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WO1997037723A1 - Procede et dispostif ameliores de retraction de collagene induite au laser - Google Patents

Procede et dispostif ameliores de retraction de collagene induite au laser Download PDF

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Publication number
WO1997037723A1
WO1997037723A1 PCT/US1997/003449 US9703449W WO9737723A1 WO 1997037723 A1 WO1997037723 A1 WO 1997037723A1 US 9703449 W US9703449 W US 9703449W WO 9737723 A1 WO9737723 A1 WO 9737723A1
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WO
WIPO (PCT)
Prior art keywords
die
tissue
laser energy
collagen
laser
Prior art date
Application number
PCT/US1997/003449
Other languages
English (en)
Inventor
David Hennings
Bruce J. Sand
Original Assignee
New Star Lasers, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by New Star Lasers, Inc. filed Critical New Star Lasers, Inc.
Priority to AU23181/97A priority Critical patent/AU2318197A/en
Publication of WO1997037723A1 publication Critical patent/WO1997037723A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/203—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser applying laser energy to the outside of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N5/067—Radiation therapy using light using laser light
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00029—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids open
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A61B2018/0047—Upper parts of the skin, e.g. skin peeling or treatment of wrinkles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B2018/2015—Miscellaneous features
    • A61B2018/2025—Miscellaneous features with a pilot laser

Definitions

  • This mvention relates to an improved method and device for laser induced sli ⁇ nktng of collagen in humans and other animals
  • a preferred embodiment of this novel method is directed to the shrinking of collagen in the skin for removing wrinkles and other aesthetic and medical applications, without causing superficial stun damage
  • Another preferred embodiment of this novel method is directed to the therapeutic contraction of the collagen connective tissue withm the musculoskeletal system
  • Collagen is the single most abundant animal protein in mammals, accounting for up to 30% of all proteins
  • the collagen molecule after being secreted by the fibroblast cell, assembles into charactenstic fibers responsible for the functional integnty of tissues making up most organs in the body
  • the skin is the largest organ of the body occupying the greatest surface area withm the human body As age advances and as a result of other noxious stimuli, such as the increased concentration of the ultraviolet part of the electromagnetic spectrum as radiated from the sun, structural integnty and elasticity of skin diminishes
  • Shrinkage temperature may be defined, therefore, as the specific point at which disruptive tendencies exceed the cohesive forces in this tissue. This temperature, thus, makes this an actual measurement of the stability of the collagen bearing tissue expressed in thermal units.
  • the cause of wrinkles around the eyelids, mouth and lips is multifactorial: photodamage, smoking and muscular activity such as squinting and smiling all contribute.
  • the end result is a general loss of elasticity, which is a textural skin condition as opposed to a skin redundancy or excess of skin tissue.
  • the surgical injection of reconstituted collagen is commonly used in order to flatten the penoral lines.
  • tendons serve as the mechanical link connecting muscle with skeleton and, thus, must possess high tensile modulus, high toughness and good resistance to tensile creep, fatigue and shock Tendon, however, must be flexible enough to bend at joints and absorb slack when muscle tone is relaxed This is true, also, of ligaments which serve to connect individual bones and are important in maintaining the integnty of joint structures It is the hierarchical organization of ligamcntous and tendon collagen, as well as the annulus fibrosis component of the intervertebral disc which permit their unique qualities
  • the present invention is an improved method and device for shrinking collagen
  • collagen connective tissue in skin can be contracted or shrunk instantaneously, thus tightening the overlying tissue without the superficial damage or destruction associated with other techniques of superficial skin resurfacing
  • the method and device is highly beneficial in therapeutic contraction of die collagen connective tissue within the musculo-skelctal system
  • These techniques match the thickness of the target tissue with the extinction depth or the spectral abso ⁇ tion coefficient of the specific laser wave length to gently heat the collagen molecule to the thermal shrinkage temperature, thus resulting m shrinkage of the underlying tissue while tightening the overlying skin
  • Superficial heat exchange either by means of passive, or more effectively, by means of a dynamic cooling process enhance this modality by eliminating pain or discomfort and reducing any nsk of superficial destruction of the skin tissue
  • the present invention is a method for sh ⁇ nking connective collagen tissue compnsing the step of irradiating the tissue with laser energy having a wavelength in the range of about 1 to about 12 microns.
