Patent Description:
Delivering various forms of electromagnetic energy into a patient for medical and cosmetic purposes has been widely used in the past. These common procedures include, but are by no means limited to, skin rejuvenation, wrinkle removal, skin tightening and lifting, cellulite and fat reduction, treatment of pigmented lesions, tattoo removal, soft tissue coagulation and ablation, vascular lesion reduction, face lifting, muscle contractions and muscle strengthening, etc..

All of these procedures are performed to improve a visual appearance of the patient.

Besides many indisputable advantages of a thermal therapy, these procedures also bring certain limitations and associated risks. Among others is the limited ability of reproducible results as these are highly dependent on applied treatment techniques and the operator's capabilities. Moreover, if the therapy is performed inappropriately, there is an increased risk of burns and adverse events.

It is very difficult to ensure a homogeneous energy distribution if the energy delivery is controlled via manual movement of the operator's hand which is the most common procedure. Certain spots can be easily over- or under-treated. For this reason, devices containing scanning or other mechanisms capable of unattended skin delivery have emerged. These devices usually deliver energy without direct contact with the treated area, and only on a limited, well-defined area without apparent unevenness. Maintaining the same distance between the treated tissue and the energy generator or maintaining the necessary tissue contact may be challenging when treating uneven or rugged areas. Therefore, usage of commonly available devices on such specific areas that moreover differ from patient to patient (e.g. the face) might be virtually impossible.

Facial unattended application is, besides the complications introduced by attachment to rugged areas and necessity of adaptation to the shapes of different patients, specific by its increased need for protection against burns and other side effects. Although the face heals more easily than other body areas, it is also more exposed, leading to much higher requirements for treatment downtime. Another important aspect of a facial procedure is that the face hosts the most important human senses, whose function must not be compromised during treatment. Above all, eye safety must be ensured throughout the entire treatment.

The current aesthetic market offers either traditional manually controlled radiofrequency or light devices enabling facial tissue heating to a target temperature in the range of <NUM> - <NUM> or unattended LED facial masks whose operation is based on light effects (phototherapy) rather than thermal effects. These masks are predominantly intended for home use and do not pose a risk to patients of burns, overheating or overtreating. The variability in facial shapes of individual patients does not represent any issue for these masks as the delivered energy and attained temperatures are so low that the risk of thermal tissue damage is minimized and there is no need for homogeneous treatment. Also, due to low temperatures, it is not important for such devices to maintain a predetermined distance between the individual diodes and the patient's skin, and the shape of the masks is only a very approximate representation of the human face. But their use is greatly limited by the low energy and minimal to no thermal effect and they are therefore considered as a preventive tool for daily use rather than a method of in-office skin rejuvenation with immediate effect.

Nowadays, the aesthetic market feels the needs of the combination of a heating treatment made by electromagnetic energy delivered to the epidermis, dermis, hypodermis or adipose tissue with a secondary energy providing muscle contraction or muscle stimulation in the field of improvement of visual appearance of a patient. However, none of the actual devices is adapted to treat the uneven rugged areas like the face. In addition, commercially available devices are usually handheld devices that need to be operated by a medical professional during the whole treatment.

Thus it is necessary to improve medical devices providing more than one treatment energy (e.g. electromagnetic energy and electric current), such that both energies may be delivered via different active elements or the same active element (e.g. electrode). Furthermore, the applicator or pad of the device needs to be attached to the patient which allows unattended treatment of the patient. In some embodiments, the applicator or pad is made of flexible material allowing sufficient contact with the uneven treatment area of the body part of the patient.

Some treatments of various body parts by one or more energies were proposed in prior art for example by <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT> and <CIT>.

In order to enable well defined unattended treatment of the uneven, rugged areas of a patient (e.g. facial area) while preserving safety, devices of minimally invasive to non-invasive electromagnetic energy delivery via a single or a plurality of active elements according to claim <NUM> are proposed. Any treatment methods described herein do not form part of the invention.

The patient may include skin and a body part, wherein a body part may refer to a body area.

The desired effect of the improvement of the visual appearance of a patient may include tissue (e.g. skin) heating in the range of <NUM> to <NUM>, tissue coagulation at temperatures of <NUM> to <NUM> or tissue ablation at temperatures of <NUM> to <NUM>. Various patients and skin conditions may require different treatment approaches - higher temperatures allow better results with fewer sessions but require longer healing times while lower temperatures enable treatment with no downtime but limited results within more sessions. Another effect of the heating in some embodiments is decreasing the number of fat cells.

Another desired effect may be muscle contraction causing muscle stimulation (e.g. strengthening or toning) for improving the visual appearance of the patient.

An arrangement for contact or contactless therapy has been proposed.

For contact therapy, the proposed device comprises at least one electromagnetic energy generator inside a main unit that generates an electromagnetic energy which is delivered to the treatment area via at least one active element attached to the skin. At least one active element may be embedded in a pad made of flexible material that adapts to the shape of the rugged surface. An underside of the pad may include of an adhesive layer allowing the active elements to adhere to the treatment area and to maintain necessary tissue contact. Furthermore, the device may employ a safety system capable of adjusting one or more therapy parameters based on the measured values from at least one sensor, e.g. thermal sensors or impedance measurement sensors capable of measuring quality of contact with the treated tissue.

For contactless therapy, the proposed device comprises at least one electromagnetic energy generator inside a main unit that generates an electromagnetic energy which is delivered to the treatment area via at least one active element located at a defined distance from the tissue to be treated. A distance of at least one active element from the treatment area may be monitored before, throughout the entire treatment or post-treatment. Furthermore, the device may employ a safety system capable of adjusting one or more therapy parameters based on the measured values from at least one sensor, for example one or more distance sensors. Energy may be delivered by a single or a plurality of static active elements or by moving a single or a plurality of active elements throughout the entire treatment area, for example via a built-in automatic moving system, e.g. an integrated scanner. Treatment areas may be set by means of laser sight - the operator may mark the area to be treated prior to the treatment.

The active element may deliver energy through its entire surface or by means of a so-called fractional arrangement when the active part includes a matrix formed by points of defined size. These points may be separated by inactive (and therefore untreated) areas that allow faster tissue healing. The points surface may make up from <NUM>% to <NUM>% of the active element area.

The electromagnetic energy may be primarily generated by a laser, laser diode module, LED, flash lamp or incandescent light bulb or by a radiofrequency generator for causing heating of a patient. Additionally, an acoustic energy or electric or electromagnetic energy, which does not heat the patient, may be delivered simultaneously, alternately or in overlap with the primary electromagnetic energy.

The active element may deliver more than one energy simultaneously (at the same time), successively or in overlap. For example, the active element may deliver a radiofrequency energy and subsequently an electric energy (electric current). In another example, the active element may deliver the radiofrequency energy and the electric energy at the same time.

Furthermore the device may be configured to deliver the electromagnetic field by at least one active element and simultaneously (at the same time) to deliver e.g. electric energy by a different element.

Thus the proposed devices may lead to proper skin rejuvenation, wrinkle removal, skin tightening and lifting, cellulite and fat reduction, treatment of pigmented lesions, tattoo removal, soft tissue coagulation and ablation, vascular lesions reduction, etc. of uneven rugged areas without causing further harm to important parts of the patient's body, e.g. nerves or internal organs. The proposed devices may lead to an adipose tissue reduction, e. g by fat cell lipolysis or apoptosis.

Furthermore, the proposed devices may lead to tissue rejuvenation, e. g muscle strengthening or muscle toning through the muscle contraction caused by electric or electromagnetic energy.

The presented methods not being part of the invention and devices may be used for stimulation and/or treatment of a tissue, including but not limited to skin, epidermis, dermis, hypodermis or muscles. The proposed apparatus is designed for minimally to non-invasive treatment of one or more areas of the tissue to enable well defined unattended treatment of the uneven, rugged areas (e.g. facial area) by electromagnetic energy delivery via a single or a plurality of active elements without causing further harm to important parts of the patient's body, e.g. nerves or internal organs.

Additionally the presented methods not being part of the invention and devices may be used to stimulate body parts or body areas like head, neck, bra fat, love handles, torso, back, abdomen, buttocks, thighs, calves, legs, arms, forearms, hands, fingers or body cavities (e.g. vagina, anus, mouth, inner ear etc.).

The proposed methods not being part of the invention and devices may include a several protocols for improving visual appearance, which may be preprogramed in the control unit (e.g. CPU which may include a flex circuit or a printed circuit board and may include a microprocessor or memory for controlling the device).

The desired effect may include tissue (e.g. skin) heating (thermal therapy) in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>, tissue coagulation at temperatures in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or tissue ablation at temperatures in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The device may be operated in contact or in contactless methods. For contact therapy a target temperature of the skin may be typically within the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> while for contactless therapy a target temperature of the skin may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The temperature within the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> may lead to stimulation of fibroblasts and formation of connective tissue - e.g. collagen, elastin, hyaluronic acid etc. Depending on the target temperature, controlled tissue damage is triggered, physiological repair processes are initiated, and new tissue is formed. Temperatures within the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> may further lead to changes in the adipose tissue. During the process of apoptosis caused by high temperatures, fat cells come apart into apoptotic bodies and are further removed via the process of phagocytosis. During a process called necrosis, fat cells are ruptured due to high temperatures, and their content is released into an extracellular matrix. Both processes may lead to a reduction of fat layers enabling reshaping of the face. Removing fat from the face may be beneficial for example in areas like submentum or cheeks.

Another desired effect may include tissue rejuvenation, e. muscle strengthening through the muscle contraction caused by electric or electromagnetic energy, which doesn't heat the patient, or the muscle relaxation caused by a pressure massage. The combined effect of muscle contractions via electric energy and tissue (e.g. skin) heating by electromagnetic field in accordance to the description may lead to significant improvement of visual appearance.

<FIG> and <FIG> are discussed together. <FIG> shows a block diagram of an apparatus for contact therapy <NUM>. <FIG> is an illustration of an apparatus for contact therapy <NUM>. The apparatus for contact therapy <NUM> may comprise two main blocks: main unit <NUM> and pad <NUM>. Additionally, the apparatus <NUM> may comprise interconnecting block <NUM> or neutral electrode <NUM>. However, the components of interconnecting block <NUM> may be implemented into the main unit <NUM>.

Main unit <NUM> may include one or more generators: a primary electromagnetic generator <NUM> which may preferably deliver radiofrequency energy in the range of <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM>, or in the range of <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM>, a secondary generator <NUM> which may additionally deliver electromagnetic energy, which does not heat the patient, or deliver electric current in the range of <NUM> to <NUM> or <NUM> to <NUM> or in the range of <NUM> to <NUM> and/or an ultrasound emitter <NUM> which may furthermore deliver an acoustic energy with a frequency in the range of <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM>. In addition, the frequency of the ultrasound energy may be in the range of <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM>.

The output power of the radiofrequency energy may be less than or equal to <NUM>, <NUM>, <NUM> or <NUM> W. Additionally, the radiofrequency energy on the output of the primary electromagnetic generator <NUM> (e.g. radiofrequency generator) may be in the range of <NUM> W to <NUM> W, or in the range of <NUM> W to <NUM> W or in the range of <NUM> W to <NUM> W or in the range of <NUM> W to <NUM> W. The radiofrequency energy may be applied in or close to the ISM bands of <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> and <NUM>.

