WO2022132841A1

WO2022132841A1 - Dermatological laser systems with pressure sensing handpiece

Info

Publication number: WO2022132841A1
Application number: PCT/US2021/063416
Authority: WO
Inventors: Michael A. Karavitis; Wytze VAN DER VEER; Amogh Kothare; Soenke A. Moeller
Original assignee: Cutera, Inc.
Priority date: 2020-12-14
Filing date: 2021-12-14
Publication date: 2022-06-23
Also published as: EP4259021A1

Abstract

Dermatological systems and methods for providing a therapeutic laser treatment using a handpiece providing contact cooling of the skin and contact sensing to ensure proper contact between therapeutic laser and the contact cooling element and skin of the patient.

Description

DERMATOLOGICAL LASER SYSTEMS WITH PRESSURE SENSING HANDPIECE

Cross-Reference to Related Applications

[0001] This application is a continuation-in-part of and claims the benefit of priority to U.S. Patent Application Serial No. 17/120,237, filed December 13, 2020, entitled “Dermatological Systems and Methods With Handpiece for Coaxial Pulse Delivery and Temperature Sensing,” which is a continuation-in-part of 16/805,761 , filed February 29, 2020, now US Patent No. 10,864,380 B1 , entitled “Systems and Methods for Controlling Therapeutic Laser Pulse Duration,” which is incorporated by reference herein in its entirety. This application claims the benefit of priority to both applications, which are hereby incorporated by reference herein in their entirety. This application also claims the benefit of priority to US Provisional Patent Application Serial No. 63/125,354, filed December 14, 2020, entitled “Dermatological Laser Systems and Methods With Pressure Sensing Handpiece,” which is hereby incorporated by reference herein in its entirety.

Background of the Invention

[0002] This invention relates generally to laser-based medical treatment systems, and more specifically to handpieces for controlling the temperature of a target skin area in the treatment of dermatological conditions.

[0003]A variety of dermatological conditions are treatable using electromagnetic radiation (EMR). Lasers are frequently used as an EMR source to treat a range of conditions including acne vulgaris, abnormal pigmentation, vascular skin conditions (e.g., spider veins), wrinkles and fine lines, dyschromia, and many others. Both pulsed and continuous-wave (CW) laser systems have been used.

[0004] Many dermatological EMR systems use a laser to photo-thermally damage a target tissue while preserving surrounding or adjacent non-targeted tissues or structures. The principle of selective photothermolysis, which involves thermally damaging a target tissue to promote a healing response, has led to the development of a variety of laser applications as standard of care in many medical fields including dermatology.

[0005] Damage to a target tissue during photothermolysis involves raising the temperature of the target tissue to a damage threshold temperature for a specified time period. For a desired level of thermal damage, there is a tradeoff between the temperature the target tissue must reach and the time that the temperature must be maintained. The same thermal damage may be achieved using a lower temperature if the time of heating is increased; if a higher temperature is used, a shorter heating time can achieve an equivalent thermal damage. To avoid thermal damage to nontargeted tissue, it is desirable to limit the heating time to the thermal relaxation time (TRT) of the target tissue, which is the time required for the target to dissipate about 63% of the thermal energy received from the laser pulse. TRT is related to the size of the target chromophore, and may range from a few nanoseconds for small chromophores such as tattoo ink particles, to hundreds of milliseconds for large chromophores such as leg venules. The TRT for a target tissue may be used for a particular laser system to select appropriate damage threshold temperatures for a desired level of thermal damage. For example, depending upon factors such as the laser power, fluence, spot size, etc. used in a given system, a damage threshold temperature to achieve a desired level of photothermolysis at time periods approximately equal to (e.g., slightly longer or shorter than) the TRT may be selected, minimizing damage to non-target tissues.

[0006] Photothermolysis can be achieved when three conditions are met: 1) the wavelength of the laser is chosen to have a preferential absorption in the target tissue over non-target tissue; 2) the laser pulse duration should be equal to or less than (=<) the TRT of the target tissue; and 3) the laser fluence (/.e., energy per unit area) must be sufficient to exceed the thermal damage threshold of the target tissue. Together, these principles permit laser systems to be developed that deliver energy at specific wavelengths, pulse durations, and fluences to provide controlled energy to damage target tissue while leaving non-targeted surrounding tissues and structures substantially unaffected.

[0007] Selectivity as well as overall safety would be improved if the temperature of the skin could be dynamically controlled. In particular, most laser-based dermatological treatment systems do not provide reliable control of the temperature of the skin during treatment, since pulse durations and the number of pulses applied to a target treatment area are typically user-selected and maintained for a given treatment session until manually changed by the user (e.g., a laser technician, physician, nurse, etc.). There is a need for laser-based treatment systems providing better control of the skin temperature. Some embodiments of the present invention achieve this by using a handpiece capable of cooling the skin surface and/or measuring the actual skin temperature to dynamically control the temperature during a treatment.

[0008] Ideally, thermal damage is highly localized to only the particular target tissue (e.g., a particular skin layer at a particular location, or particular structures such as chromophores within a skin layer at a particular location), with nearby non-targeted tissues/structures remaining unaffected and available to facilitate the healing response in the targeted tissue. However, the structural complexity of the skin, which includes a variety of layers each having unique structural and functional characteristics, has limited the development of effective EMR-based treatments for many skin conditions. [0009] Effectively reaching and limiting thermal damage to target structures within skin tissue by laser radiation is complicated by a variety of intrinsic and extrinsic factors. Intrinsic factors include, without limitation, the depth of the target structure within tissue and the associated absorption of light by non-targeted structures overlying the target (which may involve a plurality of intervening structures each having different light absorption and thermal characteristics), the scattering of light within the skin above the target, the TRT of the target structure and intervening non-target structures, and the removal (or non-removal) of heat by blood flowing through dermal and subdermal layers. Extrinsic factors include, also without limitation, the wavelength, pulse width, power, fluence, spot size, and other characteristics of the laser used to treat the target tissue or structure.

[0010] Acne vulgaris, more commonly referred to simply as acne, is the most common reason for office visits to dermatologists in the United States. Over 60 million Americans suffer from acne. Treatment options include topical applications such as disinfectants (e.g., benzoyl peroxide), retinoids (e.g., Retin-A), and antibiotics (e.g., clindamycin and erythromycin), as well as ingested compounds such as antibiotics (e.g., tetracycline), hormonal treatments (e.g., birth control pills), isotretinoin (Accutane, which has significant side effects), and optical treatments such as lasers. Laser treatments have the benefit of avoiding the side effects and inconvenience of pharmaceuticals and topical treatments but, at present, have limited effectiveness for reasons including the previously noted complexity of skin tissue structures and limitations of existing laser systems. More recently, nanosphere particles have been deposited into skin pores and/or follicles, followed by heating of the nanoparticles with laser light to treat acne. Photodynamic therapies, in which an agent is applied to the skin to increase its sensitivity to light, have also been used in conjunction with laser or other light (e.g., blue light) to treat acne.

[0011] There is a need for improved laser systems having greater efficacy for treating acne.

[0012] Precise temperature control of the target skin area becomes highly important when the patient’s skin varies in thickness or composition, such that target skin areas (e.g., spots to which one or more laser pulses are applied) may reach significantly different temperatures when the same laser pulse is applied to different skin areas. The disparity in skin temperatures for a pre-defined laser pulse applied to different skin areas is magnified when a target structure (e.g., a sebaceous gland or sebum) is deeper in the skin, because of the greater scattering and absorption of energy by overlying tissue that occurs at greater skin depths.

[0013] Heating in tissues depends upon both the absorption of the irradiated tissue structures for the wavelength of laser light used, as well as their thermal relaxation times, which is a measure of how rapidly the affected structure returns to its original temperature. By delivering the laser energy in a pulse with a time duration less than the TRT of the target tissue, highly localized heating (and destruction) of a tissue target structure (e.g., melanin, sebum, sebaceous gland, collagen) can be achieved, minimizing damage to non-target structures (e.g., non-targeted skin layers, blood vessels, etc.). If the laser pulse duration is less than the TRT of the target tissue, no significant heat can escape into non-target structures, and damage to non-target structures is limited.

[0014] For deeper target structures such as sebaceous glands, which often range from 0.3 - 2.0 mm (more commonly 0.5-1 .0 mm) below the outer surface of the epidermis, damage to overlying tissue structures is difficult to control or limit, since the laser energy must pass through overlying structures before reaching target structures. The overlying structures absorb energy depending upon their respective depths and absorption coefficients, and undesired damage may frequently occur. In some instances, the target structures are either sufficiently shallow, or the treatment temperature to which the target structures are raised is sufficiently low, that the heating of overlying structures may not cause excessive damage. Even where the risk of overheating the overlying structures of a relatively deep target is minimal, however, accurate temperature control of the target structure may be poor, resulting in overheating or underheating or the target structure, discomfort to the patient, or a combination of such undesired effects.

[0015] The skin surface may be cooled to limit the temperature increase (and damage) to non-target overlying structures, and to limit patient discomfort or pain. However, existing systems lack precise control of the cooling process. Achieving both a desired level of photothermal damage to deeper target structures and minimizing damage to non-target overlying structures has proven elusive. In many cases, the skin is cooled either too much — in which case the deeper target structure fails to reach a temperature damage threshold — or too little, in which case non-target overlying structures are damaged and the deeper target structure may be excessively damaged. There is a need for laser-based treatment systems having improved control of the cooling process to ensure that target structures reach a desired temperature (e.g., a thermal damage temperature) and that thermal damage to non-target structures is minimized or controlled to an acceptable level. There is a need for dermatological laser systems that are able to efficiently treat a variety of medical conditions to achieve these goals.

Summary

[0016] In one embodiment, the invention comprises a system for treating the skin of a patient with a therapeutic laser pulse, the system comprising: a) a laser source for generating therapeutic laser pulses for application to a target skin area; b) a handpiece comprising: 1) a handpiece body optically coupled to the laser source and having a pulse delivery region adapted to deliver the therapeutic laser pulses to the target skin area through a pulse delivery aperture; 2) a contact sensing unit for contacting the skin of the patient, comprising: A) a frame surrounding at least a portion of the pulse delivery aperture; B) a plurality of contact sensing elements coupled to the frame at different locations, each contact sensing element sensing at least one of a force and a pressure at one of the different locations when the contact sensing unit is placed in contact with the skin; and c) a contact indicator for providing at least one of a force feedback parameter and a pressure feedback parameter to a system user based on the at least one of an applied force and an applied pressure sensed by the plurality of contact sensing elements.

[0017] In one embodiment, the invention comprises a system for treating the skin of a patient with a therapeutic laser pulse, the system comprising: a) a laser source for generating therapeutic laser pulses for application to a target skin area; b) a handpiece comprising: 1) a handpiece body having a first region optically coupled to the laser source and a second region adapted to deliver the therapeutic laser pulses to the target skin area; 2) a contact cooling unit located at the second region of the handpiece body, the contact cooling unit comprising a contact cooling window having A) a contact surface adapted to contact and cool a first skin area comprising the target skin area, and B) a periphery; and 3) a contact sensing unit for contacting the skin of the patient, comprising: A) a frame surrounding at least a portion of the contact cooling window periphery; B) a first contact sensing element at a first location on the frame to sense at least one of an applied force and an applied pressure at the first location when the contact sensing unit is placed in contact with the skin; C) at least a second contact sensing element at a second location on the frame to sense at least one of an applied force and an applied pressure at the second location when the contact sensing unit is placed in contact with the skin; and c) a contact indicator for providing at least one of a force feedback parameter and a pressure feedback parameter to a system user based on the at least one of an applied force and an applied pressure sensed by the first contact sensing element and the at least a second contact sensing element.