  • the temperature of the collagen to be shrunk is raised to between about 58 and about 62 degrees Celsius In a preferred embodiment, the temperature of the collagen to be shrunk is raised to about 60 degrees Celsius
  • the energy has a wavelength in the range of about 1.2 to about 1 8 microns In a preferred embodiment, the energy has a wavelength of about 1 3-1 4 microns
  • the energy is delivered in a contmuous wave In a preferred embodiment, the energy is delivered in a pulsed mode.
  • the pulse rate of delivery of the laser energy is such that the pulses of energy are delivered within the thermal relaxation time period for the given volume of tissue being thermally treated.
  • the total energy delivered is in the range of about 4 to about 50 joules per square centimeter.
  • the present invention is a method of removing wrinkles or other tissue by shrinking the connective collagen of the target tissue comprising the step of delivering laser radiation having a thermal extinction coefficient such that the laser energy is absorbed by the target tissue below the surface of the skin.
  • the laser energy is absorbed a t a depth of between about 0.01 and about 25 millimeters which corresponds to the extinction coefficient of the energy having a wavelength of between 1 and 12 microns.
  • the method comprises the step of providing a heat sink on the surface of the skin to prevent significant thermal increase at the surface of the skin.
  • the heat sink is a suitable laser transparent material.
  • the heat sink is a suitable dynamic cooling system.
  • the energy has a wavelength in the range of about 1 to about 12 microns. In a preferred embodiment, the energy has a wavelength in the range of about 1.2 to about 1.8 microns. In a preferred embodiment, the energy has a wavelength of about 1.3- 1.4 microns. It has been observed that laser energy having a wavelength of between about 1.3 and 1.4 microns has an extinction coefficient of about 1.8 cm "1 . This corresponds to a depth of penetration of about 5.5 millimeters, the inverse of the extinction coefficient.
  • the present invention is a novel method for shrinking collage in joints, ligaments and musculoskclctal tissue comprising the step of irradiating the tissue with laser energy having a wavelength in the range of about 1 to about 12 microns.
  • the energy has a wavelength in the range of about 1.2-1.8 microns.
  • the energy has a wavelength of about 1.3-1.4 microns.
  • the present invention is a novel system for shrinking collagen tissue comprising a source of laser energy, the laser energy having a predetermined wavelength such that the laser energy is absorbed at a point in the tissue significantly below tiie surface of the skin, thereby preventing ablation or charring of the surface tissue, and a laser delivery device, the laser delivery device capable of dehve ⁇ ng a precise amount of laser energy to the tissue to be shrunk at a predeteirriined rate
  • the laser energy has a wavelength in the range of about 1 and about 12 microns
  • d e laser energy has a wavelength in the range of about 1 2 and about 1 8 microns
  • the energy has a wavelength of about 1 3-1 4 microns
  • the invention further compnses a passive heat sink.
  • the invention further comprises a dynamic heat sink
  • the invention further comprises a microprocessor and a controller for controlling d e delivery of laser energy by die laser delivery device to the tissue
  • die mvention further comp ⁇ ses a thermal scnsmg system
  • FIG 1 is a cross-section view of typical skin tissue
  • FIG 2 is a diagram showing collagen phase transition from d e molecule's tnple helical extra-cellular matrix native state at normal body temperature to states at the thermal shrinkage temperature wherein the collagen fibnls are both under tension and relaxed
  • FIG 3 is a schematic representation of die hierarchical structure of collagen in d e tendon
  • FIG 4 is a schematic representation of e macromolecular structure of the lntervertebral
  • FIG 5 is a graph demonstrating the temperature gradient through a portion of die skin as a function of both die wavelength of incident laser energy and die depth of laser radiation penetration
  • FIG 6 is a schematic view of a hand held temperature controlled collagen sh ⁇ nkage device used in die method of the present invention.
  • FIG. 7 is a graph demonstrating d e temperature gradient through a portion of die skin widi precooling as a function of both the wavelength of incident laser energy and die depth of laser radiation penetration.
  • FIG. 8 is a schematic view of a microscope mounted scanner for a temperature controlled collagen shrinkage device used in die present invention.
  • FIG. 1 is a cross-section view of typical skin tissue.