Main unit <NUM> may further comprise a human machine interface <NUM> represented by a display, buttons, a keyboard, a touchpad, a touch panel or other control members enabling an operator to check and adjust therapy and other device parameters. For example, it may be possible to set the power, treatment time or other treatment parameters of each generator (primary electromagnetic generator <NUM>, secondary generator <NUM> and ultrasound emitter <NUM>) independently. The human machine interface <NUM> may be connected to CPU <NUM>. The power supply <NUM> located in the main unit <NUM> may include a transformer, disposable battery, rechargeable battery, power plug or standard power cord. The output power of the power supply <NUM> may be in the range of <NUM> W to <NUM> W, or in the range of <NUM> W to <NUM> W, or in the range of <NUM> W to <NUM> W.

Interconnecting block <NUM> may serve as a communication channel between main unit <NUM> and pad <NUM>. It may be represented by a simple device containing basic indicators <NUM> and mechanisms for therapy control. Indicators <NUM> may be realized through the display, LEDs, acoustic signals, vibrations or other forms capable of providing adequate notice to an operator and/or the patient. Indicators <NUM> may indicate actual patient temperature, contact information or other sensor measurements as well as a status of a switching process between the active elements, quality of contact with the treated tissue, actual treatment parameters, ongoing treatment, etc. Indicators <NUM> may be configured to warn the operator in case of suspicious therapy behavior, e.g. temperature out of range, improper contact with the treated tissue, parameters automatically adjusted etc. Interconnecting block <NUM> may be used as an additional safety feature for heat-sensitive patients. It may contain emergency stop button <NUM> so that the patient can stop the therapy immediately anytime during the treatment. Switching circuitry <NUM> may be responsible for switching between active elements or for regulation of energy delivery from primary electromagnetic generator <NUM>, secondary generator <NUM> or ultrasound emitter <NUM>. The rate of switching between active elements <NUM> may be dependent on the amount of delivered energy, pulse length etc, and/or on the speed of switching circuitry <NUM> and CPU <NUM>. The switching circuitry <NUM> may include relay switch, transistor (bipolar, PNP, NPN, FET, JFET, MOSFET) thyristor, diode, or opto-mechanical switch or any other suitable switch know in the prior art. The switching circuitry in connection with the CPU may control the switching between the primary electromagnetic energy generated by the primary electromagnetic generator <NUM> and the secondary energy generated by the secondary generator <NUM> on the at least one active element.

Additionally, the interconnecting block <NUM> may contain the primary electromagnetic generator <NUM>, the secondary generator <NUM> or ultrasound emitter <NUM> or only one of them or any combination thereof.

The CPU <NUM> controls the primary electromagnetic generator <NUM> such that the primary electromagnetic energy may be delivered in a continuous mode (CM) or a pulse mode to the at least one active element, having a fluence in the range of <NUM> mJ/cm<NUM> to <NUM> kJ/cm<NUM> or in the range of <NUM> mJ/cm<NUM> to <NUM> kJ/cm<NUM> or in the range of <NUM> J/cm<NUM> to <NUM> kJ/cm<NUM>. The electromagnetic energy may be primarily generated by a laser, laser diode module, LED, flash lamp or incandescent light bulb or by radiofrequency generator for causing the heating of the patient. The CM mode may be operated for a time interval in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The pulse duration of the energy delivery operated in the pulse regime may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The primary electromagnetic generator <NUM> in the pulse regime may be operated by CPU <NUM> in a single shot mode or in a repetition mode. The frequency of the repetition mode may be in the range of <NUM> to <NUM><NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. Alternatively, the frequency of the repetition mode may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The single shot mode may mean generation of just one electromagnetic pulse of specific parameters (e.g. intensity, duration, etc.) for delivery to a single treatment area. The repetition mode may mean generation of one or more electromagnetic pulses, which may have specific parameters (e.g. intensity, duration, etc.), with a repetition rate of the above-mentioned frequency for delivery to a single treatment area. The CPU <NUM> may provide treatment control such as stabilization of the treatment parameters including treatment time, power, duty cycle, time period regulating switching between multiple active elements, temperature of the device <NUM> and temperature of the primary electromagnetic generator <NUM> and secondary generator <NUM> or ultrasound emitter <NUM>. The CPU <NUM> may drive and provide information from the switching circuitry <NUM>. CPU <NUM> may also receive and provide information from sensors located on or in the pad <NUM> or anywhere in the device <NUM>. The CPU <NUM> may include a flex circuit or a printed circuit board and may include a microprocessor or memory for controlling the device.

The CPU <NUM> may control the secondary generator <NUM> such that secondary energy (e. g electric current or magnetic field) may be delivered in a continuous mode (CM) or a pulse mode to the at least one active element, having a fluence in the range of <NUM> mJ/cm<NUM> to <NUM> kJ/cm<NUM> or in the range of <NUM> mJ/cm<NUM> to <NUM> kJ/cm<NUM> or in the range of <NUM> J/cm<NUM> to <NUM> kJ/cm<NUM> on the surface of the at least one active element. Applying the secondary energy to the treatment area of the patient may cause muscle contractions of the patient. The CM mode may be operated for a time interval in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The pulse duration of the delivery of the secondary energy operated in the pulse regime may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The secondary generator <NUM> in the pulse regime may be operated by CPU <NUM> in a single shot mode or in a repetition mode. The frequency of the repetition mode may be in the range of <NUM> to <NUM><NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>.

The proposed device may be a multichannel device allowing the CPU <NUM> to control the treatment of more than one treated area at once.

Alternatively, the interconnecting block <NUM> may not be a part of the device <NUM>, and the CPU <NUM>, switching circuitry <NUM>, indicators <NUM> and emergency stop <NUM> may be a part of the main unit <NUM> or pad <NUM>. In addition, some of the CPU <NUM>, switching circuitry <NUM>, indicators <NUM> and emergency stop <NUM> may be a part of the main unit <NUM> and some of them part of pad <NUM>, e.g. CPU <NUM>, switching circuitry <NUM> and emergency stop <NUM> may be part of the main unit <NUM> and indicators <NUM> may be a part of the pad <NUM>.

Pad <NUM> represents the part of the device which may be in contact with the patient's skin during the therapy. The pads <NUM> may be made of flexible substrate material - for example polymer-based material, polyimide (PI) films, teflon, epoxy, polyethylene terephthalate (PET), polyamide or PE foam with an additional adhesive layer on an underside, e.g. a hypoallergenic adhesive gel or adhesive tape that may be bacteriostatic, non-irritating, or water-soluble. The substrate may also be a silicone-based substrate. The substrate may also be made of a fabric, e.g. non-woven fabric. The adhesive layer may have the impedance for a current at a frequency of <NUM> in the range of <NUM> to <NUM> S2 or in the range of <NUM> to <NUM>Ω or in the range of <NUM> to <NUM>Ω, and the impedance for a current at a frequency of <NUM> or less is three times or more the impedance for a current at a frequency of <NUM>. The adhesive hydrogel may be made of a polymer matrix or mixture containing water, a polyhydric alcohol, a polyvinylpyrrolidone, a polyisocyanate component, a polyol component or has a methylenediphenyl structure in the main chain. Additionally, a conductive adhesive may be augmented with metallic fillers, such as silver, gold, copper, aluminum, platinum or titanium or graphite that make up <NUM> to <NUM> % or <NUM> to <NUM> % or <NUM> to <NUM>% of adhesive. The adhesive layer may be covered by "ST-gel®" or "Tensive®" conductive adhesive gel which is applied to the body to reduce its impedance, thereby facilitating the delivery of an electric shock.

The adhesive layer under the pad <NUM> may mean that the adhesive layer is between the surface of the pad facing the patient and the body of the patient. The adhesive layer may have impedance <NUM> times, <NUM> times, <NUM> times or up to <NUM> times higher than the impedance of the skin of the patient under the pad <NUM>. A definition of the skin impedance may be that it is a portion of the total impedance, measured between two equipotential surfaces in contact with the epidermis, that is inversely proportional to the electrode area, when the internal current flux path is held constant. Data applicable to this definition would be conveniently recorded as admittance per unit area to facilitate application to other geometries. The impedance of the adhesive layer may be set by the same experimental setup as used for measuring the skin impedance. The impedance of the adhesive layer may be higher than the impedance of the skin by a factor in the range of <NUM> to <NUM> times or <NUM> to <NUM> times or <NUM> to <NUM> times.

The impedance of the adhesive layer may have different values for different types of energy delivered to the patient, e.g. the impedance may be different for radiofrequency and for electric current delivery. The impedance of a hydrogel may be in the range of <NUM> to <NUM> Ohm or in the range of <NUM> to <NUM> Ohm or <NUM> to <NUM> Ohm or <NUM> to <NUM> Ohm in case of delivery of the electric current (e.g. during electrotherapy).

The pad <NUM> may also have a sticker on a top side of the pad. The top side is the opposite site of the underside (the side where the adhesive layer may be deposited) or in other words the top side is the side of the pad that is facing away from the patient during the treatment. The sticker may have a bottom side and a top side, wherein the bottom side of the sticker may comprise a sticking layer and the top side of the sticker may comprise a non-sticking layer (eg. polyimide (PI) films, teflon, epoxy, polyethylene terephthalate (PET), polyamide or PE foam).

The sticker may have the same shape as the pad <NUM> or may have additional overlap over the pad. The sticker may be bonded to the pad such that the sticking layer of the bottom side of the sticker is facing towards the top side of the pad <NUM>. The top side of the sticker facing away from the pad <NUM> may be made of a non-sticking layer. The size of the sticker with additional overlap may exceed the pad in the range of <NUM> to <NUM>, or in the range of <NUM> to <NUM>, or in the range of <NUM> to <NUM>, or in the range of <NUM> to <NUM>. This overlap may also comprise the sticking layer and may be used to form additional and more proper contact of the pad with the patient.

Alternatively, the pad <NUM> may comprise at least one suction opening, e.g. small cavities or slits adjacent to active elements or the active element may be embedded inside a cavity. The suction opening may be connected via connecting tube to a pump which may be part of the main unit <NUM>. When the suction opening is brought into contact with the skin, the air sucked from the suction opening flows toward the connecting tube and the pump and the skin may be slightly sucked into the suction opening. Thus by applying a vacuum the adhesion of pad <NUM> may be provided. Furthermore, the pad <NUM> may comprise the adhesive layer and the suction openings for combined stronger adhesion.

In addition to the vacuum (negative pressure), the pump may also provide a positive pressure by pumping the fluid to the suction opening. The positive pressure is pressure higher than atmospheric pressure and the negative pressure or vacuum is lower than atmospheric pressure. Atmospheric pressure is a pressure of the air in the room during the therapy.

The pressure (positive or negative) may be applied to the treatment area in pulses providing a massage treatment. The massage treatment may be provided by one or more suction openings changing a pressure value applied to the patient's soft tissue, meaning that the suction opening applies different pressure to patient tissue. Furthermore, the suction openings may create a pressure gradient in the soft tissue without touching the skin. Such pressure gradients may be targeted on the soft tissue layer, under the skin surface and/or to different soft tissue structures.

Massage accelerates and improves treatment therapy by electromagnetic energy, electric energy or electromagnetic energy which does not heat the patient, improves blood and/or lymph circulation, angioedema, erythema effect, accelerates removing of the fat, accelerate metabolism, and accelerates elastogenesis and/or neocolagenesis.