[0018] In one embodiment, the invention comprises a system for treating the skin of a patient with a therapeutic laser pulse, the system comprising: a) a laser source for generating therapeutic laser pulses for application to a target skin area; b) a handpiece comprising: 1) a handpiece body optically coupled to the laser source and having a pulse delivery region adapted to deliver the therapeutic laser pulses to the target skin area through a pulse delivery aperture; 2) a skin temperature sensing unit comprising: A) at least one temperature sensing element selected from an electrical sensing element and an infrared energy sensing element, the at least one temperature sensing element generating a temperature signal indicative of the surface temperature of the target skin area; and B) a processor for determining the surface temperature of the target skin area at a desired skin temperature determination rate based on the temperature signal; 3) a contact sensing unit for contacting the skin of the patient, comprising: A) a support frame surrounding at least a portion of the pulse delivery aperture; B) a plurality of contact sensing elements coupled to the support frame at different locations, each contact sensing element sensing at least one of a force and a pressure at one of the different locations when the contact sensing unit is placed in contact with the skin; and c) a contact indicator for providing at least one of a force feedback parameter and a pressure feedback parameter to a system user based on the at least one of a force and a pressure sensed by the plurality of contact sensing elements.

Brief Description of the Drawings

[0019] Figure 1 is a cross-sectional illustration of skin tissue depicting the epidermis, dermis, and hypodermis, with a laser pulse applied to a portion thereof.

[0020] Figure 2 is a cross-sectional illustration of skin tissue depicting a hair follicle and a sebaceous gland.

[0021] Figures 3A and 3B are graphs illustrating the absorption coefficients of human sebum lipid, water, and melanosomes for various wavelengths of light.

[0022] Figure 4A is a graph illustrating a surface temperature profile of a target skin area according to a mathematical model of a treatment with a laser pulse.

[0023] Figure 4B is a graph illustrating a sebaceous gland temperature profile within a target skin area according to the mathematical model of the laser pulse of Figure 4A.

[0024] Figure 5A is a graph illustrating a surface temperature profile of a target skin area before, during, and after a laser pulse treatment with skin cooling, according to a mathematical model.

[0025] Figure 5B is a graph illustrating a sebaceous gland temperature profile within a target skin area before, during, and after a laser pulse treatment with skin cooling, according to the mathematical model of Figure 5A.

[0026] Figure 5C is more detailed graph illustrating a surface temperature profile for a target skin area during treatment with a laser pulse according to the mathematical model of Figure 5A.

[0027] Figure 6A and 6B are block diagrams of embodiments of a dermatological treatment system according to the present invention.

[0028] Figures 7 and 8 are simplified figures of a handpiece according to an embodiment of the present invention.

[0029] Figures 9A and 9B are perspective views of a handpiece according to an embodiment of the present invention.

[0030] Figures 9C, 9E, and 9G are partially exploded views of the handpiece of Figures 9A and 9B.

[0031] Figures 9D and 9E are optical schematics showing optical paths in the handpiece of Figures 9A and 9B. [0032] Figure 10 is a flowchart illustrating a treatment method according to one embodiment of the present invention.

[0033] Figures 11A is a perspective view of a handpiece according to an embodiment of the present invention.

[0034] Figure 11 B is a partially exploded view of the handpiece of Figure 11 A.

[0035] Figure 11C illustrates an embodiment of a flexcircuit use in an embodiment of the handpiece of Figure 11 A.

[0036] Figure 11 D is a cross-section of view along section line 11 D of Figure 11 A.

[0037] Figures 12A is a perspective view of a handpiece according to an embodiment of the present invention.

[0038] Figure 12B is a partially exploded view of the handpiece of Figure 12A.

Description

[0039] Exemplary embodiments of the present disclosure are illustrated in the drawings, which are illustrative rather than restrictive. No limitation on the scope of the technology, or on the claims that follow, is to be implied or inferred from the examples shown in the drawings and discussed herein.

[0040] Treatment of many dermatological conditions involve using laser light to heat a target skin area to thermally damage a selected structure within the target skin area and promote a healing response. Consistently accurate delivery of energy to targeted structures to achieve a desired level of damage to the target structure, while minimizing the delivery of energy and corresponding damage to non-targeted structures, has remained an unrealized goal. The present disclosure is directed to providing systems and methods to achieve these objectives.

[0041] As used herein “target skin area” refers to the skin receiving the energy of a laser pulse. The target skin area may include the surface skin area illuminated by the laser pulse, as well as deeper structures beneath the surface skin area that receive at least a portion of the energy from the laser pulse. As such, “target skin areas” treated by a laser pulse may refer to a volume of skin as opposed to a true area of an outer surface of the epidermis.

[0042]As used herein, “surface temperature” in reference to a target skin area refers to the temperature of the target skin area as determined or measured at or above the surface of the skin. In particular, where infrared (I R) energy radiated from a target skin area is used to measure the temperature of the skin surface, the surface temperature determination includes energy radiated from deeper in the epidermis in addition to the outermost layer of cells. Without being bound by theory, the strong scattering effects of IR wavelengths within the epidermis limit the energy emitted and detected to the upper 100 microns, and primarily the upper portions thereof. Consequently, “determining a surface temperature” based on detection of radiated IR energy refers to the determination of a composite or average temperature of the upper portions (e.g., tens of microns in depth) of the epidermis, and not merely the outermost layer of skin cells. In embodiments of the present invention, IR-based temperature measurements or determinations provides a reliable and precise determination of the temperature of the uppermost portion of the epidermis.

[0043]As used herein in connection with optical elements and optical energy, “engages” refers to optical contact between optical energy (e.g., a laser pulse or IR energy) and an optical element such as a lens or a mirror. A laser pulse or IR energy may engage a lens by passing through it, and engages a reflective element by being reflected of its surface.

[0044] Some exemplary embodiments of the present invention discloses systems and methods using laser handpieces to achieve improved treatments for a variety of medical conditions including, without limitation, acne. In one aspect of the exemplary embodiment, the present disclosure provides laser system having handpieces providing improved skin temperature control to avoid damage to non-targeted structures and more precisely control thermal damage to target structures. In one aspect of the exemplary embodiment, the disclosure provides systems and methods having a laser source, a handpiece to cool and deliver laser pulses to a target skin area, and a temperature determination unit to monitor the target skin temperature.

[0045] In one embodiment, the handpiece includes optical elements to direct laser pulses to the target tissue along a first optical path, and a temperature determination unit determine the surface temperature of the target tissue using infrared (IR) energy radiated from the tissue along a second optical path. The surface temperature may be determined before, during, or after the delivery of the laser pulses.

[0046] In one embodiment, the temperature of a target temperature area is determined a plurality of times before and during the delivery of a laser pulse. In preferred embodiments, the first and second optical paths have a common optical axis for at least a portion of each optical path. [0047] In one aspect of exemplary embodiments herein, the present invention comprises systems and methods having a handpiece for improved temperature control of a target skin area during the delivery of one or more therapeutic laser pulses in the treatment of a medical condition. The handpiece is configured to facilitate the delivery of laser pulses traveling in a first direction to a target skin area, and to allow IR energy radiated from the target skin area to travel in a second direction generally opposite (“counterdirectional”) to the first direction to detect skin temperature. The handpiece is optically coupled to a laser source adapted to generate at least one, and preferably a plurality, of therapeutic laser pulses for application to the target skin area. The handpiece receives therapeutic laser pulses from the laser source, and includes a cooling window for contacting and cooling a first skin area that includes the target skin area. The cooling window is transmissive to the laser pulses and to IR energy radiated from the target skin area. The laser pulses travel through the handpiece along a first optical path in the first direction, and pass through the cooling window to a target skin area within the first skin area. The system further includes a temperature determination unit that includes a temperature sensing element and a processor for determining a surface temperature of the target skin area based on IR energy radiated from the target skin area through the cooling window along a second optical path travelling along a second optical path generally opposite or counterdirectional to the first optical path.

[0048] In a preferred embodiment, the first optical path and the second optical path share a common optical axis for at least a portion of their length. The handpiece includes a reflective optical element located in the first optical path and having one of a slot and an aperture through which the laser pulses pass while traveling along the first optical path. The reflective optical element is oriented to receive the IR energy radiated from the target skin area along the second optical path, and to reflect it onto the temperature sensing element. The temperature sensing element is capable of generating a signal that is processed by the processor to determine the surface temperature of the target skin area.

[0049] In a preferred embodiment, the reflective optical element is precisely oriented to receive I R energy from substantially only the target skin area, and not other adjacent tissue within the larger skin area cooled by the cooling window. The handpiece further comprises at least one second optical element within the first optical path, and the laser pulses engage the at least one second optical element. In a preferred embodiment, the at least one second optical element comprises a plurality of optical elements, including at least one lens and at least one reflective element (e.g., a mirror). In a still more preferred embodiment, the IR energy radiated from the target skin area along the second optical path also engages the plurality of optical elements. In various embodiments, the at least one second optical element may comprise elements for focusing, splitting, redirecting, collimating, or performing other operations on the laser pulses and/or IR energy.

[0050] In some embodiments, the present invention comprises systems and methods for determining or measuring a surface temperature of a target skin area of a patient during a laser treatment using a handpiece that provides contact cooling of the skin and surface temperature sensing of substantially only a target skin area receiving laser energy. In some embodiments, the present invention provides improved temperature control of a target non-surface (/.e., deeper) structure in the target skin area of a patient during the laser treatment. By providing accurate temperature control of a target skin area during the delivery of laser pulses, the invention provides systems and methods with improved efficacy, safety and/or comfort to patients being treated for a range of dermatological conditions.

[0051] In some embodiments, the present invention comprises systems and methods for treating the skin of a patient with therapeutic laser pulses with a handpiece that provides contact cooling of the skin and contact sensing to ensure proper contact between the contact cooling element and skin of the patient. In some embodiments, the handpiece further includes temperature sensing based on IR energy radiated from the target skin area receiving the laser pulse(s) and traveling counterdirectionally to the laser pulses.

[0052] In one aspect, the invention provides systems and methods of controlling a temperature of a target skin area during a laser treatment to avoid one or more of overheating or excessively damaging the target area, underheating the target structure, or causing undesired damage to overlying non-targeted structures.

[0053] In one aspect, the present invention discloses systems and methods for minimizing the temperature increase of non-target structures overlying a target structure within a target skin area during the delivery of a laser one or a plurality of laser treatment pulses to raise the target structure from a first temperature to a second temperature (e.g., a damage threshold temperature). [0054] In various embodiments, systems of the present invention may determine the temperature of a target skin area one or a plurality of times before, during, or after treatment of the target skin area using IR energy radiated from the skin. The laser treatment may comprise comprises one pulse, or a plurality of pulses comprising a single heating episode of the target skin area. As used herein, a “single heating episode” involves a plurality of pulses where the first pulse raises the temperature of the target skin area from a first or baseline temperature immediately prior to the first pulse, and each successive pulse in the heating episode is applied before the target skin area returns to the first or baseline temperature. Where a plurality of pulses is used to heat the target skin area in a single heating episode, the temperature of the target skin area may be determined during a pulse, between pulses, or a combination of during and between pulses of the single heating episode.