  • the uppermost layer 98 of typical skin tissue is composed of dead cells which form a tough, horny protective coating.
  • Intertwining S-like finger shaped portions 104 are at d e interface between die epidermal papillary layer 106 and die dermal papillary layer 108, and extend downward.
  • Beneadi die dermis is die subcutaneous tissue 110, which often contains a significant amount of fat.
  • d ough viable collagen connective tissue also exists to a certain degree in die lower subcutaneous layer as well.
  • Other structures found in typical skin include hair and an associated follicle 112, sweat or sebaceous glands and associated pores 114, blood vessels 116 and nerves 118.
  • a pigment layer 120 might be present.
  • mat die drawing is representative of typical skin and mat die collagen matrix will take different forms in different parts of the body. For example, in die eyelids and cheeks die dermis and subcutaneous layers are significantly thinner with less fat dian in otiier areas.
  • the target depdi will be a function of die amount of scattering in the particular skin type and die associated abso ⁇ tion coefficient of d e tissue.
  • d e actual target depdi will correspond to one half d e thickness of die subject tissue
  • die target depdi of tissue '/. inch duck might be about % inch below die surface of die skin
  • FIG 2 is a diagram showing collagen phase transition from die molecule's tnple helical extra-cellular matnx native state 30 at normal body temperature to states at the tiiermal shrinkage temperature wherem die collagen fibrils are bodi under tension 32 and relaxed 34
  • the molecular structure of collagen in its native state is mat of a triple coiled or helical crystalline protem structurally embedded widnn a umque ground substance Among these unique properties are its strength and its elasticity which an analogy to nylon might be drawn
  • Anodicr significant similanty with nylon is collagen's ability to undergo diermal modification resulting in the contraction or shrmking of d e molecule without die substantial loss of its strength and elasticity
  • Widnn a small diermal window of 4 to 5 degrees Celsius at about 23 degrees Celsius above body temperature, die collagen molecule will undergo a contraction to 1/3 of its o ⁇ ginal lengdi, without biochemical change If this "diermal sh ⁇ nkage temperature" (T s ) is not
  • the approp ⁇ ate wave lengdi is approximately between about 1 and about 12 microns, preferably between about 1 2 and about 1 8 microns, and more preferably about 1 3-1 4 microns
  • This ideal wavelength depends upon die abso ⁇ tion of die radiation by water order to elevate die temperature of die target tissue to T s for collagen sh ⁇ nkage - a temperature below that which results in protein denaturation
  • the Nd YAG, Nd YAP and Nd YALO- ype lasers are such sources of coherent energy This wavelength of 1 3-1 4 microns is absorbed relatively well by water, and as a result is attractive for tissue interaction It is also easily transmitted through a fiber optic delivery system as opposed to die ngid articulated arm required for me C0 2 laser Very precise mediods of controlling laser systems and optically filtering produced light currently exist By selecting die approp ⁇ ate combination of resonance optics and/or anti-reflection coatings, wavelengths in die range of 1 3-1 4 microns and even 1 32-1 34 microns can be produced
  • FIG 3 is a schematic representation of the hierarchical structure of collagen in die tendon
  • the hierarchical orgamzation of connective tissues is illustrated in die tendon 130
  • virtually all connective tissues, whether soft or hard have hierarchical structural designs arranged at discrete levels of structure
  • This hierarchical organization of diesc and other collagen bearing tissues have been widely studied and reviewed
  • Beginning at die molecular level with tropocollagcn progressively larger and more complex structures are built up on die nano- and microscopic scales
  • die tropocollagcn helix 132 These molecules aggregate to form microfibnls 134 which, m turn, are packed into a lattice structure forming a subfib ⁇ l 136
  • the subfib ⁇ ls are men joined to form fibrils 138 in which die characteristic structural 64-nannometer banding pattern is evident
  • the fascicle 140 At the fascicular level the
  • die elements absorb energy and protect die tendon as a whole from catastrophic failure. It is die current view diat proteoglycans in association witii copious amounts of water come into play as a matrix binding die fibrils togetiier. Proceeding toward macroscopic dimensions, die fascicles comprising crimped collagen fibrils are embedded in die proteoglycan-water gel witii several fascicles in turn making up the functioning tendon or ligament.
