected to thermal energy that creates heating of the area being treated causing pores and follicle ducts to open so that excess oil, sebum, fatty deposits, or other unwanted deposits can be removed. A vacuum device is used to direct suction to the treated skin area helping to remove the unwanted deposits. Patterned thermal modification of tissue is used to expedite healing and minimize pain. The heating is controlled so that no skin tissue is damaged while still providing enough heat to the skin to alter the flow of sebum and destroy bacteria in the treated area.

Description:
BACKGROUND CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application is a continuation of U.S. patent application Ser. No. 13/163,694, filed on Jun. 19, 2011, which is a continuation of U.S. patent application Ser. No. 11/752,893, filed May 23, 2007, now U.S. Pat. No. 7,981,112, issued on Jul. 19, 2011, and which also is a continuation-in-part of U.S. patent application Ser. No. 11/234,771, filed Sep. 23, 2005 which claims priority to U.S. Provisional Patent Application Ser. No. 60/615,510, filed Oct. 2, 2004, Ser. No. 60/704,602, filed Aug. 1, 2005, and Ser. No. 60/678,968, filed May 9, 2005; and which also further claims priority to U.S. Provisional Patent Application Ser. No. 60/802,960, filed May 23, 2006, and U.S. Provisional Patent Application Ser. No. 60/921,901, filed Apr. 4, 2007; all of which are incorporated herein in their entirety by reference. 
     
    
     BACKGROUND 
       [0002]    The present invention relates generally to the application of energy to biological tissue, and specifically to the application of electromagnetic energy to the skin in order to treat various skin diseases. 
         [0003]    It is known in the art to apply electromagnetic energy to biological tissue to engender changes therein. Sunbathers, for example, regularly expose themselves to bright sunlight in order to increase melanocyte activity in the basal layer of the epidermis, responsive to the sun&#39;s ultraviolet (UV) radiation. Artificial UV sources have been created to satisfy the desire for a healthy-looking tan in the winter. Other forms of electromagnetic energy, laser-light in particular, are currently used in a large range of therapeutic and cosmetic procedures, including eye surgery, hair removal, wrinkle removal, and tattoo removal. 
         [0004]    PCT publication WO 98/55035, which is incorporated herein by reference, describes methods for minimizing injury to biological tissue surrounding a site exposed to pulses of electromagnetic energy. This and all other extraneous materials discussed herein are incorporated by reference in their entirety. Where a definition or use of a term in an incorporated reference is inconsistent or contrary to the definition of that term provided herein, the definition of that term provided herein applies and the definition of that term in the reference does not apply. 
         [0005]    U.S. Pat. No. 5,720,894 to Neev et al., which is incorporated herein by reference, describes biological tissue processing using Ultrashort Pulse High Repetition Rate Laser System for Biological Tissue Processing. 
         [0006]    It is known in the art to use UV and blue light to cure acne. A beam of short wavelength light is irradiated and is supposed to destroy bacteria through sterilizing ability of the high energy photon to disrupt molecular bond and photochemical destruction of living cells. This method is deficient however, because of the relatively short depth of penetration of the short wavelengths regime and the danger of mutagenetic effect as well as the effective shielding of deeper lying bacteria by superficial skin structures. 
         [0007]    It is also known in the art to use chemical peels and tretinoin to chemically peel of the outer layer of the skin. This method is deficient however, because of side effect, long response time and longer time duration between application of the treatment and results and various side effects. 
         [0008]    It is also known in the art to apply antibiotic to patients in order to combat active acne. This method is deficient however, since the application of antibiotic is non-selective, often done systemically and thus affects the entire body, and also for the fact that various organisms and bacteria develop resistance to antibiotics and thereby increases the risk of exposure to bacteria that are now resistant to antibiotics. 
         [0009]    It is also known in the art to combat active acne by treating and controlling hormonal activity within a patient body. Again, this is a systemic approach that suffers from many side effects including, in some cases, severe depression, and impact on the entire body. 