[0055]As used in connection with temperature determinations, “real-time” refers to temperature determinations (e.g., temperature measurements or calculations based on data from an IR temperature sensor) performed with little time delay (e.g., less than 100 msec, more preferably less than 5 msec, most preferably 1 msec or less) between the initiation and conclusion of temperature determination. In some embodiments, real-time temperature determinations refer to temperature determinations that are those made sufficiently rapidly such that they are capable of use by the system to perform one or more tasks, including, but not limited to: terminating a treatment of a target skin area; logging the skin temperature profile vs time to a memory’ or providing a warning indication to a user.

[0056] In one aspect of exemplary embodiments herein, the invention also comprises contact cooling applied to an external surface of a first skin area to enable heating of deeper structures (e.g., a sebaceous gland) to a damage threshold temperature, while minimizing the heating of overlying non-targeted tissue structures. Real-time temperature determinations may occur during before, during, or after the cooling of a first skin area, and may be used (e.g., by a processor executing a treatment algorithm) to perform a responsive action such as initiating, terminating or adjusting the cooling process, initiating or terminating the delivery of one or more laser pulses to a target skin area within the skin area being cooled, or adjusting a parameter of the laser therapy.

[0057] In one aspect of exemplary embodiments herein, the invention comprises a method of treating a patient having one of more dermatological conditions including, without limitation, abnormal pigmentation conditions, acne vulgaris, dyschromia, hyperhidrosis i.e., excessive sweating), pigmented lesions, vascular lesions, and wrinkles and fine lines by controlled heating of a target skin area from a first surface temperature to a second surface temperature sufficient to cause thermal damage to one or more structures in the target skin area.

[0058] In one embodiment, the duration of a laser treatment pulse is based on determining the surface temperature of the target skin area one or more times before, during, or after the delivery of laser treatment pulses. In one embodiment, a laser treatment pulse is terminated when the second surface temperature reaches a value indicative of a deeper target structure (e.g., a sweat gland) reaching a desired treatment temperature. The second surface temperature corresponding to the target structure reaching its treatment temperature may be determined prior to treatment, e.g., by thermal (mathematical) modeling of the heating of the target skin area as a function of skin depth based on the parameters of the treatment laser such as wavelength, energy flux, and thermal characteristics of the target skin area such as thermal conductivity, the absorption coefficients of various tissue structures and/or chromophores, etc.

[0059] In one aspect of exemplary embodiments herein, the invention comprises a method of treating a patient having acne vulgaris by controlled heating of a target skin area from a first surface temperature to a second surface temperature, where the second surface temperature corresponds to a temperature resulting in thermal damage to one of sebum or a sebaceous gland within the target skin area. In one embodiment, the duration of the laser treatment pulse is based on determining the surface temperature of the target skin area a plurality of times during the delivery of one or more laser treatment pulses. In one embodiment, the laser treatment pulse is terminated when the second surface temperature reaches a value indicative of the deeper sebaceous gland reaching a sebaceous gland treatment temperature. The second surface temperature corresponding to the sebaceous gland reaching the sebaceous gland treatment temperature may be identified by thermal modeling as previously discussed.

[0060] Figure 1 is a side view illustrating a cross-sectional view of a portion 100 of the skin of a patient, including the outermost epidermis 102, the middle layer or dermis 104, and the bottom layer or hypodermis 106. The epidermis 102 has a thickness of about 80-100 pm, which may vary from patient to patient, and even for a single patient depending upon age, health status, and other factors. The epidermis 102 includes up to five sub-layers (not shown) and acts as an outer barrier.

[0061]The dermis 104 has a thickness of about 1-5 mm (1000-5000 pm). It contains the blood vessels, nerves, hair follicles, collagen and sweat glands within the skin. Because skin conditions frequently involve structures in the dermis, many laser systems must include sufficient energy to penetrate into the dermis to reach those structures. Those skilled in the art having benefit of the present disclosure would appreciate that careful selection of a number of parameters must be made in the design and construction of laser systems to achieve a desired level of damage to a target structure while minimizing or avoiding damage to non-targeted (e.g., overlying) structures. For example, incorrect selection of the laser wavelength, pulse width, energy per pulse, the use (or nonuse) of a seed laser, or the pump energy of the laser source or amplifier may result in undesired damage and poor performance in treating a dermal structure. Numerous other system choices, such as the use or non-use of an articulating arm for delivery of the laser light to a handpiece for application to the skin, may also affect overall system performance.

[0062] The lowest layer of the skin is the hypodermis 106, which includes adipose tissue and collagen. The hypodermis 106 helps control body temperature by insulating the structures of the body below the skin. In addition, the hypodermis protects the inner body tissues from damage by absorbing shock and impacts from outside the body. Because the hypodermis contains fat, its thickness varies widely from person to person based on diet, genetic makeup, and other factors.

[0063] Figure 1 depicts a laser beam 108 applied to a target skin area 110 of the skin 100. The target skin area 110 comprises a surface skin area 112, as well as underlying skin tissue 114 that absorbs at least a portion of the energy of the laser beam 108.

[0064] Figure 2 is a side view of the skin of a patient illustrating in simplified form, a hair 202 including a hair shaft 204 extending beyond the exterior skin surface 206. Hair shaft 204 includes a root 208 located below epidermis 210 in the dermis 212. The base, or papilla, of root 208 is located about 4 mm below exterior skin surface 206. Root 208 is housed within hair follicle 214 and is surrounded by tissues including connective tissue sheath 216 and blood vessels 218. Follicle 214 includes a sebaceous gland 219 below an opening 223. Sebaceous glands such as gland 219 are typically located at depths ranging from about 0.3 mm (300 pm) to about 2.0 mm (2000 pm) below exterior skin surface 206, but their depth varies depending upon body location.

[0065] Epidermis 210 includes melanin (not shown), a dark pigment found in tissues of the hair, skin and eyes. Melanin, the primary determinant of skin color, is located within globular structures known as melanosomes, which are produced by skin cells called melanocytes. Darker skin has more melanosomes (and thus more melanin) per unit skin area compared to lighter skin. Laser systems targeting deeper structures such as sebaceous gland 219 in the dermis may present a higher risk of patient discomfort where wavelengths having a relatively high absorption coefficient in melanin are used. Without being bound by theory, when laser light at wavelengths readily absorbed by melanin is applied to darker skin (or dark tattoos having ink particles that absorb laser light at similar wavelengths to melanin), the energy absorbed by the melanin (or tattoo ink particles) attenuates part of the laser energy that otherwise would reach deeper structures, heating the skin of the epidermis and/or upper dermis to a greater degree than lighter/un-tattooed skin. Additional energy — e.g., using higher fluences, higher energy per pulse, or longer treatment times — must be applied to reach and heat deeper structures to a target treatment temperature. However, higher pulse fluences and pulse energy may compound the problem, since the additional energy delivered in a shorter time period will cause the overlying skin temperature to rise even faster than using lower fluences or energies. In addition, longer treatment times can only deliver more energy to the target if the energy is delivered within the TRT of the target tissue — otherwise, the additional energy largely leaks from the target tissue into adjacent non-target tissue.

[0066]Accordingly, in one aspect of exemplary embodiments herein, the present invention provides laser treatment systems to minimize discomfort by adjusting one or more treatment parameters based on the patient’s skin type. In one embodiment, the invention provides systems and methods comprising a handpiece for determining a skin type of a patient and automatically adjusting one or more treatment parameters based on the skin type of the patient. This may involve, for patients having darker skin types, one or more of: providing additional cooling of the patient’s skin prior to applying a laser therapy to the patient’s skin; lowering a first skin temperature at which a therapy pulse is initiated and applied to the patient’s skin; lowering a fluence of a laser therapy; lowering a peak power of the laser pulses of a laser therapy; providing a longer pulse width of a pulsed laser therapy; and providing a larger beam diameter for a pulsed laser therapy.

[0067] Those skilled in the art having benefit of the present disclosure would appreciate that successful treatment of acne involves damaging sebocytes, sebum and/or sebaceous glands. This involves heating these structures to damage the gland and/or kill bacteria resident therein. Accordingly, in one embodiment the invention provides laser light at a wavelength that is highly absorbed by sebum, compared to competing skin chromophores (e.g., water), to limit the damage to non-targeted tissue and concentrate the laser energy delivered into the targeted sebaceous gland. Because sebaceous glands are relatively deep structures located in the dermis at depths of 300-2000 pm (0.3-2.0 mm), it is desirable to select a wavelength of light capable of non-ablative penetration to these depths.

[0068] Figures 3A and 3B are graphs illustrating the absorption curves for several chromophores of interest (water, sebum, and melanosomes) at wavelengths of light for portions of the near-infrared spectrum (about 750 nm - 1400 nm) and the shortwavelength IR spectrum (about 1400-3000 nm). Figure 3A illustrates the absorption curve 310 for sebum, the water absorption curve 320, and the absorption curve 330 for melanosomes. It will be appreciated that in laser treatment systems directed toward conditions other than acne, e.g., tattoo removal or pigmented lesions, the absorption of other chromophores (e.g., inks of various colors, hemoglobin, etc.), skin wrinkle-reduction, etc. will be important considerations in selecting laser treatment system parameters such as wavelength, fluence, peak power, etc.

[0069] Figure 3A demonstrates that the sebum absorption curve 310 has a peak at about 1727.5 nm, meaning that sebum absorbs laser light at this wavelength more strongly than light at other nearby wavelengths, e.g., 1650 nm or 1800 nm. The absorption coefficient of water is less than that of sebum in a range of from about 1693 nm to about 1742 nm, and within a range of from about 2280-2360 nm. The absorption coefficient of melanosomes exceeds that of sebum at all wavelengths less than about 2225 nm, although only by a small amount at the 1727.5 nm peak for sebum, as demonstrated at point 335 of Figure 3A, where the two absorptions curves approach one another. It will be appreciated by persons of skill in the art that the concentration of sebum, water, and melanin may vary from patient to patient for a given area, and even within a particular patient depending upon the target tissue structure(s), the hydration status of the patient, and the skin type or area of the patient. [0070] As shown more clearly in Figure 3B, which is a more detailed illustration of the absorption curves of Figure 3A for the 1600-1800 nm wavelength region using like numbers for like absorption curves and peaks, the absorption coefficient for sebum (curve 310) at a peak of about 1727.5 nm (point 335) is approximately twice that of water (curve 320), and is only slightly less than that of melanosomes (curve 330). Specifically, the absorption coefficient for melanosomes at 1727.5 is about 11 .0 cm-1 , and that of sebum is about 10.3 cm-1 . Accordingly, in one embodiment, the invention comprises a laser providing pulsed laser light at a wavelength of between 1693-1742 nm, more preferably at about 1720-1730 nm, and more preferably still at about 1727.5 nm.

[0071] Referring again to Figure 3A, the sebum absorption curve 310 has a further absorption peak (340) of about 2305 nm, exceeding that of both water and melanosomes at the same wavelength. In one embodiment, the invention comprises a laser providing pulsed laser light at a wavelength of between about 2287-2318 nm. Although sebum strongly absorbs light at 2305 nm, light at this wavelength is less suitable because its penetration depth into skin is much less than that of light at 1727.5 nm. In general, at wavelengths shown in Figures 3A and 3B, the penetration of light decreases with increasing wavelength. Treatment of acne and other conditions with laser light involves multiple tradeoffs, including the relative absorption coefficients of target and non-target tissues/structures, penetration depth of the wavelength of interest into skin, laser power, laser pulse fluence, pulse duration, pulse frequency, etc.