  • FIG. 4 is a schematic representation of the macromolecular structure of the intervertebral disc 150.
  • intervertebral discs are interspersed between die vertebral bones in die spinal column.
  • One of the functions of the discs is to absorb compressive forces or loads placed on die spine and skeletal structure while moving or performing functions.
  • diat the annulus fibrosis 152 the outer component of die intervertebral disc diat is made up of discrete layers or lamellae 154 of fibrous collagen arrayed around die nucleus like the layers of an onion skin.
  • the hierarchical structure with gradient characteristics at die various levels of organization is not unlike that of tendon or ligamentous tissues.
  • the collagen fibrils organized into lamellar sheets in die annulus fibrosus surround a gelatinous and highly hydrated nucleus pulposis 156.
  • the thickness of lamellae vary with location and are thicker at the anterior and lateral aspects of die disc than at the posterior.
  • fibrils are parallel and inclined with respect to die axis of die spinal column by an intcrlamcllar angle A which alternates in successive lamellae. This angle decreases from die edge of the disc inward.
  • die fibrils have a planar zig-zag waveform.
  • the crimp angle B is largest in fibrils close into tiie nucleus and decreases toward die periphery.
  • die collagen fibrils in the annulus gives the disc strength and stability in tension, bending, and torsional motions. Based upon optical microscope observations of die mo ⁇ hology of die collagen fibrils, die levels of structural hierarch below die fibrils are assumed to be identical to diat of the tendon and intestine. Axial compression, in addition to torsion and bending, is a mode of deformation normally experienced by the disc.
  • die restoring force of die stretched fibers of the annulus is considered to balance die effects of nuclear pressure
  • the fibers of die lamellae are constrained at the cartilage end-plates of the vertebral bodies, so they must extend in length to accommodate die bulging Even though the disc undergoes macroscopic compression, die fibers of the lamellae are loaded in tension and their mode of deformation can be compared witii other connective tissues such as tendon and intestine
  • This type of tissue belongs to die family of umaxial composites
  • the significant aspect of a composite is its unique set of mechamcal properties This is achieved through die synergistic mechamcal inte ⁇ lay between structural elements
  • the slippage mechamsm by which a collagen fibril elongates involves slippage of the tropocollagen umts within die microfib ⁇ l This requires over coming the lateral bonding forces but does not result in tiiese forces being completely and permanently destroyed Load bearing ability is maintained, or even improved, when uitrafibnllar stra hardemng occurs
  • the mucopolysaccha ⁇ de matnx plays a secondary role
  • the most obvious mechamcal function of die matnx is to bind the collagen fibrils into a functional sliding cord
  • This matrix which is more currently charactenzed as glycosaminoglycan or GAG, serves to cement the fibers together into fiber bundles and provides the lateral bonding force required for load bearing
  • die benefit of die use of mid-infrared laser energy withm the spectra abso ⁇ tion or extinction coefficient range of 0 4 cm ' - 1000 cm ' corresponding to the wavelength range withm the electromagnetic spectrum of 1 0 microns to 12 0 microns for the shrinkage of collagen connective tissues are as follows shnnkage of the medial or lateral collateral , or the ante ⁇ or cruciate ligament of the unstable knee joint and the treatment of the chrome unidirectional and multidirectional glcnohumeral instability or tightening of die shoulder capsule in recurrent dislocation.
  • FIG. 5 is a graph demonstrating the temperature gradient through a portion of the skin as a function of both the wavelength of incident laser energy and die depth of laser radiation penetration. No external cooling is used.
  • the graph demonstrates a change in temperature ( ⁇ T) of about 60 degrees Celsius and all curves are shown for die time point 1 millisecond following exposure to the laser energy.
  • the graph shows three lines corresponding to laser wavelengths of 10.6 microns, 1.3- 1.4 microns and 1.06 microns.
  • the present invention utilizes laser energy having a wavelength between about 1 and about
  • This type of laser energy is most frequently produced by a Nd:YAG, Nd:YAP or Nd:YALO-type laser.
  • a iaser operating at these wavelengths may either have a high repetition pulse rate or operate in a continuous wave mode.
  • This laser has been investigated in die medical community as a general surgical and tissue welding device, but has not been used for collagen tissue shrinkage in the past. Indeed, die prior art teaches away from the use of laser energy at 1.3- 1.4 microns for shrinking human collagen.