         [0010]    It is therefore desirable to have a simple, non-invasive, non-systemic treatment method and apparatus for the treatment and cure of acne, that, when applied, is free of side effects, yet is safe and effective. It is also desirable to have a method that is easy to apply and is relatively quick and easy to administer and produces rapid skin response, relief of symptoms, and cure for the condition. 
         [0011]    It is also desirable to have a simple, safe, non-invasive, non-systemic treatment method and apparatus for the treatment and cure of other skin diseases and skin conditions, that, when applied, is free of side effects, yet is safe and effective. Finally, it is particularly desirable to have a safe, home use, small and compact device that consumers can carry with them or use in the home or office environment for treatment of pimples, acne, or minor skin conditions, with or without the application and use of medicine or topical medication, to resolve irritating skin conditions, including acne. 
       SUMMARY OF THE INVENTION 
       [0012]    The present invention provides methods and apparatus in which a region of intact living skin is treated with energy pulses having a duration of short duration, at an average energy density such that a temperature at the surface rises to at least 45° C. without substantially denaturing tissue at the epidermal/dermal junction. The basic principle is to heat up the surface of the skin with sufficient heat to cause opening of the pores, but limit the amount of energy such that when it is diffused and distributed over a larger volume (in the dermis), the energy is below that which would cause substantial denaturation of cells in the skin. 
         [0013]    In especially preferred embodiments the energy pulses are produced by an electric heater coupled to a capacitor and a battery, the capacitor discharges between 0.2 J/cm 2  to 10 J/cm 2  and preferably between 0.5 J/cm 2  and 5 J/cm 2  and most preferably between 0.7 J/cm 2  and 3 J/cm 2  in pulses of between 0.1 ms and 10 ms. The energy pulses are preferably electromagnetic radiation that includes visible wavelengths. 
         [0014]    To avoid overheating of, and damage to, the dermis and underlying tissues, the pulses have durations of less than 30 seconds, more preferably less than 10 seconds, and in some cases less than 1 second, less than 0.1 sec, or even less than 0.01 sec. Pulses can be repeated at any desirable frequency, including especially between 0.5 second and 10 seconds, and more preferably between about 2 seconds and 5 seconds. Unless a different meaning is dictated by the context, all ranges herein should be interpreted as being inclusive of their endpoints. Interpulse delays of between 0.2 sec and 10 sec are preferred, with interpulse delays of between 2 sec and 5 sec even more preferred. Thus, it is contemplated that the controller could cooperate with the energy source to subject the treatment region to at least 2 energy pulses within a 20 second period, and possibly at least 10, 25, 50, 75 or even 100 such energy pulses within a 20 second period. 
         [0015]    In other aspects of preferred embodiments, the tip treatment area is preferably between 0.2 mm and 10 cm in diameter, and preferably between about 2 mm and about 2 cm in diameter. 
         [0016]    From a method standpoint, it is contemplated to operate a device as described herein such that hair follicles in the skin expand without being permanently damaged. By appropriately selecting pulse energy density, pulse width, and interpulse delays, it is possible to raise the surface temperature of the skin at least 60° C. or even 70° C. or more without substantially denaturing tissue at the epidermal/dermal junction. In some cases this effect can be facilitated by actively cooling the surface of the skin to a temperature of less than 50° C. 
         [0017]    It is still further contemplated that operation of devices as described herein can include treating the skin with anti-microbial radiation that includes blue to ultraviolet wavelengths (to achieve an antimicrobial effect), and applying a vacuum to the skin within 5, 10, or 15 minutes of application of the pulse (to help remove debris released during the heating portion of the treatment). 
         [0018]    In a preferred embodiment of the present invention, the tissue of the skin is subjected to localized heating for a given time and in a defined location, which elevates the temperature of the skin in that location as compared to its normal temperature. This elevation of skin temperature corresponds to expansion and displacement of a portion of the skin, thus leading to the opening of skin pores. 