Each suction opening may provide pressure by a suction mechanism, airflow or gas flow, liquid flow, pressure provided by an object included in the suction opening (e.g. massaging object, pressure cells etc.) and/or in other ways.

Pressure value applied on the patient's tissue means that a suction opening providing massaging effect applies positive, negative and/or sequentially changing positive and negative pressure on the treated and/or adjoining patient's tissue structures and/or creates a pressure gradient under the patient's tissue surface.

Massage applied in order to improve body liquid flow (e.g. lymph drainage) and/or relax tissue in the surface soft tissue layers may be applied with pressure lower than during the massage of deeper soft tissue layers. Such positive or negative pressure compared to the atmospheric pressure may be in range of <NUM> Pa to <NUM><NUM> Pa, or in range of <NUM> Pa to <NUM><NUM> Pa or in range of <NUM> kPa to <NUM> kPa or in a range of <NUM> kPa to <NUM> kPa.

Massage applied in order to improve body liquid flow and/or relaxation of the tissue in the deeper soft tissue layers may be applied with higher pressure. Such positive or negative pressure may be in range from <NUM> kPa to <NUM> kPa or from <NUM> kPa to <NUM> kPa or from <NUM> kPa to <NUM> kPa. An uncomfortable feeling of too high applied pressure may be used to set a pressure threshold according to individual patient feedback.

Negative pressure may stimulate body liquid flow and/or relaxation of the deep soft tissue layers (<NUM> to non-limited depth in the soft tissue) and/or layers of the soft tissue near the patient surface (<NUM> to <NUM>). In order to increase effectiveness of the massage negative pressure treatment may be used followed by positive pressure treatment.

A number of suction openings changing pressure values on the patient's soft tissue in one pad <NUM> may be between <NUM> to <NUM> or between <NUM> to <NUM> or <NUM> to <NUM> or between <NUM> to <NUM>.

Sizes and/or shapes of suction openings may be different according to characteristics of the treated area. One suction opening may cover an area on the patient surface between <NUM> mm2 to <NUM> cm2 or between <NUM> mm2 to <NUM> mm2 or between <NUM> mm2 to <NUM> mm2 or between <NUM> mm2 to <NUM> mm2. Another suction opening may cover an area on the patient surface between <NUM> cm2 to <NUM> m2 or between <NUM> cm2 to <NUM> cm2 or between <NUM> cm2 to <NUM> cm2 or between <NUM> cm2 to <NUM> cm2.

Several suction openings may work simultaneously or switching between them may be in intervals between <NUM> to <NUM> or in intervals between <NUM> to <NUM> or in intervals between <NUM> to <NUM>.

Suction openings in order to provide massaging effect may be guided according to one or more predetermined massage profiles included in the one or more treatment protocols. The massage profile may be selected by the operator and/or by a CPU with regard to the patient's condition. For example a patient with lymphedema may require a different level of compression profile and applied pressure than a patient with a healed leg ulcer.

Pressure applied by one or more suction openings may be gradually applied preferably in the positive direction of the lymph flow and/or the blood flow in the veins. According to specific treatment protocols the pressure may be gradually applied in a direction opposite or different from ordinary lymph flow. Values of applied pressure during the treatment may be varied according to the treatment protocol.

A pressure gradient may arise between individual suction openings. Examples of gradients described are not limited for this method and/or device. The setting of the pressure gradient between at least two previous and successive suction openings may be: <NUM> %, i.e. The applied pressure by suction openings is the same (e.g. pressure in all suction openings of the pad is the same); <NUM> %, i.e. The applied pressure between a previous and a successive suction opening decreases and/or increases with a gradient of <NUM> % (e.g. the pressure in the first suction opening is <NUM> kPa and the pressure in the successive suction opening is <NUM> kPa); or <NUM> %, i.e. The pressure decreases or increases with a gradient of <NUM> %. The pressure gradient between two suction openings may be in a range of <NUM> % to <NUM> % where <NUM> % means that one suction opening is not active and/or does not apply any pressure on the patient's soft tissue.

A treatment protocol that controls the application of the pressure gradient between a previous and a successive suction opening may be in range between <NUM> % to <NUM> %, or in range between <NUM> % to <NUM> %, or in range between <NUM> % to <NUM> %.

The suction opening may also comprise an impacting massage object powered by a piston, massage object operated by filling or sucking out liquid or air from the gap volume by an inlet/outlet valve or massage object powered by an element that creates an electric field, magnetic field or electromagnetic field. Additionally, the massage may be provided by impacting of multiple massage objects. The multiple massage objects may have the same or different size, shape, weight or may be created from the same or different materials. The massage objects may be accelerated by air or liquid flowing (through the valve) or by an electric, magnetic or electromagnetic field. Trajectory of the massage objects may be random, circular, linear and/or massage objects may rotate around one or more axes, and/or may do other types of moves in the gap volume.

The massage unit may also comprise a membrane on the side facing the patient which may be accelerated by an electric, magnetic, electromagnetic field or by changing pressure value in the gap volume between wall of the chamber and the membrane. This membrane may act as the massage object. During the treatment, it may be convenient to use a combination of pads with adhesive layer and pads with suction openings. In that case at least one pad used during the treatment may comprise adhesive layer and at least additional one pad used during the treatment may comprise suction opening. For example, pad with adhesive layer may be suited for treatment of more uneven areas, e.g. periorbital area, and pad with suction openings for treatment of smoother areas, e.g. cheeks.

The advantage of the device where the attachment of the pads may be provided by an adhesion layer or by suction opening or their combination is that there is no need for any additional gripping system which would be necessary to hold the pads on the treatment area during the treatment, e.g. a band or a felt, which may cause a discomfort of the patient.

Yet in another embodiment, it is possible to fasten the flexible pads <NUM> to the face by at least one band or felt which may be made from an elastic material and thus adjusted for an individual face. In that case the flexible pads, which may have not the adhesive layer or suction opening, are placed on the treatment area of the patient and their position is then fastened by a band or felt to avoid deflection of the pads from the treatment areas. Alternatively, the band may be replaced by an elastic mask that covers from <NUM>% to <NUM>% or from <NUM>% to <NUM>% or from <NUM>% to <NUM>% or from <NUM>% to <NUM>% of the face and may serve to secure the flexible pads on the treatment areas. Furthermore, it may be possible to use the combination of the pad with adhesive layer or suction opening and the fastening band, felt or mask to ensure strong attachment of the pads on the treatment areas.

Additionally, the fastening mechanism may be in the form of a textile or a garment which may be mountable on a user's body part. In use of the device, a surface of the electrode or electrode pad <NUM> lays along an inner surface of the garment, while the opposite surface of the electrode or electrode pad <NUM> is in contact with the user's skin, preferably by means of a skin-electrode hydrogel interface.

The garment may be fastened for securement of the garment to or around a user's body part, e.g. by hook and loop fastener, button, buckle, stud, leash or cord, magnetic-guided locking system or clamping band and the garment may be manufactured with flexible materials or fabrics that adapt to the shape of the user's body or limb. The electrode pad <NUM> may be in the same way configured to be fastened to the inner surface of the garment. The garment is preferably made of breathable materials. Non limiting examples of such materials are soft Neoprene, Nylon, polyurethane, polyester, polyamide, polypropylene, silicone, cotton or any other material which is soft and flexible. All named materials could be used as woven, non-woven, single use fabric or laminated structures.

The garment and the pad may be a modular system, which means a module or element of the device (pad, garment) and/or system is designed separately and independently from the rest of the modules or elements, at the same time that they are compatible with each other.

The pad <NUM> may be designed to be attached to or in contact with the garment, thus being carried by the garment in a stationary or fixed condition, in such a way that the pads are disposed on fixed positions of the garment. The garment ensures the correct adhesion or disposition of the pad to the user's skin. In use of the device, the surface of one or more active elements not in contact with the garment is in contact with the patient's skin, preferably by means of a hydrogel layer that acts as pad-skin interface. Therefore, the active elements included in the pad are in contact with the patient's skin.

The optimal placement of the pad on the patient's body part, and therefore the garment which carries the pad having the active elements, may be determined by a technician or clinician helping the patient.

In addition, the garment may comprise more than one pad or the patient may wear more than one garment comprising one or more pads during one treatment session.

The pad <NUM> may contain at least one active element <NUM> capable of delivering energy from primary electromagnetic generator <NUM> or secondary generator <NUM> or ultrasound emitter <NUM>. The active element may be in the form of an electrode, an optical element, an acoustic window, an ultrasound emitter or other energy delivering elements known in the art. The electrode may be a radiofrequency (RF) electrode. The RF electrode may be a dielectric electrode coated with insulating (e.g. dielectric) material. The RF electrode may be monopolar, bipolar, unipolar or multipolar. The bipolar arrangement may consist of electrodes that alternate between active and return function and where the thermal gradient beneath electrodes is almost the same during treatment. Bipolar electrodes may form circular or ellipsoidal shapes, where electrodes are concentric to each other. However, a group of bipolar electrode systems may be used as well. A unipolar electrode or one or more multipolar electrodes may be used as well. The system may alternatively use monopolar electrodes, where the so called return electrode has larger area than so called active electrode. The thermal gradient beneath the active electrode is therefore higher than beneath the return electrode. The active electrode may be part of the pad and the passive electrode having a larger surface area may be located at least <NUM>, <NUM>, or <NUM> from the pad. A neutral electrode may be used as the passive electrode. The neutral electrode may be on the opposite side of the patient's body than the pad is attached. A unipolar electrode may also optionally be used. During unipolar energy delivery there is one electrode, no neutral electrode, and a large field of RF emitted in an omnidirectional field around a single electrode. Capacitive and/or resistive electrodes may be used. Radiofrequency energy may provide energy flux on the surface of the active element <NUM> or on the surface of the treated tissue (e.g. skin) in the range of <NUM> W/cm<NUM> to <NUM> W/cm<NUM> or <NUM> W/cm<NUM> to <NUM> W/cm<NUM> or <NUM> W/cm<NUM> to <NUM> W/cm<NUM> or <NUM> W/cm<NUM> to <NUM> W/cm<NUM> or <NUM> W/cm<NUM> to <NUM> W/cm<NUM>. The energy flux on the surface of the active element <NUM> may be calculated from the size of the active element <NUM> and its output value of the energy. The energy flux on the surface of the treated tissue may be calculated from the size of the treated tissue exactly below the active element <NUM> and its input value of the energy provided by the active element <NUM>. In addition, the RF electrode positioned in the pad <NUM> may act as an acoustic window for ultrasound energy.

The active element <NUM> may provide a secondary energy from secondary generator <NUM> in the form of an electric current or a magnetic field. By applying the secondary energy to the treated area of the body of the patient, muscle fiber stimulation may be achieved, thus increasing muscle tone, muscle strengthening, restoration of feeling in the muscle, relaxation of the musculature and/or stretching musculature.

The proposed device may provide an electrotherapy in case that the secondary energy delivered by the active element <NUM> (e.g. a radiofrequency electrode or simply referred to just as an electrode) is the electric current. The main effects of electrotherapy are: analgesic, myorelaxation, iontophoresis, anti-edematous effect or muscle stimulation causing a muscle fiber contraction. Each of these effects may be achieved by one or more types of electrotherapy: galvanic current, pulse direct current and alternating current.