[0072] Figures 4A and 4B illustrate exemplary temperature profiles of the surface of a target skin area (Figure 4A) and a sebaceous gland (Figure 4B) located below the surface of the target skin area during a laser pulse according to a mathematical model. The laser pulse is intended to raise the temperature of the sebaceous gland to a temperature to achieve a desired cell population death for sebocytes. In this embodiment, the laser pulse is a tophat pulse (/.e., having a uniform intensity profile over the covered area) with a wavelength of 1727.5 nm, a pulse duration of 30 msec, a beam diameter of 2.8 mm, a power of 75 W, a pulse energy of 2.25 J, and a fluence of 37 J/cm2. For purposes of illustration, the skin is depicted as remaining at body temperature for 2 seconds prior to the application of the pulse, although it will be appreciated that any arbitrary time period could be shown. [0073] Referring to Figure 4A, at time t= 2 seconds, a single pulse of laser light having the parameters noted above is initiated and applied to a target skin area, depicted at point 420. The surface temperature of the skin rises during the pulse, as shown by line 430, to slightly above 100°C as shown by peak 440. After the pulse is terminated, the skin surface temperature of the target area cools rapidly over the next several seconds, as indicated by curve 450, falling to below 60°C within 4 seconds (t=6 seconds) after the termination of the pulse.

[0074] Figure 4B illustrates the temperature profile of a sebaceous gland located at a depth of 650 pm below the skin surface in the laser pulse model of Figure 4A. As in Figure 4A, the skin remains at body temperature for 2 seconds (410) prior to the initiation of a single pulse (421) applied to the target skin area. The temperature of the gland rises during the pulse (430) to a maximum temperature 440 of about 92°C — less than the surface skin temperature illustrated in Figure 4A due to scattering and the energy absorbed by the overlying tissue. Because the pulse energy at 1727.5 nm is preferentially absorbed by the sebaceous gland (as discussed in connection with Figures 3A and 3B), comparatively more energy from the laser pulse that reaches the gland is absorbed by the oily tissue therein compared to overlying tissue containing a higher water content. Consequently, the temperature profile (450) of the sebaceous gland after termination of the pulse at 440 differs significantly from that of the skin surface temperature depicted in Figure 4A. Although the temperature initially falls rapidly to about 85°C, the temperature thereafter falls more slowly than the surface temperature shown in Figure 4A.

[0075] The pulse modeled in Figures 4A and 4B has energy levels below those necessary to ablate skin tissue. Although the pulse will result in thermal damage to the sebaceous gland and could be used to treat acne, temperatures above 45-50°C are likely to result in significant discomfort when they persist, as illustrated in Figure 4A, for 4 seconds or longer. Accordingly, the pulse depicted in Figure 4A would have limited application as a viable treatment to most patients. In one embodiment, the laser pulses described in connection with Figures 4A and 4B result in temperatures too high to be used for treatment, although they could be modified (e.g., by lowering pulse fluences, shortening pulse treatment times, etc.) to result in skin temperatures more suitable for treatment. In one embodiment, temperatures may be lowered by skin cooling, as described in connection with Figures 5A and 5B. [0076] Figures 5A and 5B illustrate exemplary temperature profiles of a target skin area during a laser pulse according to a different mathematical model than those of Figures 4A-B. In the embodiment of Figures 5A and 5B, the laser pulse has the same parameters as those of Figures 4A-B (wavelength A=1727.5 nm; pulse duration = 30 msec; beam diameter = 2.8 mm, power = 75 W; pulse energy = 2.25 J; fluence = 37 J/cm2). However, in Figures 5A and 5B the target skin area is cooled prior to, during, and after the application of the laser pulse.

[0077] Although many known methods and modes of precooling the skin may be used, the embodiment of Figures 5A and 5B are modeled on a system having a contact cooling element applied to a first skin area that includes a target skin area to be treated by the laser pulse. The contact cooling element includes a cooling window that, in some embodiments, directly contacts the first skin area, and the target skin area actually irradiated by the laser pulse is wholly located within the first skin area. Although a variety of materials may be used as the contact cooling window, in the embodiment of Figures 5A and 5B, the cooling system includes a sapphire cooling window cooled by a thermoelectrical cooler (TEC) coupled to the window. The sapphire cooling window has a thickness of 3 mm and a diameter of 1 inch (25.4 mm), although many different sizes, shapes, thicknesses, and materials may be used different embodiments. For example, although the cooling window modeled in the embodiment of Figures 5A and 5B was circular, other cooling window shapes such as square, rectangular, or other polygonal or nonpolygonal shapes could be used in different embodiments and for different tissue types. The cooling window was modeled as being cooled to a temperature of 5°C.

[0078] In alternative embodiments, non-contact cooling systems (e.g., cold air or other fluid circulated onto or across the surface of a target skin area) may be used to cool the skin. However, it is believed that the thermal resistivity of the skin, and the thermal coupling between the skin and gases such as air, typically preclude non-contact systems from providing adequate cooling capacity during the delivery of laser pulses to both effectively treat deeper target structures and prevent the skin surface from reaching temperatures likely to result in significant discomfort. Accordingly, contact cooling systems are preferred. In other embodiments, evaporative cooling systems (e.g., sprayed coolant evaporating from the skin) may be used.

[0079] In Figure 5A, the contact cooling element at 5°C is applied to the skin at time t=0, and skin temperature falls rapidly along curve 510 to a target temperature of about 10°C at time t=2 second, at which point (520) the laser pulse is applied to the skin. Delivery of the laser pulse to the target skin area is continued until a target surface temperature 560 of the target skin area is reached (540), at which point the laser pulse is terminated. Because the contact cooling element continues to cool the skin both during and after the laser pulse, the surface temperature falls rapidly along curve 550 after laser pulse termination.

[0080] Figure 5B illustrates the temperature profile of a sebaceous gland located at a depth of 650 pm below the skin surface in the cooling and laser pulse delivery process of figure 5A. When contact cooling is applied to the skin at time t=0, the temperature of the gland declines (curve 510), but much less rapidly than the surface temperature, depicted in Figure 5A. The laser pulse is initiated at point 520, and the temperature of the gland rises along line 530 until the laser pulse is terminated (540). The gland temperature thereafter falls along line 550, but less rapidly than the surface temperature decline following the pulse termination in Figure 5A.

[0081 ] Because direct measurement of the gland temperature is difficult or impossible given its depth within the skin, in embodiments of the present invention, surface skin temperature may be monitored as an indirect indication of the gland temperature. Those skilled in the art having benefit of the present disclosure would appreciate that because the goal of the laser treatment is to heat the sebaceous gland to a damage threshold temperature, cooling the gland (as opposed to the skin surface) shown by curve 510 in Figure 5B is undesirable, but is an unavoidable consequence of the protective precooling of the overlying skin tissue. Precooling the overlying skin tissue to a desired surface temperature of about 10°C, as shown in Figure 5A, generates a downward cooling wave or thermal gradient in the target skin area, propagating from the skin surface toward the deeper tissues in the dermis and hypodermis. The precooling process may be controlled such that, for a sebaceous gland in a known depth range, when the laser pulse is delivered to heat the target skin area, the precooled overlying skin remains below a damage threshold temperature while the target sebaceous gland reaches (or exceeds) a damage threshold temperature. This is facilitated by selecting a laser wavelength for which the absorption coefficient of sebum/sebaceous gland tissue exceeds that of water, the primary chromophore of most of the overlying dermal and epidermal tissue.

[0082] Comparing Figures 5A and 5B, precooling the skin allows the sebaceous gland to reach a temperature of about 78°C at the termination of the laser pulse — about 13°C above the surface temperature of target skin area at the surface (about 62°C). Although the overlying tissue is unavoidably heated during pulse delivery, careful precooling before initiating the laser pulse allows the surface temperature to be precooled to a temperature well below the sebaceous gland at pulse initiation (about 10°C for the skin surface vs. about 22°C for the sebaceous gland as shown by Figures 5A and 5B at point 520). This temperature difference occurs because the cooling window creates a thermal gradient between the skin surface and deeper structures as heat is removed. In addition, the pulse energy at a wavelength of 1727.5 nm is more highly absorbed by the sebaceous gland than overlying tissue. Because of the selective precooling and differential absorption between the surface and the sebaceous gland provided by embodiments of the present invention, the non-targeted overlying tissue is heated by the laser pulse to a lower temperature (about 63°C, Figure 5A at point 540) than the targeted sebaceous gland (about 81°C, Figure 5B at point 540), reducing or minimizing damage to the non-targeted tissue and patient discomfort.

[0083] In some embodiments, the present invention includes a method of controlling the duration of a pulse to limit the surface temperature of a target skin area to a desired or target threshold using a handpiece capable of contact cooling and rapid, real-time temperature measurement of the skin during the delivery of one or more laser pulses. Figure 5C demonstrates a method of achieving such control by monitoring the temperature of a pulse during the delivery of a single pulse. The surface temperature of the skin may be determined one or more times during pulse delivery, and the pulse may be terminated based on one or more of the skin temperatures. In one embodiment, the skin temperature is periodically determined during the pulse delivery, and the pulse is terminated when the surface skin temperature reaches (or is within a desired interval of) a threshold temperature.

[0084] Figure 5C, illustrates a surface temperature profile during the delivery of the laser pulse of Figure 5A. From time t=1 .99 to t=2.00 seconds, the temperature of the skin near the surface (modeled in Figure 5C at a depth of 100 pm) is relatively constant at about 10 °C (line 510). At time t=2.00 seconds (520), the pulse is initiated and applied to the skin through the cooling window. Simultaneously, the first of a plurality of surface temperature determinations of the target skin area 570 is made. Pulse delivery continues along line 530, and the surface temperature rises until the pulse is terminated at 540. After pulse termination, the surface temperature falls as indicated by line 550. During pulse delivery, multiple temperature determinations 570 are made at equal intervals, although the frequency of temperature sampling may vary based on a variety of factors such as the time frame desired for heating the tissue, thermal relaxation time of the target structure, pulse fluence, pulse power, pulse wavelength, and exogenous factors such as the target structure damage threshold, and other factors. Temperature determinations may be performed at a desired sampling interval, e.g., 100 msec or less (/.e., 10 or more temperature determinations per second) and may occur at uniform or non-uniform time intervals, e.g., varying based on the difference between a measured temperature and a desired threshold, or on other exogenous factors. In one embodiment, the temperature sampling interval is increased as the surface skin temperature approaches a desired temperature. Depending upon the sensing element and processor used, the surface temperature may be determined at a sampling or time interval of 0.001-100.0 msec (/.e., 1-100,000 psec, or performing 10 to 1 million temperature determinations per second).

[0085] Figures 5A and 5B illustrate methods of treating a sebaceous gland according to one embodiment of the present invention. Additional details of treating a sebaceous glans may be found in US 10,864,380, which is incorporated herein by reference. However, embodiments of the present invention may be used to treat other structures in the dermis or hypodermis (e.g., sweat glands, hair follicles, etc.) by facilitating precise control of surface and deeper temperatures within a target skin area.