         [0019]    In another preferred embodiment of the present invention, the tissue of the skin is subjected to localized heating for a given time and in a defined location, which elevates the temperature of the skin in that location as compared to an adjacent location. This elevation of skin temperature corresponds to expansion and displacement of a portion of the skin with respect to the adjacent location, thus leading to the opening of skin pores. 
         [0020]    In a further preferred embodiment, an intermediate substance, which is capable of absorbing at least a portion of the electromagnetic energy from a source, is placed between the energy source and the skin. The intermediate substance absorbs the source energy and converts it to heat. Being in contact with the skin, the intermediate substance elevates the temperature of the skin to cause to an expansion and displacement, leading to the opening of skin pores and relieving of acne conditions. 
         [0021]    In yet a further preferred embodiment, an intermediate substance, which is capable of absorbing at least a portion of the electromagnetic energy from a source, is placed between the energy source and the skin. The intermediate substance absorbs the source energy and converts it to heat. Being in contact with the skin, the intermediate substance elevates the temperature of the skin in one location as compared to an adjacent location. This elevation of skin temperature corresponds to expansion and displacement of a portion of the skin with respect to the adjacent location, thus leading to the opening of skin pores. 
         [0022]    As will be apparent from the description contained herein, aspects of the inventive subject matter include: a. Providing an improved apparatus and methods for applying energy to a material; b. Providing improved apparatus and methods for removing heat generated during application of electromagnetic energy to a material; c. Providing improved apparatus and methods for removing heat generated during application of electromagnetic energy to biological tissue; d. Providing improved apparatus and methods for decreasing pain during application of electromagnetic energy to biological tissue; e. Providing improved apparatus and methods for performing medical treatments; f. Providing improved apparatus and methods for performing cosmetic treatments; g. Providing improved apparatus and methods for healing of skin diseases and skin illnesses; h. Providing improved apparatus and methods for enabling electromagnetic energy source to allow healing of skin diseases and skin illnesses or improved conditions; i. Providing methods and apparatus for enabling a chemical, RF, Microwave, mechanical, electric, magnetic, or ultrasound energy to advance healing skin diseases and skin illnesses; j. Providing improved methods and apparatus for enabling a low-power electromagnetic energy source to advance healing skin diseases and skin illnesses substantially without pain, while substantially minimizing the amount of damage or modification to remaining tissue; k. Providing improved methods and apparatus for enabling a low-power electromagnetic energy source to perform skin treatment, treatment of acne and treatment that prevent the occurrence of acne; l. Providing improved methods and apparatus for enabling a low-power electromagnetic energy source to perform tissue treatment that cures acne and relieves symptoms of acne. 
         [0023]    These and other objects, features, aspects and advantages of the inventive subject matter will become more apparent from the following detailed description of preferred embodiments, along with the accompanying drawings in which like numerals represent like components. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0024]    In the accompanying figures, like elements are identified by like reference numerals among the several preferred embodiments of the present invention. 
           [0025]      FIG. 1A  is a simplified diagram of an apparatus for treatment of acne and skin condition and its components. 
           [0026]      FIGS. 1B and 1C  are simplified diagrams of contemplated heating elements. 
           [0027]      FIG. 1D  is a simplified diagram of an array of heating elements. 
           [0028]      FIG. 1E  is a simplified diagram of an alternative treatment head. 
           [0029]      FIG. 2  is a simplified diagram showing a representative heat accumulation and temperature vs. pulse number effect on the skin surface. 
           [0030]      FIG. 3  is a simplified diagram of a possible circuit diagram for an electric heater skin and acne treatment device. 
           [0031]      FIG. 4  is a simplified diagram showing how a handheld skin treatment device is used to treat the skin. 
           [0032]      FIG. 5  is a simplified block diagram of device components 
           [0033]      FIG. 6  is a simplified diagram of an acne and skin treatment device utilizing an energy source and a source of suction to enhance treatment. 