Galvanic current (or "continuous") is a current that may have a constant electric current and/or absolute value of the electric current is in every moment higher than <NUM>. It may be used mostly for iontophoresis, or its trophic stimulation (hyperemic) effect is utilized. This current may be substituted by galvanic intermittent current. Additionally, a galvanic component may be about <NUM> % but due to interruption of the originally continuous intensity the frequency may reach <NUM>-<NUM> or <NUM>-<NUM> or <NUM>-<NUM> or <NUM>-<NUM>.

The pulse direct current (DC) is of variable intensity but only one polarity. The basic pulse shape may vary. It includes e.g. diadynamics, rectangular, triangular and exponential pulses of one polarity. Depending on the used frequency and intensity it may have stimulatory, tropic, analgesic, myorelaxation, iontophoresis, at least partial muscle contraction and anti-edematous effect and/or other.

Alternating Current (AC or biphasic) is where the basic pulse shape may vary - rectangular, triangular, harmonic sinusoidal, exponential and/or other shapes and/or combinations of those mentioned above. It can be alternating, symmetric and/or asymmetric. Use of alternating currents in contact electrotherapy implies much lower stress on the tissue under the electrode. For these types of currents the capacitive component of skin resistance is involved, and due to that these currents are very well tolerated by patients.

AC therapies may be differentiated to five subtypes: TENS, Classic (four-pole) Interference, Two-pole Interference, Isoplanar Interference and Dipole Vector Field. There also exist some specific electrotherapy energy variants and modularity of period, shape of the energy etc..

Due to interferential electrotherapy, different nerves and tissue structures by medium frequency may be stimulated in a range of <NUM> to <NUM> or in a range of <NUM> to <NUM>, or <NUM> to <NUM>, creating pulse envelopes with frequencies for stimulation of the nerves and tissues e.g. sympathetic nerves (<NUM>-<NUM>), parasympathetic nerves (<NUM>-<NUM>), motor nerves (<NUM>-<NUM>), smooth muscle (<NUM>-<NUM>), sensor nerves (<NUM>-<NUM>) nociceptive fibers (<NUM>-<NUM>).

Electrotherapy may provide stimulus with currents of frequency in the range from <NUM> to <NUM> or in the range from <NUM> to <NUM> or in the range from <NUM> to <NUM>.

Muscle fiber stimulation by electrotherapy may be important during and/or as a part of RF treatment. Muscle stimulation increases blood flow and lymph circulation. It may improve removing of treated cells and/or prevent hot spot creation. Moreover internal massage stimulation of adjoining tissues improves homogeneity of tissue and dispersing of the delivered energy. The muscle fiber stimulation by electrotherapy may cause muscle contractions, which may lead to improvement of a visual appearance of the patient through muscle firming and strenghtening, Another beneficial effect is for example during fat removing with the RF therapy. RF therapy may change structure of the fat tissue. The muscle fiber stimulation may provide internal massage, which may be for obese patient more effective than classical massage.

Muscle stimulation may be provided by e.g. intermittent direct currents, alternating currents (medium-frequency and TENS currents), faradic current as a method for multiple stimulation and/or others.

Frequency of the currents may be in the range from <NUM> to <NUM> or from <NUM> to <NUM> or from <NUM> to <NUM> or from <NUM> to <NUM>.

Frequency of the current envelope is typically in the range from <NUM> to <NUM> or from <NUM> to <NUM> or from <NUM> to <NUM> or from <NUM> to <NUM>.

The electrostimulation may be provided in a combined manner where various treatments with various effects may be achieved. As an illustrative example, the electromagnetic energy with the electrostimulation may be dosed in trains of pulses of electric current where the first train of electrostimulation may achieve a different effect than the second or other successive train of stimulation. Therefore, the treatment may provide muscle fiber stimulation or muscle contractions followed by relaxation, during continual or pulsed radiofrequency thermal heating provided by electromagnetic energy provided by an electromagnetic energy generator.

The electrostimulation may be provided by in a monopolar, unipolar, bipolar or multipolar mode.

An absolute value of voltage between the electrotherapy electrodes operated in bipolar, multipolar mode (electric current flow between more than two electrodes) and/or provided to at least one electrotherapy electrode may be in a range between <NUM> V and <NUM> kV; or in a range between <NUM> V and <NUM> kV; or in a range between <NUM> V and <NUM> V or in a range between <NUM> V and <NUM> V.

A current density of electrotherapy for non-galvanic current may be in a range between <NUM> mA/cm<NUM> and <NUM> mA/cm<NUM>, or in a range between <NUM> mA/cm<NUM> and <NUM> mA/cm<NUM>, or in a range between <NUM> mA/cm<NUM> and <NUM> mA/cm<NUM>, or in a range between <NUM> mA/cm<NUM> and <NUM> mA/cm<NUM>; for galvanic current may be preferably in a range between <NUM> mA/cm<NUM> and <NUM> mA/cm<NUM>, or in a range between <NUM> mA/cm<NUM> and l mA/cm<NUM>,or in a range between <NUM> mA/cm<NUM> and <NUM> mA/cm<NUM>. The current density may be calculated on the surface of the electrode providing the electrotherapy to the patient.

During electrotherapy, e.g. bipolar electrotherapy, two or more electrodes may be used. If polarity of at least one electrode has a non-zero value in a group of the electrodes during bipolar mode, the group of the electrodes has to include at least one electrode with an opposite polarity value. Absolute values of both electrode polarities may or may not be equal. In bipolar electrostimulation mode, a stimulating signal passes through the tissue between electrodes with opposite polarities.

The distance between two electrodes operating in bipolar mode may be in a range between <NUM> and <NUM> or in a range between <NUM> to <NUM> or in a range between <NUM> and <NUM> or in a range between <NUM> and <NUM> or in a range of <NUM> and <NUM> or in a range between <NUM> and <NUM>, or in a range between <NUM> and <NUM>.

During monopolar electrotherapy mode, a stimulating signal may be induced by excitement of action potential by changing polarity of one electrode that changes polarization in the nerve fiber and/or neuromuscular plague.

During the electrotherapy, one of the bipolar or monopolar electrotherapy mode may be used or bipolar or monopolar electrotherapy modes may be combined.

The ultrasound emitters may provide focused or defocused ultrasound energy. The ultrasound energy may be transferred to the tissue through an acoustic window. The output power of the ultrasound energy on the surface of the active element <NUM> may be less than or equal to <NUM> W or <NUM> W or <NUM> W or <NUM> W. Ultrasound energy may provide energy flux on the surface of the active element <NUM> or on the surface of the treated tissue (e.g. skin) in the range of <NUM> W/cm<NUM> to <NUM> W/cm<NUM>, or in the range of <NUM> W/cm<NUM> to <NUM> W/cm<NUM>, or in the range of <NUM> W/cm<NUM> to <NUM> W/cm<NUM>, or in the range of <NUM> W/cm<NUM> to <NUM> W/cm<NUM>. The treatment depth of ultrasound energy may be in the range of <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM>. At a depth of <NUM> the ultrasound energy may provide an energy flux in the range of <NUM> W/cm<NUM> to <NUM> W/cm<NUM> or <NUM> W/cm<NUM> to <NUM> W/cm<NUM>. An ultrasound beam may have a beam non-uniformity ratio (RBN) in the range of <NUM> to <NUM> or <NUM> to <NUM> to <NUM> to <NUM>. In addition, an ultrasound beam may have a beam non-uniformity ratio below <NUM> or below <NUM>. An ultrasound beam may be divergent, convergent and/or collimated. The ultrasound energy may be transferred to the tissue through an acoustic window. It is possible that the RF electrode may act as the acoustic window. Furthermore, the ultrasound emitter <NUM> may be a part of the active element <NUM>, thus ultrasound emitter <NUM> may be a part of the pad <NUM>.

At least some of the active elements <NUM> may be capable of delivering energy from primary electromagnetic generator <NUM> or secondary generator <NUM> or ultrasound emitter <NUM> simultaneously (at the same time), successively or in an overlapping method or in any combination thereof. For example, the active element <NUM> may be capable of delivering radiofrequency energy and electric current sequentially, which may mean that firstly the active element <NUM> may provide primary electromagnetic energy generated by the primary electromagnetic generator <NUM> and subsequently the active element <NUM> may provide the secondary energy generated by the secondary generator <NUM>. Thus the active element <NUM> may e.g. apply radiofrequency energy to the tissue of the patient and then the same active element <NUM> may apply e.g. electrical current to the tissue of the patient.

Pad <NUM> may further comprise thermal sensors <NUM> enabling temperature control during the therapy, providing feedback to CPU <NUM>, enabling adjustment of treatment parameters of each active element and providing information to the operator. The thermal sensor <NUM> may be a contact sensor, contactless sensor (e.g. infrared temperature sensor) or invasive sensor (e.g. a thermocouple) for precise temperature measurement of deep layers of skin, e.g. epidermis, dermis or hypodermis. The CPU <NUM> may also use algorithms to calculate the deep or upper-most temperatures. A temperature feedback system may control the temperature and based on set or pre-set limits alert the operator in human perceptible form, e.g. on the human machine interface <NUM> or via indicators <NUM>. In a limit temperature condition, the device may be configured to adjust one or more treatment parameters, e.g. output power, switching mode, pulse length, etc. or stop the treatment. A human perceptible alert may be a sound, alert message shown on human machine interface <NUM> or indicators <NUM> or change of color of any part of the interconnecting block <NUM> or pad <NUM>.

Memory <NUM> may include, for example, information about the type and shape of the pad <NUM>, its remaining lifetime, or the time of therapy that has already been performed with the pad.

Neutral electrode <NUM> may ensure proper radiofrequency distribution within the patient's body for mono-polar radiofrequency systems. The neutral electrode <NUM> is attached to the patient's skin prior to each therapy so that the energy may be distributed between active element <NUM> and neutral electrode <NUM>. In some bipolar or multipolar radiofrequency systems, there is no need to use a neutral electrode - radiofrequency energy is distributed between multiple active elements <NUM>. Neutral electrode <NUM> represents an optional block of the apparatus <NUM> as any type of radiofrequency system can be integrated.

Additionally, device <NUM> may include one or more sensors. The sensor may provide information about at least one physical quantity and its measurement may lead to feedback which may be displayed by human machine interface <NUM> or indicators <NUM>. The one or more sensors may be used for sensing delivered electromagnetic energy, impedance of the skin, resistance of the skin, temperature of the treated skin, temperature of the untreated skin, temperature of at least one layer of the skin, water content of the device, the phase angle of delivered or reflected energy, the position of the active elements <NUM>, the position of the interconnecting block <NUM>, temperature of the cooling media, temperature of the primary electromagnetic generator <NUM> and secondary generator <NUM> and ultrasound emitter <NUM> or contact with the skin. The sensor may be a thermal, acoustic, vibration, electric, magnetic, flow, positional, optical, imaging, pressure, force, energy flux, impedance, current, Hall or proximity sensor. The sensor may be a capacitive displacement sensor, acoustic proximity sensor, gyroscope, accelerometer, magnetometer, infrared camera or thermographic camera. The sensor may be invasive or contactless. The sensor may be located on or in the pad <NUM>, in the main unit <NUM>, in the interconnecting block <NUM> or may be a part of a thermal sensor <NUM>. One sensor may measure more than one physical quantity. For example, the sensor may include a combination of a gyroscope, an accelerometer and/or a magnetometer. Additionally, the sensor may measure one or more physical quantities of the treated skin or untreated skin.