[0086] Figure 6A is a schematic illustration, in block diagram form, of an embodiment of a therapeutic laser system 600 having a handpiece with contact cooling and temperature sensing for providing therapeutic laser pulses along a first optical path that is coaxial with a second optical path for sensing skin temperature for at least a portion of the first and second optical paths. A laser 610, which is preferably a semiconductor laser, provides laser pulses having a wavelength with a high absorption coefficient in a target tissue. The target tissue may be sebaceous gland tissue, sweat gland tissue, fat, or other tissue. Laser 610 is optically coupled, e.g., by an optical fiber, articulating arm, or other optical coupling elements known in the art, to a handpiece 620 for delivery of one or more laser pulses to a target skin area. Although semiconductor (e.g., diode) lasers are preferred, it will be appreciated that other laser types (e.g., fiber lasers, dye lasers, etc.) may be used in different embodiments. [0087] Handpiece 620 includes a cooling system 622 for cooling a first skin area that includes a target skin area within the first skin area. Cooling system 622 includes a contact cooling element comprising a cooling window 628 maintained in a fixed position in contact with a heatsink portion of a thermoelectric cooler (TEC) 630 by a window frame 626. Cooling window 628 may comprise any of a variety of IR- transmissive materials, including for example, sapphire, ZnS, diamond, ZnSe, and other thermally conductive material that are transmissive to infrared light. In alternative embodiments (not shown), the contact cooling element may comprise components or structures in addition to cooling window 628, such as a copper (or other material having a high thermal conductivity) cooling element that is not light- transmissive to provide additional cooling capacity.

[0088] In some embodiments, TEC 630 may be a Peltier-type cooler and has a warm side and a cold side (not shown). The heatsink portion of the TEC 630 is part of the cold side and is used to remove heat from the cooling window 628 to maintain the cooling window at desired temperature as it contacts the first skin area. A cooling medium 632 removes heat from the hot side of the TEC 630 to prevent heat buildup in handpiece 620. In one embodiment, the cooling medium comprises circulating cold water, although other thermally conductive fluids or other materials may be used in different embodiments. In preferred embodiments, the cooling medium is circulated to and from TEC 630 from a reservoir (not shown) that is not part of the handpiece.

[0089] To ensure efficient skin cooling, it is necessary to maintain good contact between the skin and the cooling window 628 during treatment. In two alternative embodiments (see Figures 11A-11 D; and Figures 12A-12B), the invention comprises a laser treatment system including a handpiece having one or more contact sensing elements to detect when the cooling window 628 is properly in contact with the first skin area. The contact sensing element(s) may be coupled to, or separate from, cooling window 628 and/or frame 626 (e.g., a heatsink surrounding the cooling window periphery), and may comprise, e.g., one or more electrical contacts capable of sensing electrical activity, conductivity, or resistance of the skin indicative of adequate skin/cooling window contact. Other contact sensing elements (e.g., ultrasonic sensors) detecting different skin parameters or features associated with proper contact (e.g., force, vibration, pressure, temperature, the presence of sweat or skin oils) may also be used. [0090]0ne or more skin contact indicators (Figures 11A-D, and 12A-B) may alert a user to the contact status between the skin and cooling window 628. The skin contact indicator may indicate when the contact element(s) are — or are not — in good contact with the first skin area and may prompt the user to manipulate the handpiece to restore good contact when necessary. The skin contact indicator(s) may comprise, e.g., an LED indicator on handpiece 620 that displays a first color when good skin contact exists and a second color when the window 628 is not in proper contact with the skin. Other indicators, such as an audible sound or alarm, may also be provided, and the system may be interlocked such that the system will not apply (or will terminate) a laser pulse if good contact between the cooling window 268 and the skin is absent.

[0091] Handpiece 620 may further include a temperature determination unit (TDU) 624 for determining a surface temperature of the target skin area. TDU 624 may, in various embodiments, sense the temperature of the target skin area one or more times before (e.g., during a precooling step), during, or after (e.g., during a postcooling step) laser pulse delivery. During delivery laser pulse(s) to a target skin area, the skin surface temperature may be influenced by two different heating mechanisms, including energy absorbed directly from the laser, and thermal bloom resulting from energy conducted from deeper skin tissue as the thermal energy absorbed by deeper structures relaxes into the environment. Thermal bloom from deeper structures back to the skin surface may be a significant cause of epidermal damage in laser systems targeting relatively deep structures such as sebaceous or sweat glands. Therapeutic laser systems such as system 600 enable improved treatment outcomes by ensuring that the surface temperature of a target skin area remains below a desired surface temperature even while heating deeper structures to higher temperatures, minimizing both skin damage and patient discomfort.

[0092] Temperature determination unit (TD) 624 may comprise a temperature sensing element for generating a first signal indicative of skin surface temperature, and a processor for processing the first signal to determine the surface temperature. TDU 624 may sense the surface temperature of the target skin area one or more times before, during, or after delivery of laser pulse(s) from laser 610. TDU 624 may be capable of sensing the surface temperature of the target skin area at from 10 to 1 million times per second. In one embodiment, the temperature sensing element of TDU 624 comprises an infrared (IR) radiation detector, shown in Figure 9A, to detect IR energy radiating from the surface of the target skin area through the cooling window 628, and a processor (e.g., controller 640 as discussed below) to determine the surface temperature of the target skin area based on data received from the temperature determination unit 624. It will be appreciated that non-IR temperature sensors (e.g., an electrical temperature sensor) 624 may be used. In the embodiment of Figure 6A, TDU 624 is a part of the handpiece 620. In some embodiments, the temperature sensing element, the processor, or the entire TDU 624 may be located outside the handpiece. In preferred embodiments, an IR temperature sensing element is provided as part of the handpiece 620.

[0093] Handpiece 620 may also include a plurality of optical elements 634 to sequentially direct laser pulses along a first optical path within the handpiece to a target skin area, and to direct IR energy from the target skin area along a second optical path that is coaxial with and generally counterdirectional to the first optical path for at least a portion of both optical paths. Additional details on embodiments of the optical elements are provided in connection with Figures 9A-9F. To facilitate the counterdirectional flow of laser and IR energy, the handpiece comprises a first optical element (not shown) having a first open area through which the first optical path passes, /.e., the laser pulses do not substantially engage the first optical element, and pass through the first open area. In contrast to the laser pulses, however, the IR energy does engage the first optical element, which is preferably a reflective optical element (e.g., a mirror). The first optical element directs the IR energy from the target skin area to the temperature sensing element in TDU 624. The signal from the temperature sensing element is processed to determine skin surface temperature at a desired rate of from 10 to 1 million times per second.

[0094] The plurality of optical elements 634 in handpiece 620 also includes at least one second optical element (not shown), and more preferably a plurality of second optical elements, that are engaged by the laser pulses and/or I R energy from the target skin area. In one embodiment, shown in more detail in Figures 9A-9F, the at least one second optical element comprises eight (8) optical elements, with the first optical path (/.e., the laser pulse path) engaging all eight optical elements, and the second optical path engaging five of the optical elements in addition to the first optical element. The optical elements may include one or more of lenses (e.g., plano-convex lenses, turning mirrors, meniscus lenses, aspherical lenses, flat lenses, etc.), mirrors (e.g., aspherical mirrors), or other optical elements (e.g., optical parametric oscillators) to direct the laser pulses received from the optical laser source (e.g., via an optical fiber cable) to a target skin area. In preferred embodiments, the at least one second optical element comprises a plurality of lenses (e.g., at least three lenses) and at least one mirror, and the first and second optical paths engage at least two lenses and the last least one mirror. The optical elements 634 may in various embodiments concentrate the laser energy to a single target skin area, or may include beam-splitting elements to split each pulse beam into multiple beams to treat a plurality of target skin areas simultaneously.

[0095] In one embodiment (see Figures 7, 9C, 9E, 9G), the plurality of optical elements 634 includes a movable scanning mirror capable of movement to direct laser pulses to different target skin areas within a first skin area cooled by cooling window 628. The movable scanning mirror also limits IR energy received by TDU 624 to IR energy from substantially only the target skin area to which the laser is directed at any given time, /.e., it eliminates IR light from other skin areas within the larger first skin area cooled by cooling window 628, which is significantly larger than a single target skin area. In embodiments including a movable scanning mirror, after a first target skin area is treated by one or more laser pulses, the scanning mirror is repositioned to direct subsequent pulses to a new (/.e., second, third, etc.) target skin area within the larger first skin area cooled by the cooling window 628. When a desired number of target skin areas have been treated at a single cooling window position, the user may reposition the cooling window 628 to a new position covering a new skin area, and a different group of target skin areas within the new skin area may be treated by laser 610 using scanner in handpiece 620. In one embodiment, the position of the movable scanning mirror may be adjusted on two or more axes, e.g., by one or more motors, thereby directing succeeding pulses to different target skin areas within the first skin area, enabling treatment of a relatively high proportion of the total area in contact with the cooling window. In alternative embodiments, the plurality of optical elements 634 may not include a scanner.

[0096] Referring again to Figure 6, system 600 further includes a controller 640, which may comprise one or more processing elements such as microprocessors, microcontrollers, field programmable gate arrays (FPGAs), application-specific integrated circuits (ASICs), etc. to control the operations of the laser treatment system. [0097] Controller 640 may include a pulse timing control unit 642 that controls the timing of the laser pulses from laser 610, including initiating the pulse at a first timepoint and terminating the pulse at a second timepoint. The pulse timing control unit 642 may receive data from temperature sensor 624, and may initiate the therapeutic laser pulse at a first timepoint based on, e.g., a manual signal from a user or a determination that target skin area has been cooled to a desired surface temperature (e.g., 15°C, 10°C, 5°C, 0°C, -5°C, -10°C, etc.). Pulse timing control unit 642 may also terminate the therapeutic laser pulse at a second timepoint based on, e.g., a predetermined pulsewidth or a determination that the surface temperature of the target skin area has reached a threshold surface temperature (e.g., indicating that a deeper target structure such as a sebaceous gland has reached a damage threshold temperature, e.g., 60°C - 75°C).

[0098] Controller 640 may also include a temperature sensing control unit 644 that controls the operation of the TDU 624. Temperature sensing control unit 644 ensures that the TDU 624 determines the surface temperature of a target skin area at a desired (e.g., programmed or predetermined) sampling rate such as 10 or more times per second. Controller 640 may synchronize the operations of the temperature sensing control unit 644 with the pulse timing control unit 642.

[0099] In one embodiment, the pulse timing control unit 642 and the temperature sensing control unit 644 may comprise one or more of software, firmware, or other programming code operating in the controller 640. In one embodiment, the pulse timing control unit 642 and the temperature sensing control unit 644 may comprise separate processors or sub-processors, and/or separate executable code programs comprising one or more of software, firmware, etc., within controller 640. A wide variety of hardware and software designs may be used to achieve the functions described herein, and all are considered as within the scope of the present disclosure. [0100] Controller 640 may also control other operations within the therapeutic laser treatment system 600 (e.g., software and firmware units and subunits, timers, mechanical or electrical elements or subsystems, etc.). These functions may also include, without limitation, control of the positioning of a movable scanning mirror for determining a target skin area, as discussed above and in greater detail in connection with Figures 7 and 9A-9F. Controller 640 also controls the operation of cooling system 622, including without limitation the temperature at which the cooling window is maintained (which may be determined by a user or by the patient’s skin type as described in connection with Figure 6B), the cooling capacity (/.e., the thermal energy removal rate of the TEC), status alarms, etc. [0101] A user interface 650 is preferably provided to allow a system user to select or program one or more parameters (e.g., beam diameter or spot size, fluence, wavelength, target temperature of the surface of the target skin area, cooling temperature of the target skin area at which a pulse may be delivered, etc.) to control the operation of therapeutic laser system 600. User interface 650 may also display various status indicators and data associated with the system and/or a treatment session, such as the current laser parameters, duration of treatment, number of pulses delivered, etc. Controller 640 may also receive and process inputs from the user interface 650, and provide outputs to the user interface. In alternative embodiments, the user interface may be omitted.