           [0034]      FIG. 7  is a simplified diagram showing a schematic representation of a surface of the skin or tissue treated with a pattern of thermal modification to minimize collateral damage and enhance healing time. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0035]    Devices and methods are contemplated herein for treatment of a variety of skin conditions, and in particular, cyst, acne, aged skin, and wrinkles. In  FIG. 1A  the device  3 , designed to treat a skin surface  5 , comprises the following components: an energy source  10 , for example, a battery, an electro-mechanical dynamo, or an electric wall outlet, among other possible energy sources, that provides energy to the device control elements  30 , for example a control element on a circuit board  35 . The device control elements  30  are activated by input switches (not shown), for example, a power level switch, a trigger switch, or an off/on switch, that allows the user to interface with the device, for example they allow the user to control the operation, power level and activation of the device. The device control elements  30  allows the energy source  10  to power a treatment head  50  directly or to charge up a plurality of capacitors  55  or other intermediate elements (resistors, diodes, etc.) that modify the energy output of the treatment heads. The treatment head  50  can include a resistor that provides heating to the skin by diffusion. 
         [0036]    In preferred embodiments of  FIGS. 1B and 1C , the treatment head  50  can be made from a heating element, for example a resistor  53  can be embedded in an insulating material  57 , for example PTFE or a plastic material that is sufficiently thin to allow rapid conduction of the thermal energy to the skin. In another preferred embodiment, the resistor  53  can be made of a conductor in a flat configuration so that it conducts heat uniformly in a planar configuration of temperature gradient as shown in  FIG. 1C . This will allow the heat to diffuse as a flat planar diffusion of thermal energy to the skin. The resistor  53  can be mounted on a layer of glass or PTFE, plastic, or other insulating material  57 , which reduces removal of thermal energy from the resistor, and facilitates diffusion of the thermal energy by conduction towards the targeted skin. Between the resistor  53  and the target skin one can advantageously include a thin layer of electrically insulating material  57  that prevents electricity from the resistor  53  from reaching the skin but allows thermal energy from the resistor  53  to reach the skin. The resistor  53  can be made of typical materials known in the art such as copper, aluminum, tungsten, steel, nichrome, or copper and tin alloys. 
         [0037]    Resistor  53  can advantageously be coated with a thin layer of electrically insulating but thermally conducting material that allows the heat to flow but prevents electric current from reaching the skin—for example by anodizing processes. The treatment head  50  can have any suitable thickness, preferably 10 micrometers to 1 mm, more preferably between 25 micrometers and 500 micrometers, and most preferably between 50 micrometers and 200 micrometers. The electrical insulating layer  57  can also have any suitable thickness, preferably between 5 micrometers and 1 mm, more preferably between 10 micrometers and 500 micrometers, and most preferably between 20 micrometers and 250 micrometers. 
         [0038]    Because the maximum amount of energy that is loaded up onto the heater element is the maximum amount of energy (or heat) available to treat and also to possibly cause excessive collateral damage, it determines the upper limit of the risk of the method and the device contemplated herein. The upper limit of the amount of energy provided by the resistor  53  is determined by its heat capacity (for example, the most energy a heating element can have is the full amount of energy from a discharging capacitor, ½ CV 2 , where C is the capacitor capacitance and V is the final voltage across the capacitor). If the heating element  53  is completely insulated, and is designed to reach a temperature increase DT above normal skin temperature (for example, if we designate DT=200° C.), then the amount of energy that will allow it to reach that temperature is determined by the heat capacity of the heating element  53 . The heat capacitance is a function of the heating element volume and hence for a designated treatment area (for example between about 0.2 cm 2  to about 9 cm 2 , and preferably 2 cm 2 ) a thinner heating element will have smaller heat capacitance and hence will store less energy, corresponding to its designated temperature DT. Thus, by proper design of the heat capacitance and thickness of the heater, we can calculate and limit the upper value of energy available for transfer into the skin. For this reason, a thin heater will serve to limit the amount of energy available for heating of the skin. For example, a total thickness of the heating element  53  should be between 20 micrometers and about 500 micrometers, and preferably between about 30 micrometers and about 300 micrometers. As shown in  FIG. 1C , the wires  58  provide current to the resistive heating element  53 . 