A resistance sensor may measure skin resistance, because skin resistance may vary for different patients, as well as the humidity - wetness and sweat may influence the resistance and therefore the behavior of the skin in the energy field. Based on the measured skin resistance, the skin impedance may also be calculated.

Information from one or more sensors may be used for generation of a pathway on a model e.g. a model of the human body shown on a display of human machine interface <NUM>. The pathway may illustrate a surface or volume of already treated tissue, presently treated tissue, tissue to be treated, or untreated tissue. A model may show a temperature map of the treated tissue providing information about the already treated tissue or untreated tissue.

The sensor may provide information about the location of bones, inflamed tissue or joints. Such types of tissue may not be targeted by electromagnetic energy due to the possibility of painful treatment. Bones, joints or inflamed tissue may be detected by any type of sensor such as an imaging sensor (ultrasound sensor, IR sensor), impedance sensor, and the like. A detected presence of these tissue types may cause general human perceptible signals or interruption of generation of electromagnetic energy. Bones may be detected by a change of impedance of the tissue or by analysis of reflected electromagnetic energy.

The patient's skin over at least one treatment portion may be pre-cooled to a selected temperature for a selected duration, the selected temperature and duration for pre-cooling may be sufficient to cool the skin to at least a selected temperature below normal body temperature. The skin may be cooled to at least the selected temperature to a depth below the at least one depth for the treatment portions so that the at least one treatment portion is substantially surrounded by cooled skin. The cooling may continue during the application of energy, and the duration of the application of energy may be greater than the thermal relaxation time of the treatment portions. Cooling may be provided by any known mechanism including water cooling, sprayed coolant, presence of an active solid cooling element (e.g. thermoelectric cooler) or air flow cooling. A cooling element may act as an optical element. Alternatively, the cooling element may be a spacer. Cooling may be provided during, before or after the treatment with electromagnetic energy. Cooling before treatment may also provide an environment for sudden heat shock, while cooling after treatment may provide faster regeneration after heat shock. The temperature of the coolant may be in the range of -<NUM> to <NUM>. The temperature of the cooling element during the treatment may be in the range of -<NUM> to <NUM> or -<NUM> to <NUM> or -<NUM> to <NUM>. Further, where the pad is not in contact with the patient's skin, cryogenic spray cooling, gas flow or other non-contact cooling techniques may be utilized. A cooling gel on the skin surface might also be utilized, either in addition to or instead of, one of the cooling techniques indicated above.

<FIG> show different shapes and layouts of pad <NUM> used by an apparatus for contact therapy. Pads <NUM> comprise at least one active element <NUM> and may be available in various shapes and layouts so that they may cover a variety of different treatment areas and accommodate individual patient needs, e.g. annular, semicircular, elliptical, oblong, square, rectangular, trapezoidal, polygonal or formless (having no regular form or shape). The shapes and layouts of the pad <NUM> may be shaped to cover at least part of one or more of the periorbital area, the forehead (including frown lines), the jaw line, the perioral area (including Marionette lines, perioral lines - so called smoker lines, nasolabial folds, lips and chin), cheeks or submentum, etc. The shape of the pad <NUM> and distribution, size and number of active elements <NUM> may differ depending on the area being treated, e.g. active elements <NUM> inside the pad <NUM> may be in one line, two lines, three lines, four lines or multiple lines. The pad <NUM> with active elements <NUM> may be arranged into various shapes, e.g. in a line, where the centers of at least two active elements <NUM> lie in one straight line, while any additional center of an active element <NUM> may lie in the same or different lines inside the pad <NUM>.

In addition, the pad <NUM> may be used to treat at least partially neck, bra fat, love handles, torso, back, abdomen, buttocks, thighs, calves, legs, arms, forearms, hands, fingers or body cavities (e.g. vagina, anus, mouth, inner ear etc.).

The pad <NUM> may have a rectangular, oblong, square, trapezoidal form, or of the form of a convex or concave polygon wherein the pad <NUM> may have at least two different inner angles of the convex or concave polygon structure. Additionally, the pad <NUM> may form at least in part the shape of a conic section (also called conic), e.g. circle, ellipse, parabola or hyperbola. The pad <NUM> may have at least in part one, two, three, four, five or more curvatures of a shape of an arc with the curvature k in the range of <NUM> to <NUM>-<NUM> or in the range of <NUM> to <NUM>-<NUM> or in the range of <NUM> to <NUM>-<NUM> or in the range of <NUM> to <NUM>-<NUM>. The pad <NUM> may have at least one, two, three, four, five or more arcs with the curvature k or may have at least two different inner angles of a convex or concave polygon structure, and may be suitable for the treatment of chin, cheeks, submental area (e.g. "banana shape <NUM>" <NUM>), for treating jaw line, perioral area, Marionette lines and nasolabial folds (e.g. "banana shape <NUM>" <NUM>), for the treatment of periorbital area (e.g. "horseshoe shape" <NUM>) or other regions of face and neck. The "banana shape" pad <NUM> or <NUM> may have a convex-concave shape, which means that one side is convex and the opposite side is concave, that occupies at least <NUM> % to <NUM>% or <NUM> % to <NUM> % or <NUM> % to <NUM> % or <NUM> % to <NUM>% of a total circumference of the pad <NUM> seen from above, wherein the shortest distance between the endpoints <NUM>. 21a and <NUM>. 21b of the "banana shape" pad <NUM> (dashed line in <FIG>) is longer than the shortest distance between the endpoint <NUM>. 21a or <NUM>. 21b and the middle point <NUM> of the "banana shape" (full line in pad <NUM> in <FIG>). The "horseshoe shape" <NUM> seen from above may have the convex-concave shape that occupies at least <NUM> % to <NUM> % or <NUM> % to <NUM> % or <NUM> % to <NUM> % or <NUM> % to <NUM> % of its total circumference, wherein the shortest distance between the endpoints <NUM>. 31a and <NUM>. 31b of the "horseshoe shape" pad <NUM> (dashed line in <FIG>) is equal or shorter than the shortest distance between the endpoint <NUM>. 31a or <NUM>. 31b and the middle point <NUM> of the "horseshoe shape" (full line in pad <NUM> in <FIG>). When seen from above, if the longest possible center curve, which may be convex or concave and whose perpendiculars at a given point have equidistant distance from perimeter edges of the pad at each of its points (dotted line in pad <NUM> in <FIG>), intersects the circumference of the pad <NUM> then this point is the endpoint of the pad, e.g. endpoint <NUM>. 21a or <NUM>. The middle point, e.g. <NUM>, is then given as the middle of the center curve, wherein the total length of the center curve is given by two endpoints, e.g. <NUM>. 21a and <NUM>. 21b, thus the length of the center curve (dotted line in pad <NUM> in <FIG>) from point <NUM>. 21a to point <NUM> is the same as the length from point <NUM>. 21b to point <NUM>. The total length of the center curve may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>.

In addition, the center curve may have at least in part circular, elliptical, parabolic, hyperbolic, exponential, convex or concave curve such that the straight line connecting endpoint of the pad <NUM> with the middle point of the center curve forms an angle alpha with the tangent of the middle of the center curve. The angle alpha may be in a range of <NUM>° to <NUM>° or in a range of <NUM>° to <NUM>° or in a range of <NUM>° to <NUM>° or in a range of <NUM>° to <NUM>°.

The pad <NUM> whose shape has at least two concave arcs with the curvature k or has at least two concave inner angles of the polygon structure may be suitable for the treatment of the forehead like the "T shape" <NUM> in <FIG>. The "T shape" <NUM> may be also characterized by the arrangement of the active elements <NUM> where the centers of at least two active elements <NUM> lie in one straight line and center of at least one additional element <NUM> lies in a different line.

Pads may have different sizes with the surface areas ranging from <NUM> to <NUM><NUM> or from <NUM> to <NUM><NUM> or from <NUM> to <NUM><NUM> or in the range of <NUM> to <NUM><NUM>. The pad may occupy approximately <NUM> to <NUM> % or <NUM> to <NUM> % or <NUM> to <NUM> % or <NUM> to <NUM> % of the face. The number of active elements <NUM> within a single pad <NUM> ranges from <NUM> to <NUM> or from <NUM> to <NUM> or from <NUM> to <NUM> or from <NUM> to <NUM>. A thickness at least in a part of the pad <NUM> may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>.

Furthermore the pads <NUM> may have a shape that at least partially replicates the shape of galea aponeurotica, procerus, levatar labii superioris alaeque nasi, nasalis, lavator labii superioris, zygomaticus minor, zygomaticus major, levator angulis oris, risorius, platysma, depressor anguli oris, depressor labii inferioris, occipitofrontalis (frontal belly), currugator supercilii, orbicularis oculi, buccinator, masseter, orbicularis oris or mentalis muscle when the pad <NUM> is attached to the surface of the patient skin.

The pad <NUM> may be characterized by at least one aforementioned aspect or by a combination of more than one aforementioned aspect or by a combination of all aforementioned aspects.

The electromagnetic energy generator <NUM> or the secondary generator <NUM> inside the main case may generate an electromagnetic or secondary energy (e.g. electric current) which may be delivered via a conductive lead to at least one active element <NUM> attached to the skin, respectively. The active element <NUM> may deliver energy through its entire surface or by means of a so-called fractional arrangement. Active element <NUM> may comprise an active electrode in a monopolar, unipolar, bipolar or multipolar radiofrequency system. In the monopolar radiofrequency system, energy is delivered between an active electrode (active element <NUM>) and a neutral electrode <NUM> with a much larger surface area. Due to mutual distance and difference between the surface area of the active and neutral electrode, energy is concentrated under the active electrode enabling it to heat the treated area. In the unipolar, bipolar or multipolar radiofrequency system, there is no need for neutral electrode <NUM>. In the bipolar and multipolar radiofrequency system, energy is delivered between two and multiple active electrodes with similar surface area, respectively. The distance between these electrodes determines the depth of energy penetration. In the unipolar radiofrequency system, only a single active electrode is incorporated and energy is delivered to the tissue and environment surrounding the active electrode. The distance between the two nearest active elements <NUM> (e.g. the nearest neighbouring sides of electrodes) in one pad <NUM> may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>.

<FIG> represents a side view of the pad <NUM> configured for contact therapy. Pads <NUM> may be made of flexible substrate material <NUM> - polyimide (PI) films, teflon, epoxy or PE foam with an additional adhesive layer <NUM> on the underside. They may be of different shapes to allow the operator to choose according to the area to be treated. Active elements <NUM> may have a circumference of annular, semicircular, elliptical, oblong, square, rectangular, trapezoidal or polygonal shape with a surface area in the range from <NUM> to <NUM><NUM> or from <NUM> to <NUM><NUM> or from <NUM> to <NUM><NUM> or from <NUM> to <NUM><NUM>. The material used may be copper, aluminium, lead or any other conductive medium that can be deposited or integrated in the pad. Furthermore the active elements <NUM> (e.g. electrodes) may be made of silver, gold or graphite. Electrodes <NUM> in the pad <NUM> may be printed by means of biocompatible ink, such as silver ink, graphite ink or a combination of inks of different conductive materials.