[0102] Finally, the system 600 includes a power supply 660 for providing power to one or more of the foregoing portions of the system. In one embodiment, power supply 660 may comprise a power supply coupled to a standard A/C power outlet to convert AC to DC power at one or more voltages, and may include a battery (e.g., for backup in the event of a power outage), a supercapacitor, etc. Power supply 660 also provides power to controller 640, which in turn includes a current-controlled power supply for driving the laser 610 and/or other system components and subassemblies at rapid switching rates based on inputs from pulse timing control unit 642, temperature sensing control unit 644, cooling system 622, temperature sensor 24, and scanner 634.

[0103] One or more elements illustrated in Fig. 6A may be comprised of hardware, software, firmware, and/or a combination thereof.

[0104] Figure 6B is a block diagram of an alternative embodiment of therapeutic laser system 600 of Figure 6A. The therapeutic laser system of Figure 6B is capable of determining the skin type of a patient, and adjusting one or more treatment parameters based thereon. Like numbers are used for like elements in Figures 6A and 6B, and the discussion of Figure 6B omits or limits previously discussed elements of Figure 6A for brevity and to avoid repetition. Elements previously described in connection with Figure 6A will have similar functions in Figure 6B.

[0105] The system of Figure 6B allows one or more treatment parameters of the system 600 to be adjusted to minimize discomfort and/or pain to patients that may result from differences in skin type. Handpiece 620 includes a skin typing light source 636 for applying a multi-wavelength light signal to determine a skin type of the patient. Although different skin typing systems may be used, in one embodiment the system 600 of Figure 6B determines a Fitzpatrick skin type of the patient. Skin typing light source 636 may generate noncoherent, multi-wavelength light in one or more of the visible and IR light ranges. A skin typing light sensor 638 is provided to sense a portion of the light from light source 636 that is reflected from the skin of the patient.

[0106] Controller 640 includes a skin type determination unit 646 that receives data from the skin typing light sensor 638 relating to, e.g., the absorbance or nonabsorbance of the patient’s skin of particular wavelengths of light from the skin typing light source 636. The skin type determination unit 646 analyzes the absorbance/non- absorbance data and determines a skin type of the patient. Controller 640 includes logic (e.g., executable software or firmware code, not shown) to modify one or more aspects of the laser treatment based on the patient’s skin type to maintaining the skin surface temperature below a desired maximum during treatment.

[0107] Without being bound by theory, patients with darker skin (/.e., a higher melanin content than lighter skin) may experience a more rapid temperature rise as relatively more energy from laser pulses is absorbed by the more highly concentrated melanin particles. To avoid an excessive temperature (and an increased risk of patient discomfort/pain), controller 640 may, for example, provide additional cooling (/.e., longer cooling time) for patients with darker skin; lower a target skin temperature at which a therapy pulse is or may be initiated (e.g., automatically initiating therapy or providing a prompt to a user when the skin is cooled to 5°C for patients with darker skin instead of 10°C for lighter-skin patients); lower a fluence of the laser pulses to deliver less energy per unit time for darker skin patients; or lower a peak power of the laser pulses of a laser therapy. The controller may also modify or change other parameters such as laser pulse duration and laser spot size to ensure efficacious surface temperature control in the treatment of a wide range of skin types.

[0108] The therapeutic laser system of Figure 6B is also capable of insuring that the handpiece 900, 1100, 1200 shown in Figures 9,11 , and 12 includes a mechanism for assisting the user with properly positioning the handpiece against the skin of the patient. For example, in one embodiment, the controller 600 includes a contact sensing controller 645. The contact sensing controller 645 is generally configured to interact with a contact sensing unit 625 to determine when the handpiece is oriented with substantially planar contact with the skin of the patient and/or to sense when the handpiece is pressed onto the skin of the patient with sufficient pressure and/or force to cause the laser pulses to properly cool a first skin area in contact with the contact window, and to heat the target skin areas within the first skin area to a desired temperature and with a desired distribution. The contact sensing controller 645 may be configured to communicate with the user of the handpiece via a contact indicator 652, such as by communicating that planar contact has been established and/or that sufficient pressure/force is being applied between the handpiece (e.g., via the contact window) and the skin of the patient. The contact sensing unit 625 may include a plurality of contact sensing elements 627 located on the frame 626, which may take the form of mechanical or optical sensing elements, as discussed more fully in connection with Figures 9, 11 , and 12.

[0109] Figures 6A and 6B illustrate a system according to certain embodiments of the invention involving cooling the skin before, during, and after pulse delivery. Alternative embodiments of the invention include systems with no cooling of the skin, or without cooling of the skin during one or more of the periods before, during, and after delivery of the therapeutic laser pulse. Additional alternative embodiments include systems in which different cooling capacities (/.e., rate of heat removal from the skin) are used in the periods before, during, or after delivery of the laser pulse, and during portions of these periods.

[0110] One or more elements illustrated in Fig. 6B may be comprised of hardware, software, firmware, and/or a combination thereof

[0111] Figure 7 is a simplified sectional view of the interior of one embodiment of a handpiece 700 for cooling a first skin area 730, applying laser pulses to one or more target skin areas within the first skin area, and determining the surface temperature of the target skin area(s). Laser pulses, visually shown as a laser beam 720 at an instant of time, are delivered to the handpiece 700 via an optical fiber 740 from a diode laser (e.g., laser 610 of Figure 6). After exiting optical fiber 740, pulses 720 pass along a first optical path through focusing lenses 770 and an aperture in a temperature detection mirror 780. Pulses 720 are redirected by a scanning mirror 760, and pass through a cooling window 710 to a target skin area within a first skin area cooled by the cooling window. Scanning mirror 760 may be controllable (e.g., by a motor) and repositionable such that one or more laser pulses 720 are sequentially directed to a series of target skin areas within the cooling window, without moving the cooling window 710 to contact a different area of skin 730. Scanning mirror 760 also receives IR energy traveling from substantially only the target skin area, and excludes IR energy from other (/.e., non-target) areas within the first skin area. The IR energy from the target skin area (not shown) travels along a second optical path generally counterdirectional to the first optical path, and may occur simultaneously with the delivery of a laser pulse.

[0112] Handpiece 700 also includes a thermoelectric cooler 750, which includes a heatsink portion (not shown) in contact with cooling window 710 to maintain the cooling window at a desired (e.g., programmed) temperature during contact with the first skin area 730. Cooling window 710 preferably cools the first skin area from a first surface temperature (e.g., body temperature) to a second surface temperature before laser pulses 720 are applied to the skin. In one embodiment, the first skin area is cooled before, during, and after application of a laser pulse thereto.

[0113] Skin temperatures may be detected by infrared energy radiated generally counterdirectionally to the laser pulses from the target skin area through the cooling window 710. This infrared energy is reflected by scanning mirror 760 onto temperature detector mirror 780, which focuses the infrared energy on a detection element (not shown), which generates a temperature signal processed by a processor to determine the temperature of the target skin area at a desired sampling rate.

[0114] Figure 8 is a simplified partial exploded, external view of a handpiece 800 for cooling skin and applying laser pulses thereto. In one embodiment, the internal components of Figure 7 may be enclosed within a housing 805. A cooling window 810 (which may be the same as cooling window 710 of Figure 7) is maintained in contact with a cooling heatsink 820 (which may be the same as heatsink of TEC 750 of Figure 7) by a window frame 830, which has no thermal function and merely maintains cooling window 810 in contact with heatsink portion 820. It will be appreciated that additional or alternative components may be included in the handpiece of Figures 7 and 8, and that other similar handpiece configurations and geometries may be used to provide a handpiece providing skin cooling and laser pulse delivery along a first optical path as well as skin temperature determination and monitoring by IR energy traveling along a second optical path generally counterdirectional to the first optical path.

[0115] Figures 9A-9F are perspective (9A, 9B), optical schematic (9D, 9F), and exploded (9C, 9E, 9G) views, respectively, of one embodiment of a handpiece 900 for providing laser therapy to a patient’s skin as part of a laser treatment system. The handpiece 900 provides contact cooling of the skin, and senses skin temperature from IR energy emitted by the skin along a second optical path that is at least partially coaxial with the first optical path traveled by the laser pulses. By sensing temperature along an optical path that is partially coaxial with the laser pulse path, greater accuracy is achieved in sensing the temperature of only the target skin area — i.e., the skin actually receiving the energy of a laser pulse — as opposed to adjacent tissues not receiving laser energy. This is achieved by sensing IR energy from the skin through the contact cooling window, and by using optical elements that limit the IR energy received by the temperature sensor (and used to determine skin temperature) to substantially only IR energy emitted by the target skin area. Because the temperature determination is based only on IR energy emitted from the target tissue actually receiving the laser pulses, and not on IR energy emitted from adjacent non-target tissue that does not receive laser pulse energy, the temperature of the target skin area is obtained with high accuracy.

[0116] Figures 9A and 9B are perspective views of the handpiece 900, which includes a proximal end 902 and a distal end 904, and comprises a housing 910 having a shape adapted for holding by a user (e.g., a physician or technician), and having an inner volume shielding a plurality of optical elements, discussed more fully below in connection with Figures 9C, 9E, and 9G). An optical cable 905, which comprises an optical fiber core (not shown), is coupled to the proximal end 902 of the handpiece 900. Optical cable 905 is coupled to a laser source (not shown) which generates and delivers laser pulses to the handpiece 900 through the cable. Optical cable 905, and specifically the optical fiber therein, terminates inside the proximal end 902 of handpiece 900 in a standard optical coupler 907 (Figures 9C, 9E, and 9G) such as an SMA coupler, although other standard optical couplings may be used.

[0117] At the distal end 904 of the handpiece 900, a contact cooling unit 915 includes a cooling window 920 to cool, by direct contact, a first skin area equal in size to the cooling window. In addition to the cooling window 920, contact cooling unit 915 also comprises other elements more fully shown in Figure 9C, including a cooling window heatsink 916 that surrounds the cooling window 920, a thermoelectric cooler (TEC) 917, and a second heat sink 918. Laser pulses from optical cable 905 pass through handpiece 900 along a first optical path and are applied to a target skin area, which comprises a smaller skin area within the first skin area cooled by the cooling window. [0118] As shown in Figure 9B, housing 910 of handpiece 900 includes an optical aperture or port 914 through which laser pulses exit the housing and travel along the first optical path through the cooling window 920 to the target skin area. Cooling window 920 is spaced a desired distance from housing 910 by cooling unit 915, which also functions as a spacing member to allow a user to visualize the area being cooled and treated by the handpiece 900.