         [0039]    A temperature monitoring element  67  (for example, a thermocouple or an IR detector, such as an HgCdTe detector) can be integrated into the heating element as shown in  FIG. 1A , and be operatively coupled to the heating element  53 . A cooling element  69 , for example a thermoelectric cooler (or TEC), can also be integrated into the treatment head  50  to reduce the temperature of the treatment head  50  before the next shot is fired. For example, a reduction in temperature range between about 25° C. to 45° C., and preferably between about 27° C. and about 37° C., can be required before the device can be fired again. 
         [0040]    As shown in  FIG. 1D , a plurality of treatment heads can be used. Thus, heads  51 ,  52  can be used while treatment head  50  is cooling. For convenience, the treatment heads  50 ,  51  and  52  can all be mounted on a conveyer belt or other actuator, and thereby moved in the direction of the arrow  61 . 
         [0041]    In  FIG. 1E  an alternative treatment head  75  includes heating element  53  mounted on insulating material  57  and flexible layer  59 . Treatment head  75  is flexible, and is mounted on a collapsible/extendable rack  70 , which can be extended or expanded in the direction of the arrows  73 , pulling with it the entire assembly of treatment head  75 , in respect to a variable treatment area  77 . The variable size treatment area  77  can range, for example, from about 0.5 mm in diameter to about 5 cm in diameter, and preferably from about 2 mm in diameter to 25 mm in diameter. 
         [0042]    The above treatment head cooling and adjustable head size may not be necessary if a simple handheld device is desired. Thus, in general, a preferred embodiment includes a device for treatment of skin conditions comprising: an energy source adapted and configured to provide energy to the skin surface; and a controller adapted and configured to automatically energize the energy source so it heats the skin to a temperature sufficient to loosen, dislodge, destroy or otherwise desirably modify the blockage within a follicle so as to allow drainage thereof in response to a user input. 
         [0043]    Heating elements  53  can be coated for several reasons, including to enhance safety, to provide quicker temperature changes, and for improved patient experience. For example, as shown in  FIGS. 1B and 1C  a resistor  53  can be embedded in an insulating material  57 . For example, PTFE or other plastic or glass electrically insulating materials that allow the heat to thermally conduct and reach the skin  5  can be used. In some contemplated embodiments, a thin electrically insulating coating (for example, a thin plastic coating can be applied or an anodizing process can be used) can be applied to the resistor  53  to prevent electrical current from reaching the skin  5 , while still allowing heat to diffuse and reach the skin  5 . 
         [0044]    It is contemplated that controller  30  can operate to cease providing energy to the heating element  53 , and to reheat the heating element  53  without a further user input. 
         [0045]    It is also contemplated that energy provided to the skin can causes substances inserted in the hair follicle to expand. 
         [0046]    It is also contemplated that the energy source  10  and controller  30  can be co-located in a housing, and that the housing can be sized and dimensioned to be hand held. 
         [0047]    One or more energy removal (i.e., cooling) elements  69  may also be used. The energy removal element  69  should be adapted and configured to cool said heating element  53  and/or a skin surface  5  to a temperature of less than about 50° C., and an electromagnetic source of energy in the blue to ultraviolet range is also applied to achieve sterilization of the skin  5 . 
         [0048]    Particularly preferred methods and apparatus include: a heating element  53  adapted and configured to contact a skin surface  5 ; and a controller  30  adapted and configured to automatically heat the heating element  53  to a temperature sufficient to loosen, dislodge, destroy or otherwise desirably modify a blockage within a follicle or improve the condition and health of the skin  5  in response to a user input. Such devices can advantageously raise the temperature surface of the skin  5  to above 38° C., more preferably to above 45° C., and in some cases could transiently raise the temperature of the surface of the skin  5  to 70° C., or even 100° C., 200° C., 250° C., 300° C., 350° C. or more. 