  • FIG 6 is a schematic view of a hand held temperature controlled collagen shnnkage device used in the method of die present mvention Modern instruments to provide dynamic cooling of the surface layers of tissue are well suited to these applications
  • a typical handpiece 40 compnses the laser delivery device as well as vanous pcnpheral systems
  • a fiber optic cable 42 guides the laser light mto the device
  • a preferred embodiment of such a device contains a focusmg lens 44 and, optionally, other laser optics or mechamcal equipment including a beam splitter, focusmg knob and adjustable mounting means, thereby producing a laser focus spot 46 on the surface of the tissue above the collagen to be shrunk
  • a separate electronic or other thermal detector 48 is useful Additionally a coolant spiay 50 can be provided through the handpiece or it could be provided witii another separate device
  • a connection to a computer and the laser 52 will allow the device to utilize the electromc or other thermal
  • cryogen spray would be tetrafluoroediane, C 2 H 2 F 4 , an environmentally compatible, non-toxic, non-flammable freon substitute.
  • distance between die aperture of the spray valve and the skin surface should be maintained at about 20 millimeters.
  • die surface of die skin is pre-cooled to as low as 0 degrees Celsius or lower, at a rate fast enough to cool the surface only but not dissipate heat from below about 400-500 microns below the surface.
  • dunng the cooling step the target tissue remains at body temperature and is not cooled at all.
  • a passive heat sink includes glass or sapphire tip probes, and otiier types of devices to lay on the surface of the skin.
  • a dynamic type of heat sink will refer to those actively cooled by flowing gas or liquid, jets or spurts of coolant such as freon, and otiier active types of heat exchangers suitable for surface cooling while irradiating sub-surface portions of collagen tissue.
  • FIG. 7 is a graph demonstrating the temperature gradient through a portion of the skin with precooling as a function of both the wavelength of incident laser energy and the deptii of laser radiation penetration.
  • the graph demonstrates a change in temperature ( ⁇ T) of about 60 degrees Celsius.
  • ⁇ T change in temperature
  • precooling of the skin surface tissue for a period of 20 milliseconds was conducted immediately prior to exposure to laser energy. All curves arc shown for a time point 1 millisecond following exposure to the laser energy.
  • the graph shows three lines corresponding to laser wavelengths of 10.6 microns, 1.3-1.4 microns and 1.06 microns.
  • Scanners such as those manufactured by Sha ⁇ lan and Reliant Technologies are presently available. These devices utilize one or more rotating mirrors to scan the beam over a circular or other shaped area. Power density of the beam incident on die tissue can be adjusted manually or by computer control. Automatically scanned systems previously used to vaporize holes into tissue with complex shapes and precisely defined dimensions, can be used in collagen shrinking applications as well. Applications where large areas of tissue are to be irradiated with a certain predetermined spectrum or gradient of power density over those areas are particularly well suited for computer- controlled laser scanner systems.
  • the electronic diermal sensor can be a fast response thermocouple like the OS40 series devices from Omega. This detector will analyze a 0.125 inch spot from 1 " away and accurately indicate temperature within 0.1 seconds, fast enough to servo the applied laser energy or to simply turn it off when the desired temperature has been reached.
  • the safe and appropriate application of the laser energy requires accurate delivery of the laser energy to the target tissue.
  • the laser energy can be delivered in a continuous or pulsed wave by means of a highly accurate fiber optic microprocessor controlled delivery system known.
  • FIG. 8 is a schematic view of a microscope mounted scanner for a temperature controlled collagen shrinkage device used in the present invention.
  • a laser console 60 is installed adjacent a floor-mounted microscope 62.
  • a fiber optic cable 64 conducts laser energy from the laser source to the scanner 66.
  • a laser delivery attachment 68 may be necessary to conduct die laser energy in an appropriate beam pattern and focus.
  • servo feedback 70 signals are also conducted along die fiber optic back to the laser console. The servo feedback signals could also be directed back to the laser console via an additional fiber optic or other wiring or cabling.
  • This servo feedback may comprise thermal or optical data obtained via exter.—i sensors or via internal systems, such as a fiber-tip protection system which attenuates die laser energy transmitted, to provide control in operation and to prevent thermal runaway in the laser delivery device.