[0119] Figure 9C is a partially exploded view of the interior portion of handpiece 900 with housing 910 removed, showing in greater detail the optical elements, contact cooling unit, and temperature determination unit included in the handpiece 900. In alternative embodiments, the temperature determination unit may be separate from the handpiece 900. The handpiece 900 includes a plurality of optical elements 925, 930, 923, 934, 936, 938, 940, 942, and 944 within the housing 910, although in alternate embodiments one or more optical elements by be located outside the housing. Different combinations of these optical elements each define the first optical path taken by laser pulses 908 to the target skin area (Figure 9D) and the second optical path taken by the IR energy from the target skin area to a temperature sensing element 950 (Figure 9E).

[0120] Figure 9C also shows additional details of contact cooling unit 915, which includes a cooling window heatsink 916 surrounding the cooing window 920. Heat is removed from the skin by direct contact between the first skin area and the cooling window 920, and is passed to the heatsink 918, which is coupled to the cool side of a TEC 917 to maintain the cooling window 920 at a desired temperature (e.g., a user selectable temperature in the range of -10 °C to 25 °C). TEC 917 passes heat received on its cool side from cooling window 920 via cooling window heatsink 916 to its hot side, and is removed from the TEC hot side by a second heatsink 918, which is coupled to a circulating cooling medium (not shown) such as water.

[0121] The handpiece 900 of Figure 9C includes a temperature determination unit, which may be a temperature determination unit 624 as shown in Figure 6. Although the temperature determination unit of Figures 6 and 9C is part of handpiece 900, in alternative embodiments, all or portions of the temperature determination unit may be located outside of handpiece 900. Referring again to Figure 9C, handpiece 900 includes a temperature sensing element 950 for receiving IR energy emitted from the target skin area through the contact window 920 along a second optical path generally counterdirectional to the first optical path taken by laser pulses 908. The first and second optical paths share a common optical axis for at least a portion of their lengths. In response to receiving IR energy from the target skin area, temperature determination unit determines the surface temperature of the target skin area one or more times before, during, or after the application of the at least one therapeutic laser pulses. Temperature sensing element 950 generates a signal indicative of the temperature of the target skin area, and is coupled to a processor (not shown) which receives and processes the signal to determine the surface temperature of the target skin area at a desired rate (e.g., 10-1 million times per second). The temperature determination unit that may determine or measure surface temperature of the target skin area before during, or after treatment with laser pulses 908. Operation of the temperature determination unit may be controlled by a temperature sensing control unit 644 (Figure 6).

[0122] Figure 9D is an optical schematic showing the optical path taken by the laser pulses 908 in passing through the handpiece to the target skin area, and the optical elements that the laser pulses engage (e.g., lenses through which a laser pulse passes or mirrors reflecting the pulses). Figure 9D shows a laser pulse beam 908 exiting the optical fiber coupling 907 and passing through three plano-convex lenses 930, 932, 934 before being reflected by a turning mirror 936. Plano-convex lenses 930, 932, 934 in the embodiment of Figure 9D comprising BK7, fused silica lenses, although many different lens types may be used. In an alternative embodiment, lenses 930, 932, and 934 may be replaced by a single aspherical lens (not shown). Although fixed in position in the embodiment of Figure 9D, turning mirror 936 in alternative embodiments may comprise a steerable mirror that is adjustable to change the angle of reflection.

[0123] After the laser pulse beam 908 is reflected by turning mirror 936, it passes through another plano-convex lens 938 and is reflected by a beam steering element comprising a movable turning mirror 940 that is movable or adjustable on two axes by motors, also known as a “scanning mirror.” By moving the position of the mirror, succeeding pulses may be directed to different target skin areas within the first skin area cooled by the cooling window 920. In alternative embodiments, beam steering elements different from or in addition to the movable turning mirror 940 may be used. Plano-convex lens 938 is made of ZnSe in one embodiment, although other materials may be used in different embodiments. Movable turning mirror 940 reflects the laser pulse beam 908 through a meniscus lens 942 and a plano-convex lens 944 before passing through cooling window 920. Meniscus lens 942 and plano-convex lens 944 comprise ZnSe in one embodiment, but may be made of different materials in alternative embodiments. In a further alternative embodiment, lenses 938, 942, and 944 together may be replaced by a single aspherical lens (not shown). Cooling window 920 is made of a material that is transmissive to both laser light at the wavelength(s) output by the laser source as well as IR light emitted from the target skin area. In one embodiment, cooling window 920 is made of sapphire. In alternative embodiments, ZnS, diamond, or ZnSe may be used successive.

[0124] Figure 9E is the partially exploded view of the interior portion of handpiece 900 shown in Figure 9C, but includes added lines showing an exemplary laser pulse 908 to illustrate the first optical path traveled by such a pulse. For brevity, discussion of the optical elements already noted in Figure 9C is omitted. As can be seen, the laser pulse 908 initially follow a path having a linear optical axis from optical coupler 907 to the turning mirror 936. Turning mirror 936 redirects the laser pulse along a different linear optical axis to movable turning mirror 940, which again redirects the laser pulse along a final optical axis to the target skin area cooled by the cooling window 920.

[0125] Figure 9F is an optical schematic showing the optical path taken by infrared (IR) energy 920 emitted from a target skin area and traveling along a second optical path, and in particular the optical elements engaged by the IR energy in passing through the handpiece 900 to the temperature sensing element 950. As previously noted, the second optical path is generally opposite to the direction of the first optical path, and is coaxial with the first optical path for at least a portion of the length of both paths. Because the target skin area is within the first skin area and in contact with cooling window 920, Figure 9F shows IR energy 926 emitted from the skin directly through cooling window 920. As noted in connection with Figure 9D, cooling window 920 is transmissive to the IR energy and is made of sapphire in the embodiment of Figures 9A-9F. Passing through cooling window 920, the IR energy 926 passes through plano-convex lens 944 and meniscus lens 942 and is then reflected by movable turning mirror (“scanning mirror”) 940. The scanning mirror 940 may comprise any of a number of commercially available movable turning mirrors, such as a model MR-15-30 mirror available from Optotune Switzerland AG, Dietikon, Switzerland. In a given position, movable turning mirror 940 directs the laser pulses 908 to the target skin area (and not, e.g., adjacent tissue), and also reflects IR energy 926 emitted in the opposite direction from substantially only the target skin area. IR energy 926 reflected from scanning mirror 940 passes through plano-convex lens 938 before being reflected by turning mirror 936. Convex lens 944, meniscus lens 942, movable turning mirror 940, plano-convex lens 936, and turning mirror 936 are as described in connection with Figure 9D, and for brevity further discussion is omitted here.

[0126]After reflection from turning mirror 936, IR energy 926 is reflected by a first optical element comprising a concentric mirror 925 onto the temperature sensing element 950. Concentric mirror 925 includes an open area (e.g., an aperture or slot) through which the laser pulses 908 pass without engaging the concentric mirror 925. From cooling window 920 to concentric mirror 295, the second optical path taken by IR energy 926 is generally opposite to — but coaxial with — the first optical path taken by laser pulses 908. As noted, highly accurate temperature measurements are made possible by sensing IR energy 926 traveling opposite to but coaxial with the laser pulses 908, because it enables the temperature sensing element 950 to sense IR energy from substantially only the target skin area (/.e., the same skin area receiving the laser pulse energy). However, it will be appreciated that the second optical path taken by the IR energy must eventually be diverted to a non-coaxial path from the first optical path to reach the temperature sensing element 950, which cannot be located in the first optical path without blocking the laser pulses 908. By including a concentric mirror 925 having an aperture, handpiece 900 allows the laser pulses 908 to pass through the concentric mirror but also allows IR energy 926 to travel along second optical path that is initially coaxial with first optical path until being reflected off-axis to the first optical path onto the temperature sensing element 950. Temperature sensing element 950 may comprise any of a number of commercially available infrared sensors, such as a model P13243-013CA-SPL sensor available from Hamamatsu Corp., Bridgewater, NJ. In a preferred embodiment, temperature sensing element 950 includes an optical filter (e.g., a substrate transparent to the IR radiation from the target skin area with an optical coating) such that the temperature sensing element reflects the wavelength(s) of the laser source but transmits the IR energy radiated from the target skin area.

[0127] Figure 9G is the partially exploded view of the interior portion of handpiece 900 shown in Figure 9C, but includes added lines showing the path taken by IR energy 926 emitted from the target skin area to illustrate the second optical path traveled by the IR energy to the temperature sensing element 950. Further discussion of the optical elements already noted in Figure 9C is omitted. Figure 9G depicts IR energy 926 emitted from the target skin area directly through the cooling window 905, initially following a path having a linear optical axis from the target skin area to movable turning mirror 940, which reflects the IR energy 926 along a different optical axis to turning mirror 936. Turning mirror 936 again reflects the IR energy 926 along a different optical axis to the concentric mirror 925, which reflects the IR energy onto the temperature sensing element 950. A processor (not shown) processes the signal from temperature sensing element 950 to determine the surface skin temperature at a desire rate. The processor may be provided either as part of handpiece 950 or may be coupled by wire or wireless connection to temperature sensing element 950. In preferred embodiments, temperature sensing element 950 and the processor associated with it are including in the housing 910, while in alternate embodiments one or both may be located outside the housing or separate from handpiece 910.

[0128] In some embodiments, a user interface 955 may provide an indicator to a user of one or more parameters of the system. This may include an indication of temperature (e.g., that a desired precooling or laser treatment temperature has been achieved, or that proper contact between the handpiece 950 and the skin of the patient has been achieved).

[0129] Figure 10 discloses one embodiment of method 1000 of treating the skin of a patient with one or more therapeutic laser pulses according to the present disclosure. The method involves the use of one embodiment of a laser system as described in connection with Figures 9A-9F. The method includes providing a laser source for generating one or more laser pulses as a laser therapy (1010). In one embodiment, the laser source comprises a semiconductor laser having a wavelength in one of the near-infrared spectrum and the short-wavelength IR spectrum.

[0130] The method also includes the step of providing a handpiece coupled to the laser source to receive at least one therapeutic laser pulse from the laser source, and to direct the pulses along a first optical path to a target skin area (1020). The handpiece includes a first optical element, at least one second optical element, and a contact cooling unit. The first optical element includes a first open area comprising one of an aperture and a slot through which the first optical path passes. In one embodiment, the first optical element may comprise concentric mirror 925 of Figure 9C. The at least one second optical element comprises one of a refracting element (e.g., a lens), and a reflective element (e.g., a mirror), and may include multiple lenses and mirrors similar to handpiece 900 in Figure 9C. The contact cooling unit comprises a cooling window for contacting and cooling a first skin area of the patient by direct contact. The first skin area includes a target skin area to be treated by the at least one therapeutic laser pulse (/.e., the target skin area is the skin that actually receives the energy of one or more therapeutic laser pulses). The cooling window is made of a thermally conductive material that is transmissive to infrared energy and laser light at a first wavelength range that includes the wavelength of the laser source.

[0131] Referring again to Figure 10, the method includes the step of providing a temperature determination unit (TDU) to determine a surface temperature of the target skin area based on IR energy radiated from the target skin area through the cooling window (1030). The IR energy radiates along a second optical path that is shares a common optical axis with the first optical path for at least a portion of the first and second optical paths. The second optical path is preferably generally counterdirectional to the first optical path for at least a portion of the first and second optical paths, such that the IR energy for determining skin temperature propagates in the opposite direction to the direction of the laser pulse(s) for at least a portion of the second optical path. The TDU comprises a temperature sensing element that detects IR energy radiated through the cooling window along the second optical path, and a processor that determines the surface temperature of the target skin area based on the IR energy detected by the temperature sensing element. In one embodiment, the temperature sensing element may be the temperature sensing element 950 of Figure 9C, which provides a continuous or intermittent signal that is processed at a desired rate by the processor to determine the surface temperature of the target skin area at a desired rate (e.g., 10-1 ,000,000 times per second, or a sampling interval of from 100 msec or less). In some embodiments, the temperature determinations may comprise real-time temperature measurements used by a processor to control the duration of the laser therapy.