         [0049]    Of course, such high temperatures would be maintained for only a short period of time, to avoid substantial permanent damage to the majority of the living cells in the skin. Thus, the contemplated devices and methods would preferably not be applied in an ablative manner. To that end elevated heating of the surface of the skin would typically occur for a heating period that is less than about one second, more preferably less than about 0.1 second more preferably yet less than about 0.01 second and most preferably less than about 1 ms. 
         [0050]    Also contemplated herein are methods of treating a subject having a skin lesion, comprising applying energy to a lesion; heating the lesion to a temperature sufficient to modify skin condition and treat disease but cause serious burn; and repeating the energy applications and heating steps at least one time. 
         [0051]    For example, if an electric current is used to heat up a resistor, for example by charging up and discharging a capacitor through the resistor as is contemplated by one preferred embodiment, or, for example, by providing a DC or AC current through the resistor adapted to contact the skin, and using automated or manual interruption to terminate the current flow and heating phase, then repeating the heating cycle will result in accumulation of heat in the skin and temperature build up, for example, as shown in  FIG. 2 . 
         [0052]    As shown in  FIG. 2 , the temperature of the skin due to the first heating cycle  210  is a peak temperature, for example, 300° C., and then decays to lower values due to conduction to the skin  5  and some loss to the insulating material  57  of  FIG. 1A . A second pulse, for example a few seconds later, may raise the temperature of the skin  5  which has not yet been able to decay to its normal ambient temperature, for example 37° C., and has only reached a lower temperature of 45° C., will now rise again due to cycle number 2, for example to a peak temperature of 310° C. as shown in  220 . A third pulse will raise the peak temperature for example to 320° C. peak and will decay to a temperature of, for example, 50° C. We can see that the accumulation of thermal energy from repeated heating cycles  1 ,  2 ,  3 , and  4 , as shown by the curves  210 ,  220 ,  230  and  240 , will result in a slow average skin temperature increase, as shown by the curve  250  from its ambient temperature 37° C. to an elevated temperature of 50° C. The tail of the curve  210  (broken line) shows what the decay of a single pulse will look like. 
         [0053]    The number of such repeated heating cycles should there be limited or spaced apart by several seconds to allow cooling between pulses, or utilize active cooling such as thermoelectric cooling or cryogen spray cooling incorporated with the method or device to prevent accumulation of excess heating of the skin surface, which can lead to deeper tissue effects or burn. The heating step, if done through a slower heating process, should be limited in time or monitored with the thermocouple  67  of  FIG. 1A . If limited in time, this preferred heating step should preferably be limited to less than 3 minutes, more preferably to less than 1 minute, more preferably yet to less than 30 second, more preferably yet to less than 1 second, more preferably yet to less than 100 ms, more preferably yet to less than 10 ms, more preferably yet to less than 1 ms, and more preferably yet to less than 0.1 ms. 
         [0054]    In an additional preferred embodiment, an electrical device  3  for the treatment of skin lesions comprises: (a) an interface  50  for contacting the skin  5  of a subject; (b) a heater  53  capable of heating the interface to a temperature sufficient to cause expansion of a hair follicle and treatment of skin conditions without irreversible damage to living cells. The device  3  may optionally include an energy removal (i.e., cooling) element  69 , preferably capable of cooling the heating element  53  and/or treatment surface to a temperature of less than about 50° C. Still further, the device  3  may include a source of electromagnetic energy  87  in the blue to ultraviolet range, which can be applied to at least partially sterilize the skin  5 . 