  • a thermal feedback controller 72 will regulate die laser energy being transmitted.
  • This controller can comprise an analog or digital PI, PD or PID-type controller, a microprocessor and set of operating instructions, or any other controller known to those skilled in the art
  • Other preferred embodiments can also be provided with additional features
  • die surgeon or technician operating the laser could also manipulate an energy adjust knob 74, a calibration knob 76 and a footpedal 78
  • a very accurately adjustable system is provided which allows a surgeon to deliver laser energy via a computer controlled scanning device, accordmg to mstructions given by the surgeon or an observer mspectmg the region of the skin where collagen is to be shrunk through a very accurate microscope
  • die scanner can deliver a very precise, predetermined amount of laser energy, m precisely chosen, predetermined regions of the skin over specific, predetermined penods of time

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Abstract

L'invention a pour objet un procédé et un dispositif améliorés de rétraction de collagène. Dans une forme d'exécution préférée, le tissu cutané en contact avec le collagène est contracté ou réduit, parfois instantanément, entraînant une tension du tissu sus-jacent sans endommagement, voire destruction, de la surface de la peau, comme cela peut se produire avec d'autres techniques de restructuration de la peau en surface. Dans une autre forme d'exécution préférée, le procédé et le dispositif servent à contracter à des fins thérapeutiques le tissu de la peau en contact avec le collagène à l'intérieur du système osso-musculaire. Grâce à ces techniques on peut adapter l'épaisseur du tissu cible à la profondeur d'extinction ou au coefficient d'absorption spectrale de la longueur d'onde du laser utilisé, afin de chauffer doucement la molécule de collagène pour qu'elle atteigne une température de rétraction thermique, entraînant ainsi un rétrécissement du tissu sous-jacent, tout en tendant la peau en surface. En procédant à un échange de chaleur en surface, effectué par refroidissement passif, ou plus efficacement encore, par refroidissement dynamique, on améliore encore le système car on élimine le douleur ou la sensation d'inconfort, tout en réduisant tout risque de destruction en surface du tissu cutané.
PCT/US1997/003449 1996-04-10 1997-03-07 Procede et dispostif ameliores de retraction de collagene induite au laser WO1997037723A1 (fr)

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AU23181/97A AU2318197A (en) 1996-04-10 1997-03-07 Improved method and device for laser induced shrinking of collagen

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US63180096A 1996-04-10 1996-04-10
US08/631,800 1996-04-10

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Cited By (26)

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WO1998033558A1 (fr) * 1997-02-05 1998-08-06 Candela Corporation Procede et appareil destines a traiter des rides de la peau au moyen d'un rayonnement
WO1999061105A1 (fr) 1998-05-28 1999-12-02 Carl Baasel Lasertechnik Gmbh Procede et dispositif pour chauffer superficiellement un tissu
US6026816A (en) * 1998-01-22 2000-02-22 Candela Corporation Method of treating sleep-disordered breathing syndromes
WO2000044297A1 (fr) * 1999-01-29 2000-08-03 Candela Corporation Refroidissement dynamique de tissus pour un traitement par rayonnement
US6436094B1 (en) 2000-03-16 2002-08-20 Laserscope, Inc. Electromagnetic and laser treatment and cooling device
EP1139898A4 (fr) * 1998-12-08 2003-09-10 Joseph Neev Application d'energie avec refroidissement
US6743222B2 (en) 1999-12-10 2004-06-01 Candela Corporation Method of treating disorders associated with sebaceous follicles
US6869430B2 (en) 2000-03-31 2005-03-22 Rita Medical Systems, Inc. Tissue biopsy and treatment apparatus and method
EP1294444A4 (fr) * 2000-04-03 2005-08-10 Ceramoptec Gmbh Systeme laser therapeutique fonctionnant entre 1000 et 1300 nm et son application
US7041094B2 (en) 1999-03-15 2006-05-09 Cutera, Inc. Tissue treatment device and method
WO2006116141A1 (fr) * 2005-04-22 2006-11-02 Cynosure, Inc. Procedes et systemes de traitement au laser mettant en application un faisceau de sortie non uniforme
US7291140B2 (en) 2003-07-18 2007-11-06 Cutera, Inc. System and method for low average power dermatologic light treatment device
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