The active element <NUM> (e.g. electrode providing radiofrequency field and/or electric field) may be full-area electrode that has a full active surface. This means that the whole surface of the electrode facing the patient may be made of conductive material deposited or integrated in the pad <NUM> as mentioned above.

Alternatively, the surface of the electrode <NUM> facing the patient may be formed from a combination of a conductive (e.g. copper) and a non-conductive material (for example dielectric material, insulation material, substrate of the pad, air or hydrogel). The electrode <NUM> may be framed by a conductive material and the inside of the frame may have a combination of conductive and non-conductive material. The frame may create the utmost circumference of the electrode from the side facing the patient. The frame may have an annular, semicircular, elliptical, oblong, square, rectangular, trapezoidal or polygonal shape. The inside of the frame <NUM> may have a structure of a grid <NUM> as shown in <FIG> with the non-conductive part <NUM>. The frame <NUM> may be of the same thickness as the thickness of the grid lines <NUM> or the thickness of the frame <NUM> may be thicker than the grid lines <NUM> in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> %. Additionally the frame <NUM> may be thinner than the grid lines <NUM> in the range of <NUM> times to <NUM> times or in the range of <NUM> times to <NUM> times or in the range of <NUM> times to <NUM> times or in the range of <NUM> times to <NUM> times. It may be also possible to design the electrode such that the conductive material of the electrode is getting thinner from the center <NUM> of the electrode <NUM> as shown in <FIG>. The thinning step between adjacent grid lines <NUM> in the direction from the center <NUM> may be in the range of of <NUM> times to <NUM> times or in the range of <NUM> times to <NUM> times or in the range of <NUM> times to <NUM> times with the frame <NUM> having the thinnest line of conductive material. Alternatively, the electrode may not be framed, e.g. it may have a form of a grid with no boundaries as shown in <FIG>. A ratio of conductive to non-conductive material of the electrode may be in the range of <NUM> % to <NUM> %, or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> %. Additionally the ratio of conductive to non-conductive material of the electrode may be in the range of <NUM> % to <NUM> %, or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> % or in the range of <NUM> % to <NUM> %. Such a grated electrode may be very advantageous. It may be much more flexible, it may ensure contact with the patient that is more proper and it may have much better self-cooling properties than full-area electrode.

In cases where the active element <NUM> is in the form of the grated electrode, the energy flux of the grated electrode may be calculated as an energy flux of the grid <NUM> and/or the frame <NUM> of the active element <NUM> and may be in the range of <NUM> W/cm<NUM> to <NUM> W/cm<NUM> or <NUM> W/cm<NUM> to <NUM> W/cm<NUM> or <NUM> W/cm<NUM> to <NUM> W/cm<NUM>.

The active elements <NUM> may be partially embedded within the flexible substrate layer <NUM> or adhesive layer <NUM> or in the interface of the flexible substrate layer <NUM> and adhesive layer <NUM>. The active elements <NUM> may be supplied and controlled independently by multiple conductive leads 41a or they may be conductively interconnected and supplied/controlled via a single conductive lead 41b. The multiple conductive leads 41a may be connected to the active elements <NUM> via a free space (e.g. hole) in the flexible substrate layer <NUM>. The free space (e.g. hole) may have such dimensions that each conductive lead 41a may fit tightly into the substrate layer <NUM>, e.g. the conductive lead 41a may be encapsulated by flexible substrate layer <NUM>. In case of a single conductive lead connection, the active elements <NUM> may be partially embedded inside the flexible substrate <NUM> or adhesive layer <NUM> or in the interface of the flexible substrate layer <NUM> and adhesive layer <NUM>, and the active elements <NUM> may be connected via single conductive lead 41b which may be situated in the flexible substrate <NUM> or at the interface of the flexible substrate <NUM> and adhesive layer <NUM>. The single conductive lead 41b may leave the pad <NUM> on its lateral or top side in a direction away from the patient. In both cases the conductive lead 41a or 41b does not come into contact with the treatment area.

Additionally, the active elements <NUM> may be partially embedded within the flexible substrate <NUM> and the adhesive layer <NUM> may surround the active elements <NUM> such that a surface of active elements <NUM> may be at least partially in direct contact with the surface of a treatment area.

Total pad thickness in the narrower spot may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>.

The apparatus configured in a fractional arrangement may have the active element <NUM> comprising a matrix formed by active points of defined size. These points are separated by inactive (and therefore untreated) areas that allow faster tissue healing. The surface containing active points may make up from <NUM> to <NUM> % or from <NUM> to <NUM> % or from <NUM> to <NUM> % or from <NUM> to <NUM> % of the whole active element area. The active points may have blunt ends at the tissue contact side that do not penetrate the tissue, wherein the surface contacting tissue may have a surface area in the range of <NUM><NUM> to <NUM><NUM><NUM> or in the range of <NUM><NUM> to <NUM><NUM><NUM> or in the range of <NUM><NUM> to <NUM><NUM><NUM> or in the range of <NUM><NUM> to <NUM><NUM><NUM>. The blunt end may have a radius of curvature of at least <NUM>. A diameter of the surface contacting tissue of one active point may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>.

Additionally, the device may employ a safety system comprising thermal sensors and a circuit capable of adjusting the therapy parameters based on the measured values. One or more thermal sensors, depending on the number and distribution of active elements <NUM>, may be integrated onto pad <NUM> to collect data from different points so as to ensure homogeneity of heating. The data may be collected directly from the treatment area or from the active elements <NUM>. If uneven heating or overheating is detected, the device may notify the operator and at the same time adjust the therapy parameters to avoid burns to the patient. Treatment parameters of one or more active elements might be adjusted. The main therapy parameters are power, duty cycle and time period regulating switching between multiple active elements <NUM>. Therapy may be automatically stopped if the temperature rises above the safe threshold.

Furthermore, impedance measurement may be incorporated in order to monitor proper active element <NUM> to skin contact. If the impedance value is outside the allowed limits, the therapy may be automatically suspended and the operator may be informed about potential contact issues.

CPU <NUM> may be incorporated onto the pad <NUM> itself or it may form a separate part conductively connected to the pad <NUM>. In addition to the control mechanism, CPU <NUM> may also contain main indicators (e.g. ongoing therapy, actual temperature and active element to skin contact).

<FIG> shows some delivery approaches of apparatus for contact therapy.

It is possible to switch between multiple active elements <NUM> within the single pad <NUM> in such a way so that the multiple active elements <NUM> deliver energy simultaneously, successively or in an overlapping method or any combination thereof. For example, in the case of two active elements: in the simultaneous method, both active elements are used simultaneously during the time interval e.g., <NUM>-<NUM>. In the successive method, the first active element is used during the first time interval e.g., from <NUM> to <NUM>. The first active element is then stopped and the second active element is immediately used in a subsequent time interval e.g., from <NUM> to <NUM>. This successive step may be repeated. In the overlapping method, the first active element is used during a time interval for e.g., <NUM>-<NUM>, and the second active element is used in a second overlapping time interval for e.g., <NUM>-<NUM>, wherein during the second time interval the first active element and the second active element are overlapping e.g., with total overlapping method time of <NUM>-<NUM>. Active elements <NUM> may deliver energy sequentially in predefined switching order or randomly as set by operator via human machine interface <NUM>. Schema I in <FIG> represents switching between pairs/groups formed of non-adjacent active elements <NUM> located within a pad <NUM>. Every pair/group of active elements <NUM> is delivering energy for a predefined period of time (dark gray elements in <FIG> - in schema I elements <NUM> and <NUM>) while the remaining pairs/groups of active elements <NUM> remain inactive in terms of energy delivery (light gray elements in <FIG> - in schema I elements <NUM> and <NUM>). After a predefined period of time, energy is delivered by another pair/group of active elements <NUM> and the initial active elements become inactive. This is indicated by arrows in <FIG>. Switching between pairs/groups of active elements <NUM> may continue until a target temperature is reached throughout the entire treatment area or a predefined energy is delivered by all active elements <NUM>. Schema II in <FIG> represents switching of all active elements <NUM> within the pad <NUM> between state ON when active elements are delivering energy and OFF when they are not delivering energy. The duration of ON and OFF states may vary depending on predefined settings and/or information provided by sensors, e.g. thermal sensors. Schema III in <FIG> shows sequential switching of individual active elements <NUM> within a pad <NUM>. Each active element <NUM> is delivering energy for predefined periods of time until a target temperature is reached throughout the entire treatment area or a predefined energy is delivered by all active elements <NUM>. This sequential switching may be executed in a clockwise or anticlockwise order. Schema IV in <FIG> represents a zig-zag switching order during which preferably non-adjacent active elements <NUM> deliver energy sequentially until all active elements <NUM> within a pad <NUM> have been switched ON. Each active element <NUM> delivers energy for a predefined period of time until a target temperature is reached throughout the entire treatment area or a predefined energy is delivered by all active elements.

The CPU may be configured to control the stimulation device and provide treatment by at least one treatment protocol improving visual appearance. A treatment protocol is set of parameters of the primary electromagnetic energy and the secondary energy ensuring the desired treatment effect. Each pad may be controlled to provide the same or alternatively a different protocol. Pair areas or areas where symmetrical effect is desired may be treated with the same treatment protocol. Each protocol may include one or several sections or steps.

As a non-limiting example: in a case of applying radiofrequency energy by the active elements one by one as shown in Schema III and IV in <FIG>, the time when one active element delivers the radiofrequency energy to the tissue of the patient may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. Two consecutive elements may be switched ON and OFF in successive or overlapping method. Additionally, the delivery of the radiofrequency energy by two consecutive active elements may be separated by a time of no or low radiofrequency stimulation, such that none of the two consecutive active elements provides a radiofrequency heating of the treatment tissue. The time of no or low radiofrequency stimulation may be in the range of <NUM> to <NUM>, or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>.

In case of a treatment when more than one pad is used, the sequential switching of the active elements providing radiofrequency treatment may be provided within each pad independently of the other pads or active elements may deliver energy sequentially through all pads.

As an example for three dependent pads, each with two active elements:.

In case that the pads are treating paired areas (e.g. cheeks, thighs or buttocks), where symmetrical effect is desired, the pair pads may be driven by the same protocol at the same time.

An example of a treatment protocol for one pad delivering radiofrequency energy for heating of the patient and electric current causing the muscle contractions is as follows. The protocol may include a first section where electrodes in one pad may be treated such that the electrodes provide electric current pulses modulated in an envelope of increasing amplitude modulation (increasing envelope) followed by constant amplitude (rectangle envelope) followed by decreasing amplitude modulation (decreasing envelope), all these three envelopes may create together a trapezoidal amplitude modulation (trapezoidal envelope). The trapezoidal envelope may last <NUM> to <NUM> seconds or <NUM> to <NUM> seconds or <NUM> to <NUM> seconds. The increasing, rectangle, or decreasing envelope may last for <NUM> to <NUM> seconds or <NUM> to <NUM> seconds or <NUM> to <NUM> seconds. The increasing and decreasing envelopes may last for the same time, thus creating a symmetrical trapezoid envelope. Alternatively, the electric current may be modulated to a sinusoidal envelope or rectangular envelope or triangular envelope. The respective envelopes causing muscle contractions may be separated by a time of no or low current stimulation, such that no muscle contraction is achieved or by a radiofrequency energy causing the heating of the tissue. During this time of no muscle contraction, a pressure massage may be provided by suction openings, which may cause relaxation of the muscles. The first section may be preprogrammed such that electrodes on various places of the pad may be switched in time to provide alternating current pulses wherein some other electrodes in the pad may not provide any alternating current pulses but only RF pulses causing heating of the tissue. All electrodes in the pad may ensure providing (be switched by the switching circuitry <NUM> to provide) RF pulses for heating the tissue during a section of protocol or protocol, while only a limited number of the electrodes may provide (be switched by the switching circuitry <NUM> to provide) alternating currents for muscle contracting during a section of a protocol or a protocol. The device may be configured such that the first section lasts for <NUM>-<NUM> minutes.