         [0055]      FIG. 3  shows one possible circuit diagram to pulse a flash lamp  350 . A switch  320  is turned on to draw power from battery  310 , through transformer  330 , to activate the device and charge the capacitor  340 . When the capacitor is fully charged a lamp  345  (or LED) is turned on and the circuit is ready to fire. Push button  360  is pressed to discharge capacitor  340 . After firing, the capacitor  340  begins to charge, and after several seconds (depending on the battery and resistance) is fully charged. This circuit releases a maximum energy per pulse of ½ CV 2 , where C is the capacitance of capacitor  340  and V is the final voltage across the capacitor  340 . By selecting appropriate values of C and V, the released energy can be kept at the appropriate level so it loads up sufficient amount of energy into the top layer of the tissue. For example, a discharge time of 1 ms will allow diffusion into about 30 micrometers of tissue with thermal conductivity similar to that of water, thus the amount of energy in this tissue should be enough to cause a temperature jump high enough to cause sufficient tissue expansion so that pores and spacing in the epidermis are opened to allow healing of acne and other skin conditions. However, the amount of energy discharged and conducted into the tissue is not enough to cause serious collateral damage or a serious burn, because the total amount of energy per unit volume conducted into the deeper tissue, i.e. less than ½ CV 2 , is too low to interact with the living cells and cause significant irreversible damage or a serious burn. 
         [0056]      FIG. 4  shows how the device  420  can be used by a consumer suffering from acne or other skin conditions. The user  410  holds the device  420  in his hand  430 , and pushes a charge button  440  to initiate charging and a fire button  450  to fire the device  420  once it has made good contact with the user&#39;s face. 
         [0057]    In  FIG. 5 ,  510  is a source of energy, for example, a battery or a wall plug;  520  is a user interface such as a power control, a charge button, and/or a fire button;  530  is a microprocessor powered by the power source  510  and controlling the firing sequence, charging times, firing repletion rate, and power levels, the microprocessor  530  being responsive to a user input;  540  is a capacitor and pulse generator assembly capable of using the power source  510  to charge the capacitor and store the electrical energy;  550  is the full charge indictor telling the user that the device is ready to fire; and 560 is a heater adapted to contact the skin to heat the skin surface to the required level. 
         [0058]    An additional preferred embodiment of the present invention contemplates a device for treatment of skin conditions and acne, the device comprising: an energy source adapted and configured to provide energy to the skin surface; a controller adapted and configured to automatically energize the energy source so it heats the skin to treat said skin conditions and acne; and a vacuum source to be applied to the skin before, during or after the energy application to said skin. In a preferred embodiment, an energy source is applied to the skin. The energy may be, for example, a laser, a broad lamp, a flash lamp, an RF energy source, an ultrasound beam, or a microwave energy source. 
         [0059]    As shown in  FIG. 6 , the device  605  comprises an energy source  610  which delivers energy to the surface of the skin  650  of a user  630 . A source providing suction, for example a vacuum pump  640 , delivers suction to the surface of the skin  650  at the same location that the energy is applied. The suction can be applied to the skin  650  before, during, or after the application of energy to the skin  650 . The suction can help clean pores, enhance energy delivery to target tissue and skin components, remove debris, sebum, fat, bacteria, or smoke from the surface, clean pores and hair follicle openings as well as sweat pores, and minimize the sensation of pain. The source of energy  610  can be one of the following: mechanical, thermal, electrical, optical, electromagnetic, ultrasound, microwave, nuclear, chemical, or RF energy. It emits a beam  620  that can be manipulated with lenses, mirrors and scanners  635 , as well as other optical components  625 , or may be adapted to directly contact the skin  650  of the user  630 . 
         [0060]    In an additional preferred embodiment, the device  605  may also comprise an intermediate element capable of converting some energy to thermal energy and conducting sufficient thermal energy to the skin to open and clean skin pores and follicle openings, treat skin ailments, and improve skin condition and look. The thermal energy thus generated may also be applied in conjunction with the application of suction before, during, or after the thermal energy or other energy application. 
         [0061]    In further preferred embodiments, the device  605  may additionally and preferably comprise an energy removal element, said energy removal element adapted and configured to cool said heating element and/or a skin surface to a temperature of less than about 50° C., and an electromagnetic source of energy in the blue to ultraviolet range is also applied to achieve sterilization of the skin  650 . A source of coolant  673 , for example a gas container can dispense coolant, for example through a coolant dispensing tube  677 . Alternatively, a TEC can be used to cool the target skin. The device  605  can advantageously also incorporate a contact suction head, for example a plurality of suction heads  655  attached with a plurality of tubes  657  to a plurality of vacuum pumps  640  so that the suction is applied to the targeted skin area  650  before during or after the application of energy. 