A second section may follow the first section. The second section may be preprogrammed such that different electrodes than the ones used in the first section on various places of the pad may be switched in time to provide alternating current pulses wherein some other electrodes (same or different electrodes than the ones used in the first section) in the pad may not provide any alternating current pulses but only RF pulses causing heating of the tissue.

A third section may follow the second section. The third section may be preprogrammed such that different electrodes than the ones used in the second section on various places of the pad may be switched in time to provide alternating current pulses wherein some other electrodes (the same or different electrodes than the ones used in the second section) in the pad may not provide any alternating current pulses but only RF pulses causing heating of the tissue.

The protocol may be preprogrammed such that the electrodes providing the electric current causing the muscle contractions are switched to provide radiofrequency heating after they produce a maximum of one, two, three, four or five contractions.

The respective sections are assembled by the control unit (CPU) in the treatment protocol to provide at least <NUM>-<NUM> contractions or <NUM>-<NUM> contractions, or <NUM>-<NUM> contractions by a single pad.

A forehead pad may include a layout of electrodes such that the anatomical area <NUM> and anatomical area <NUM> are stimulated by alternating currents which may cause muscle contractions while anatomical area <NUM> is not stimulated by alternating currents causing muscle contractions. The control unit (CPU) is configured to provide a treatment protocol energizing by alternating electric currents only those electrodes located in proximity to or above the anatomical areas <NUM> and <NUM>; and energizing electrode/electrodes in proximity of or above anatomical area <NUM> by radiofrequency signal only as shown in <FIG>. The anatomical areas <NUM> and <NUM> may comprise the Frontalis muscles and the anatomical area <NUM> may comprise the center of the Procerus muscle.

A pad used for a treatment of the cheek (either side of the face below the eye) may include a layout of electrodes such that the anatomical area comprising the Buccinator muscle, the Masseter muscle, the Zygomaticus muscles or the Risorius muscle are stimulated by electrical currents, which may cause muscle contractions, wherein other anatomical areas may be only heated by radiofrequency energy.

On the contrary the pad may be configured such, that the layout of electrodes close to the eyes (e.g. the body part comprising Orbicularis oculi muscles) or teeth (e.g. the body part comprising Orbicularis oris muscles) may not provide energy causing muscle contractions.

The treatment device may be configured such, that in each section or step an impedance sensor provides information about the contact of the pad or active element with the patient to the CPU. The CPU may determine, based on pre-set conditions, if the contact of the pad or active element with the patient is sufficient or not. In case of sufficient contact, the CPU may allow the treatment protocol to continue. In case that the contact is inappropriate, the valuated pad or active element is turned off and the treatment protocol continues to a consecutive pad or active element or the treatment is terminated. The determination of proper contact of the pad or active element may be displayed on human machine interface <NUM>.

An impedance measurement may be made at the beginning of the section/step, during the section/step or at the end of the section/step. The impedance measurement and/or the proper contact evaluation may be determined only on the active electrodes for the given section/step or may be made on all electrodes of all pads used during the section/step.

<FIG> and <FIG>, showing an embodiment not covered by the subject-matter of claim <NUM>, are discussed together. <FIG> shows a block diagram of an apparatus for contactless therapy <NUM>. <FIG> is an illustration of an apparatus for contactless therapy <NUM>. Apparatus for contactless therapy <NUM> may comprise two main blocks: main unit <NUM> and a delivery head <NUM> interconnected via fixed or adjustable arm <NUM>.

Main unit <NUM> may include electromagnetic generator <NUM> which may generate one or more forms of electromagnetic radiation wherein the electromagnetic radiation may be e.g., in the form of incoherent light or in the form of coherent light (e.g. laser light) of predetermined wavelength. The electromagnetic field may be primarily generated by a laser, laser diode module, LED, flash lamp or incandescent light bulb. The electromagnetic radiation may be such that it may be at least partially absorbed under the surface of the skin of the patient. The wavelength of the applied radiation may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or it may be in the form of second, third, fourth, fifth, sixth, seventh or eighth harmonic wavelengths of the above mentioned wavelength ranges. Main unit <NUM> may further comprise a human machine interface <NUM> represented by display, buttons, keyboard, touchpad, touch panel or other control members enabling an operator to check and adjust therapy and other device parameters. The power supply <NUM> located in the main unit may include a transformer, disposable battery, rechargeable battery, power plug or standard power cord. The output power of the power supply <NUM> may be in the range of <NUM> W to <NUM> W, or in the range of <NUM> W to <NUM> W, or in the range of <NUM> W to <NUM> W. Indicators <NUM> may provide additional information about the current status of the device independently on human machine interface <NUM>. Indicators <NUM> may be realized through the display, LEDs, acoustic signals, vibrations or other forms capable of adequate notice.

Delivery head <NUM> may be interconnected with the main unit via arm <NUM> which may form the main optical and electrical pathway. Arm <NUM> may comprise transmission media, for example wires or waveguide, e.g. mirrors or fiber optic cables, for electromagnetic radiation in the form of light or additional electric signals needed for powering the delivery head <NUM>. The CPU <NUM> controls the electromagnetic generator <NUM> which may generate a continuous electromagnetic energy (CM) or a pulses, having a fluence in the range of <NUM> pJ/cm<NUM> to <NUM> J/cm<NUM> or in the range of <NUM> pJ/cm<NUM> to <NUM> J/cm<NUM> or in the range of <NUM> pJ/cm<NUM> to <NUM> J/cm<NUM> or in the range of <NUM> pJ/cm<NUM> to <NUM> J/cm<NUM> on the output of the electromagnetic generator. The CM mode may be operated for a time interval in the range of <NUM> to <NUM> hours or in the range of <NUM> to <NUM> hours or in the range of <NUM> to <NUM> hours or in the range of <NUM> to <NUM> hours. The pulse duration of the electromagnetic radiation operated in the pulse regime may be in the range of <NUM> fs to <NUM> or in the range of <NUM> fs to <NUM> or in the range of <NUM> fs to <NUM> or in the range of <NUM> fs to <NUM>. Alternatively, the pulse duration may be in the range of <NUM> fs to <NUM> ns or in the range of <NUM> fs to <NUM> ns or in the range of <NUM> fs to <NUM> ns or in the range of <NUM> fs to <NUM> ns. Alternatively, the pulse duration may be in the range of <NUM> to <NUM> ps or in the range of <NUM> to <NUM> ps or in the range of <NUM> to <NUM> ps or in the range of <NUM> to <NUM> ps. Or alternatively the pulse duration may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The electromagnetic generator <NUM> in the pulse regime may be operated by CPU <NUM> in a single shot mode or in a repetition mode or in a burst mode. The frequency of the repetition mode or the burst mode may be in the range of <NUM> to <NUM><NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. Alternatively the frequency of the repetition mode or the burst mode may be in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM> or in the range of <NUM> to <NUM>. The single shot mode may be configured to generate a single electromagnetic energy of specific parameters (e.g. intensity, duration, etc.) for irradiation of a single treatment area. The repetition mode may be configured to generate an electromagnetic energy, which may have one or more specific parameters (e.g. intensity, duration, etc.), with a repetition rate of the above-mentioned frequency for irradiation of a single treatment area. The burst mode may be configured to generate multiple consecutive electromagnetic energies, which may have variable parameters (e.g. intensity, duration, delay etc.), during one sequence, wherein the sequences are repeated with the above-mentioned frequency and wherein the sequence may include the same or different sets of consecutive electromagnetic energies.

Alternatively, the device may contain more than one electromagnetic generator <NUM> for generation of the same or a different electromagnetic energy, e.g. one electromagnetic generator is for generation of an ablative electromagnetic energy and the other is for generation of a non ablative electromagnetic energy. In this case, it is possible for an operator to select which electromagnetic generators may be used for a given treatment or the clinician can choose a required treatment through the human machine interface <NUM> and the CPU <NUM> will select which electromagnetic generators will be used. It is possible to operate one or more electromagnetic generators of the device <NUM> simultaneously, successively or in an overlapping method. For example in the case of two electromagnetic generators: in the simultaneous method, both electromagnetic generators are used simultaneously during a time interval e.g., <NUM>-<NUM> ps. In the successive method, the first electromagnetic generator is used during the first time interval e.g., from <NUM> to <NUM> ps. The first electromagnetic generator is then stopped and the second electromagnetic generator is immediately used in a subsequent time interval e.g., from <NUM> to <NUM> ps. Such a sequence of two or more successive steps may be repeated. In the overlapping method, the first electromagnetic generator is used during a time interval, e.g., <NUM>-<NUM> ps, and the second electromagnetic generator is used in a second overlapping time interval for e.g., <NUM>-<NUM> ps, wherein during the second time interval the first electromagnetic generator and the second electromagnetic generator are overlapping e.g., with total overlapping method time for <NUM>-<NUM> ps. In the case of more than two electromagnetic generators, the activating and deactivating of the electromagnetic generators in a successive or overlap method may be driven by CPU <NUM> in the order which is suitable for a given treatment, e.g. first activating the pre-heating electromagnetic generator, then the ablation electromagnetic generator and then the non-ablative electromagnetic generator.

The active elements <NUM> in the delivery head <NUM> may be in the form of optical elements, which may be represented by one or more optical windows, lenses, mirrors, fibers or diffraction elements. The optical element representing active element <NUM> may be connected to or may contain electromagnetic generator <NUM> inside the delivery head <NUM>. The optical element may produce one beam of electromagnetic energy, which may provide an energy spot having an energy spot size defined as a surface of tissue irradiated by one beam of light. One light generator may provide one or more energy spots e.g. by splitting one beam into a plurality of beams. The energy spot size may be in the range of <NUM><NUM> to <NUM><NUM>, or in the range of <NUM><NUM> to <NUM><NUM>, or in the range of <NUM><NUM> to <NUM><NUM>, or in the range of <NUM><NUM> to <NUM><NUM>. Energy spots of different or the same wavelength may be overlaid or may be separated. Two or more beams of light may be applied to the same spot at the same time or with a time gap ranging from <NUM> to <NUM> seconds. Energy spots may be separated by at least <NUM>% of their diameter, and in addition, energy spots may closely follow each other or may be separated by a gap ranging from <NUM> to <NUM> or from <NUM> to <NUM> or from <NUM> to <NUM>.