         [0062]    Devices and methods can also advantageously comprise: an energy source adapted and configured to provide energy to the skin surface; and a controller adapted and configured to automatically energize the energy source so it heats the skin to a temperature sufficient to treat skin conditions and wrinkles. The device may further comprise an intermediate material, which may contain a substance capable of absorbing said energy, said absorbing substance arranged in patterns that maximize the penetration of light while at the same time creating surface heating on the skin surface. This will allow the deeper penetrating energy to heat from below while the upper surface heating creates heat flow downward from the surface. The partial heating of the surface also allows faster healing as smaller portions of the epidermis are damaged. For example, surface heating of the upper layers of the skin can be between about 0% to about 70%, and preferably between 3% and 50%. 
         [0063]    The intermediate absorbing material may contain a laser absorbing substance arranged in patterns that maximize the penetration of light to depths of between about 100 micrometers to about 1 mm in order to maximize penetration of the light to heat the sebaceous glands and minimize secretion of sebum. The preferred density for deeper laser light penetration and direct light heating of the upper layers of the skin is between about 0% to about 70% and preferably (if surface heating utilizing the intermediate absorbing material is taken into account) between 3% and 50%. A laser in the blue to ultraviolet range can be used in order to utilize the sterilization effect of these wavelengths, as well as generating heat. The heat generation will be increased due to the increased absorption resulting from the shorter wavelengths. In addition, blue and green to orange wavelengths are more readily absorbed by the hemoglobin in the blood and thus enhance heat generation at the surface of the skin and in layers below the surface. 
         [0064]    Various tissue conditions can be effectively treated using a plurality of microscopic treatment zones. In that regard zones can be between 1 micrometer in diameter and 7 mm in diameter, preferably between 20 micrometers and 300 micrometers in diameter, and most preferably between 50 micrometers in diameter and about 250 micrometers in diameter. Zones can advantageously be created in a predetermined treatment pattern, wherein a subset of said plurality of discrete microscopic treatment zones includes individual discrete microscopic treatment zones. 
         [0065]    In  FIG. 7 , a pattern of treated spots  710  in the skin  725  is treated so that at least some tissue modification takes place, and wherein the spaces between the spots are not treated. The extent of the spots stretch to a depth  720 . The spot diameter of the treated zone is as described above. The percentage of the treated area can advantageously vary from 5% to 95%, more preferably from 20% to 80%, more preferably yet from 30% to 70%, and most preferably from 40% to 60%. In especially preferred embodiments, the tissue can be modified in a region extending from the surface to a depth of between about 25 micrometers to about 750 micrometers, and more preferably from about 50 micrometers to about 400 micrometers. The percentage of the modified or thermally modified tissue to unchanged tissue is preferably from about 0% to about 70% and more preferably between 3% and 50%. The dotted line  727  represents the epidermal dermal junction and the line  728  represents the boundaries of the dermis. The depth  720  within which the tissue is modified thus extends to either the epidermis, the dermis, or both. 
         [0066]    Thus, specific embodiments and applications of skin treating apparatus and methods have been disclosed. It should be apparent, however, to those skilled in the art that many more modifications besides those already described are possible without departing from the inventive concepts herein. The inventive subject matter, therefore, is not to be restricted except in the spirit of the appended claims. Moreover, in interpreting both the specification and the claims, all terms should be interpreted in the broadest possible manner consistent with the context. In particular, the terms “comprises” and “comprising” should be interpreted as referring to elements, components, or steps in a non-exclusive manner, indicating that the referenced elements, components, or steps may be present, or utilized, or combined with other elements, components, or steps that are not expressly referenced. Where the specification claims refers to at least one of something selected from the group consisting of A, B, C . . . and N, the text should be interpreted as requiring only one element from the group, not A plus N, or B plus N, etc.