The CPU <NUM> may be further responsible for switching between active elements <NUM> or for moving the active elements <NUM> within the delivery head <NUM> so that the electromagnetic radiation may be delivered homogeneously into the whole treatment area marked with aiming beam <NUM>. The rate of switching between active elements <NUM> may be dependent on the amount of delivered energy, pulse length, etc. and the speed of CPU <NUM> or other mechanism responsible for switching or moving the active elements <NUM> (e.g. scanner). Additionally, a device may be configured to switch between multiple active elements <NUM> in such a way that they deliver energy simultaneously, successively or in an overlapping method. For example, in the case of two active elements: in the simultaneous method, both active elements are used simultaneously during the time interval e.g., <NUM>-<NUM> ps. In the successive method, the first active element is used during the first time interval e.g., from <NUM> to <NUM> ps. The first active element is then stopped and the second active element is immediately used in a subsequent time interval e.g., from <NUM> to <NUM> ps. This successive step may be repeated. In the overlapping method, the first active element is used during a time interval for e.g., <NUM>-<NUM> ps, and the second active element is used in a second overlapping time interval for e.g., <NUM>-<NUM> ps, wherein during the second time interval the first active element and the second active element are overlapping e.g., with total overlapping method time for <NUM>-<NUM> ps.

The aiming beam <NUM> has no clinical effect on the treated tissue and may serve as a tool to mark the area to be treated so that the operator knows which exact area will be irradiated and the CPU <NUM> may set and adjust treatment parameters accordingly. An aiming beam may be generated by a separate electromagnetic generator or by the primary electromagnetic generator <NUM>. Aiming beam <NUM> may deliver energy at a wavelength in a range of <NUM> - <NUM> and may supply energy at a maximum power of 10mW.

In addition, the pad may contain a CPU <NUM> driven distance sensor <NUM> for measuring a distance from active element <NUM> to the treated point within the treated area marked by aiming beam <NUM>. The measured value may be used by CPU <NUM> as a parameter for adjusting one or more treatment parameters which may depend on the distance between an electromagnetic generator and a treating point, e.g. fluence. Information from distance sensor <NUM> may be provided to CPU <NUM> before every switch/movement of an active element <NUM> so that the delivered energy will remain the same across the treated area independent of its shape or unevenness.

The patient's skin may be pre-cooled to a selected temperature for a selected duration over at least one treatment portion, the selected temperature and duration for pre-cooling preferably being sufficient to cool the skin to at least a selected temperature below normal body temperature. The skin may be cooled to at least the selected temperature to a depth below the at least one depth for the treatment portions so that the at least one treatment portion is substantially surrounded by cooled skin. The cooling may continue during the application of radiation, wherein the duration of the application of radiation may be greater than the thermal relaxation time of the treatment portions. Cooling may be provided by any known mechanism including water cooling, sprayed coolant, presence of an active solid cooling element (e.g. thermoelectric cooler) or air flow cooling. A cooling element may act as an optical element. Alternatively, a spacer may serve as a cooling element. Cooling may be provided during, before or after the treatment with electromagnetic energy. Cooling before treatment may also provide an environment for sudden heat shock, while cooling after treatment may provide faster regeneration after heat shock. The temperature of the coolant may be in the range of -<NUM> to <NUM>. The temperature of the cooling element during the treatment may be in the range of -<NUM> to <NUM> or -<NUM> to <NUM> or -<NUM> to <NUM>. Further, where the pad is not in contact with the patient's skin, cryogenic spray cooling, gas flow or other non-contact cooling techniques may be utilized. A cooling gel on the skin surface might also be utilized, either in addition to or instead of, one of the cooling techniques indicated above.

Additionally, device <NUM> may include one or more sensors. The sensor may provide information about at least one physical quantity and its measurement may lead to feedback which may be displayed by human machine interface <NUM> or indicators <NUM>. The one or more sensors may be used for sensing a variety of physical quantities, including but not limited to the energy of the delivered electromagnetic radiation or backscattered electromagnetic radiation from the skin, impedance of the skin, resistance of the skin, temperature of the treated skin, temperature of the untreated skin, temperature of at least one layer of the skin, water content of the device, the phase angle of delivered or reflected energy, the position of the active elements <NUM>, the position of the delivery element <NUM>, temperature of the cooling media or temperature of the electromagnetic generator <NUM>. The sensor may be a temperature, acoustic, vibration, electric, magnetic, flow, positional, optical, imaging, pressure, force, energy flux, impedance, current, Hall or proximity sensor. The sensor may be a capacitive displacement sensor, acoustic proximity sensor, gyroscope, accelerometer, magnetometer, infrared camera or thermographic camera. The sensor may be invasive or contactless. The sensor may be located on the delivery element <NUM> or in the main unit <NUM> or may be a part of a distance sensor <NUM>. One sensor may measure more than one physical quantity. For example, a sensor may include a combination of a gyroscope, an accelerometer or a magnetometer. Additionally, the sensor may measure one or more physical quantities of the treated skin or untreated skin.

The temperature sensor measures and monitors the temperature of the treated skin. The temperature can be analyzed by a CPU <NUM>. The temperature sensor may be a contactless sensor (e.g. infrared temperature sensor). The CPU <NUM> may also use algorithms to calculate a temperature below the surface of the skin based on the surface temperature of the skin and one or more additional parameters. A temperature feedback system may control the temperature and based on set or pre-set limits alert the operator in human perceptible form e.g. on the human machine interface <NUM> or via indicators <NUM>. In a limit temperature condition, the device may be configured to adjust treatment parameters of each active element, e.g. output power, activate cooling or stop the treatment. Human perceptible form may be a sound, alert message shown on human machine interface <NUM> or indicators <NUM> or change of colour of any part of the device <NUM>.

A resistance sensor may measure the skin resistance, since it may vary for different patients, as well as the humidity - wetness and sweat may influence the resistance and therefore the behaviour of the skin in the energy field. Based on the measured skin resistance, the skin impedance may also be calculated.

Information from one or more sensors may be used for generation of a pathway on a convenient model e.g. a model of the human body shown on a display of human machine interface <NUM>. The pathway may illustrate a surface or volume of already treated tissue, presently treated tissue, tissue to be treated, or untreated tissue. A convenient model may show a temperature map of the treated tissue providing information about the already treated tissue or untreated tissue.

The sensor may provide information about the location of bones, inflamed tissue or joints. Such types of tissue may not be targeted by electromagnetic radiation due to the possibility of painful treatment. Bones, joints or inflamed tissue may be detected by any type of sensor such as an imaging sensor (ultrasound sensor, IR sensor), impedance and the like. A detected presence of these tissue types may cause general human perceptible signals or interruption of generation of electromagnetic radiation. Bones may be detected for example by a change of impedance of the tissue or by analysis of reflected electromagnetic radiation.

Furthermore, the device <NUM> may include an emergency stop button <NUM> so that the patient can stop the therapy immediately anytime during the treatment.

The method of treatment not being part of the invention includes the following steps:
preparation of the tissue; positioning the proposed device; selecting or setting up the treatment parameters; and application of the energy. More than one step may be executed simultaneously.

Preparation of the tissue may include removing make-up or cleansing the patient's skin. For higher target temperatures, anaesthetics may be applied topically or in an injection.

Positioning the device may include selecting the correct shape of the pad according to the area to be treated and affixing the pad or the neutral electrode to the patient, for example with an adhesive layer, vacuum suction, band or mask, and verifying proper contact with the treated tissue in the case of contact therapy. In the case of contactless therapy, positioning of the device may include adjusting the aiming beam of proposed device so that the device can measure the distance of the active element(s) from the treatment area and adjust the treatment parameters accordingly.

Selecting or setting up the treatment parameters may include adjusting treatment time, power, duty cycle, delivery time and mode (CM or pulsed), active points surface density/size for fractional arrangement and mode of operation. Selecting the mode of operation may mean choosing simultaneous, successive or overlapping methods or selecting the switching order of active elements or groups of active elements or selecting the proper preprogrammed protocol.

Application of the energy may include providing at least one type of energy in the form of RF energy, ultrasound energy or electromagnetic energy in the form of polychromatic or monochromatic light, or their combination. The energy may be provided from at least one active element into the skin by proposed device. Energy may be delivered and regulated automatically by the CPU according to information from temperature sensors and impedance measurements and, in the case of contactless therapy, distance sensors. All automatic adjustments and potential impacts on the therapy may be indicated on the device display. Either the operator or the patient may suspend therapy at any time during treatment. A typical treatment might have a duration of about <NUM> to <NUM> or <NUM> to <NUM> or <NUM> to <NUM> per pad depending on the treated area and the size and number of active elements located within the pad.

In one example, application of energy to the tissue may include providing radiofrequency energy or ultrasound energy or their combination, from the active elements embedded in the pad, to the skin of the patient. In such case, active elements providing radiofrequency energy may be dielectric and capacitive or resistive RF electrodes and the RF energy may cause heating, coagulation or ablation of the skin. Ultrasound energy may be provided through an acoustic window and may rise the temperature in the depth which may suppress the gradient loss of RF energy and thus the desired temperature in a germinal layer may be reach. In addition, the RF electrode may act as an acoustic window for ultrasound energy.

Alternatively, the application of the energy to the tissue may include providing electromagnetic energy in the form of polychromatic or monochromatic light from the active elements into the skin of the patient. In such case, active elements providing the electromagnetic energy may comprise optical elements described in the proposed device. Optical elements may be represented by an optical window, lens, mirror, fiber or electromagnetic field generator, e.g. LED, laser, flash lamp, incandescent light bulb or other light sources known in the state of art. The electromagnetic energy in the form of polychromatic or monochromatic light may entail the heating, coagulation or ablation of the skin in the treated area.

Claim 1:
A device (<NUM>) for a non-invasive treatment of a patient for improving the visual appearance of a patient, comprising:
a radiofrequency generator (<NUM>) configured to generate radiofrequency energy with an output power in a range of <NUM> W to <NUM> W;
an electric current generator (<NUM>) configured to generate a pulsed electric current;
a flexible pad (<NUM>) comprising an electrode (<NUM>), wherein the flexible pad (<NUM>) is configured to be attached to a body part of a patient during a treatment,
wherein the flexible pad in its narrower spot has a thickness in a range of <NUM> to <NUM>, and
wherein a surface area of the electrode (<NUM>) facing towards the patient during the treatment is in a range of <NUM><NUM> to <NUM><NUM> configured to fit to the area over a muscle within the body part;
a switching circuitry (<NUM>) configured to regulate energy delivery from the radiofrequency generator (<NUM>) and the electric current generator (<NUM>) to the electrode (<NUM>);
a control unit comprising a CPU (<NUM>), in connection with the switching circuitry (<NUM>), wherein the control unit is configured to control the radiofrequency generator (<NUM>) such that radiofrequency energy is delivered to the electrode (<NUM>) and to control the electric current generator (<NUM>) such that a pulsed electric current is delivered to the electrode (<NUM>),
wherein the control unit is configured to control the device in order to:
apply radiofrequency energy to the body part of the patient via the electrode in radiofrequency pulses, thereby causing radiofrequency heating of skin of the body part to a temperature in a range of <NUM> to <NUM>,
wherein each radiofrequency pulse has a duration in a range of <NUM> to <NUM>; and
apply the pulsed electric current with a pulse duration in a range of <NUM> to <NUM> to the body part via the electrode, thereby causing an electric muscle stimulation causing contraction of the muscle within the body part; and
wherein the device is configured to provide the radiofrequency heating and the electric muscle stimulation during the treatment.