[0132] The method also includes the step of contacting the first skin area with the cooling window (1040). This may be done by a handpiece user (e.g., a physician or technician) bringing the cooling window into contact with a skin area to be treated, which cools the first skin area in contact with the cooling window from a first temperature to a second temperature (1045). The method further includes the step of generating, using the laser source, at least one therapeutic laser pulse having a wavelength with the first wavelength range (1050), and receiving the at least one therapeutic laser pulse with the handpiece (1055). The method also includes the step of applying the at least one therapeutic laser pulse to the target skin area by passing the pulse along the first optical path through the first open area of the first optical element, engaging the at least a second optical element, and through the cooling window into the target skin area (1060).

[0133]The method also includes determining the surface temperature of the target skin area one or more times before, during, or after the application of the at least one therapeutic laser pulse (1070). As part of this step, the temperature sensing element receives IR energy radiated from the target skin area along the second optical path, with the IR energy engaging the at least a second optical element and being reflected by the first optical element onto the temperature sensing element. The processor determines the surface temperature of the target skin area based on the infrared energy received by the temperature sensing element.

[0134] In some embodiments, the TDU may determine the surface temperature of the target skin area a plurality of times before, during, or after the application of the at least one therapeutic laser pulse. As a nonlimiting example, the TDU may initiate determining the surface temperature of the target skin area when the contact cooling window contacts the skin of the patient, and may determine the surface temperature of the target skin area once every millisecond as the skin is cooled, during the application of one or more therapeutic laser pulses to the target skin area, and after the termination of the pulses until the target skin area is cooled to a desired final temperature. In another nonlimiting example, the TDU may determine the temperature of the target skin area at least one time during the delivery of a therapeutic laser pulse, and at least one time before or after the pulse. In preferred embodiments, the temperature sensing element receives IR energy radiated substantially only from the target skin area, and the TDU determines the surface temperature based only on this IR energy.

[0135] Finally, the method includes performing at least one responsive action in response to determining the surface temperature of the target skin area (1080). The responsive action may include one or more actions selected from a list of responsive actions. These may include, e.g., terminating the application of the at least one therapeutic laser pulse to the target skin area (/.e., terminating a single pulse or a sequence of pulses), indicating (e.g., via a user interface or display) the instantaneous surface temperature of the target skin area, indicating a maximum surface temperature of the target skin area (e.g., displaying the maximum temperature reached during delivery of one or more pulses), changing at least one parameter of the laser therapy (e.g., reducing or increasing the intensity or duration of therapeutic laser pulses), and indicating when the surface temperature of the target skin area returns to a desired temperature following delivery of one or more therapeutic laser pulses to the target skin area.

[0136] In some embodiments, step of providing a handpiece includes providing a handpiece in which the at least a second optical element includes a mirror movable in at least two axes to direct the at least one therapeutic laser pulse to one or more desired target skin areas within the first skin area. The mirror may be the movable turning mirror 940 described in Figure 9C. In one embodiment, after one or more first therapeutic laser pulses are applied to a first target skin area with the mirror in a first position, the mirror may be moved to a second position, and the method may comprise delivering subsequent laser pulse(s) to a second target skin area different from the first target skin area, but still within the first target skin area cooled by the cooling window. In this case, the laser pulse(s) again pass along a first optical path through the first open area, engage the mirror in the second position, and pass through the cooling window to the second target skin areas. When the pulses are delivered to the second target skin area, the method may also comprise determining the temperature of the second target skin area one or more times before, during, or after the delivery of the laser pulse(s) to the second target skin area by receiving IR energy radiating from the second target skin area along the second optical path, engaging the mirror in the second position, and reflecting from the first optical element onto the temperature sensing element. As previously noted, the first and second optical axes are coaxial for at least a portion of the first and second optical paths. In a preferred embodiment, the first and second optical paths share a common optical axis for at least the portion of the first and second optical axes from the movable mirror to the cooling window.

[0137] In some embodiments, the step of providing a handpiece includes providing a handpiece in which the at least a second optical element includes a plurality of lenses and at least one mirror, and the first and second optical paths engage at least two of the plurality of lenses and the at least one mirror. In some embodiments, providing a handpiece in which the at least a second optical element incudes at least four lenses and at least one mirror.

[0138] In some embodiments, the steps of generating at least one laser pulse, receiving the at least one pulse with the handpiece and applying it to the target skin area are repeated until the determined surface temperature of the target skin area reaches a target treatment temperature. In some embodiments, determining the surface temperature of the target skin area comprises repeatedly determining the target skin area a plurality of times during the application of a therapeutic laser pulse, and the method further comprises terminating the application of the laser pulse when the surface temperature of the target skin area reaches a target treatment temperature.

[0139] As noted in the discussion of Figure 6A, in some embodiments a contact sensing element or system may be provided to ensure good contact between the skin of the patient and the cooling window during treatment. In various embodiments, contact may be sensed by electrical contacts (e.g., electrodes capable of sensing changes in electrical conductivity or resistivity of the skin), or by detecting other skin parameters associated with contact such as force, pressure, vibration, temperature, sweat, etc. In two particular embodiments illustrated in Figures 11A-11 D and 12A- 12B, the invention comprises systems and methods for laser treatment using a handpiece capable of sensing pressure or force on the external periphery of the cooling window. By sensing the pressure or force between the contact sensor and the skin, the system can determine when contact between the skin and cooling window is sufficient to enable effective treatment to be achieved. Poor contact may result in non- uniform cooling such that one or more target skin areas within the first skin area (/.e., the skin area in contact with the cooling window) are not cooled to a sufficiently low temperature to avoid pain, discomfort, or damage to overlying a target during laser pulse(s), especially for deeper target structures such as a sebaceous gland. Poor contact may involve a failure to fully contact the skin with the cooling window; failure to maintain even pressure of the cooling window across the first skin area; maintaining excessive pressure on the skin; or maintaining too little pressure. For example, if part of the cooling window is not in contact with the skin, or pressure is not evenly maintained, cooling may be uneven. Where cooling is uneven, some target skin areas may be overheated, while others may be underheated, resulting in poor efficacy.

[0140] Figure 11A shows one embodiment of a handpiece 1100 (which may be the handpiece of Figures 9A-9F) that includes a contact sensing unit 1150 for ensuring good contact between a cooling window 1120 and the skin during treatment. Handpiece 1100 includes similar structures to those in Figures 9A-9F, including a housing 1110 having an optical aperture or port 1114 through which laser pulses exit the housing, and a contact cooling unit 1115 comprising the cooling window 1120. The handpiece 1100 has a distal end 1104 at which the contact cooling unit 1115 and pressure sensor is located, and a proximal end 1102 coupled to an optical cable 1105 through which the laser pulses are delivered to the handpiece. Structures of handpiece 1100 that are also present in handpiece 900 of Figures 9A-9F will have similar functions, and further discussion is omitted here for brevity.

[0141 ] Cooling window 1120 has a generally planar and circular shape, and contact sensing unit 1150 includes a ring-shaped contact surface 1152 that is generally coplanar with cooling window 1120. Contact surface 1152 may be part of a shroud 1154 that encloses sensing elements and/or electrical circuitry described in greater detail in connection with Figure 11 B-11 D. It will be appreciated that while the contact cooling window 1120 and contact surface 1152 are generally circular in the embodiment of Figures 11A-D, other geometries (e.g., squares, ellipses, rectangles, etc.) could be used, including non-planar surfaces. Contact surface 1152 includes a plurality of protrusions 1155 that extend slightly from the plane of the contact area, and which each overlay a contact sensing element discussed more fully in connection with Figures 11 B-11 D.

[0142] Figure 11 B is a partially exploded view of the distal end 1104 of handpiece 1100, showing additional details of the contact sensing unit 1150. Handpiece 1100 is shown in unexploded form with contact cooling unit 1115, including cooling window 1120 and heatsink 1116, which includes a generally planar surface having a groove or recess 1167, as shown in more detail in Figure 11 D. Contact sensing unit 1150 includes a flexcircuit 1180 that includes a ring 1181 that fits in groove 1167 of heatsink 1116, a ring 1160 having a plurality of pressure or force sensing regions 1161 capable of changing one or more electrical properties such as impedance, conductance, or resistance in response to an applied force or pressure, and a shroud 1154 that includes the contact surface 1152. Flexcircuit 1180 is shown in greater detail in Figure 11 C, and ring 1160 is discussed in greater detail in connection with Figure 11 D.

[0143] Although depicted in Figure 11 B as integrally formed with shroud 1154, in alternative embodiments, contact surface 1152, may be provided as separate from but couplable to shroud 1154 (e.g., by slot-and-groove, screwed, or other connection). In the assembled handpiece (Figure 11 A), contact surface 1152 is generally coplanar with cooling window 1120, and includes protrusions 1155 from the contact surface plane that are compressible or resiliently movable to generate a force and/or pressure on the pressure/force sensing regions 1161 of ring 1160. In one embodiment, shroud 1154, contact surface 1152, and raised protrusions 1155 are preferably formed of a resilient polymer such as silicone rubber or another polymer that allows the protrusions 1155 to be compressed into contact with force sensing regions 1161 of ring 1160, discussed in greater detail in Figure 11 D. In an alternative embodiment, protrusions 1155 are pins or buttons biased outwardly via a spring located in groove 1167, and which when pressed against the skin compress the springs, transferring the force to the force sensing regions 1161 of ring 1160. In a further alternative embodiment, ring

1160 and ring 1181 of flexcircuit 1180 are located with an annular chamber within heatsink 1116, and spring-biased pins or buttons in contact with each of the forcesensing regions 1161 of ring 1160 extend through small apertures in the heatsink 1116 and contact surface 1152, replacing protrusions 1155. This embodiment provides additional shielding of the ring 1160 and the pressure/force sensing regions 1161 thereof, as well as the flexcircuit, from contamination by moisture or debris.

[0144] Figure 11C provided additional details of flexcircuit 1180, which includes a generally flexible body 1188 with circuit elements provided (e.g., by printing, soldering, etc.) thereon. Although the pressure sensing unit 1150 of Figures 11A-11 D includes flexcircuit 1180 to provide electrical connections between pressure/force sensing regions 1161 of ring 1160 and a power source (not shown), it will be appreciated that other circuit coupling means (e.g., wires, wireless wi-fi connectivity, etc.) may be used instead of flexcircuit 1180. At one end, the flexcircuit 1180 includes a ring 1181 having electrically conductive or pickup regions 1182, each of which is electrically coupled to one of the pressure/force sensing regions 1161 of ring 1160 (e.g., by direct contact, soldering, etc.) as shown more clearly in Figure 11 D. Ring 1181 also includes electrically inert areas 1184 that are not coupled to a pressure/force sensing region

1161 of ring 1160. Electrical lines 1186 connect each pickup region 1182 to a connection pad 1190 for each of the pressure/force sensing regions 1161 of ring 1160. A processor (not shown), preferably located in handpiece 1100, provides an electrical signal through each pressure sensing element circuit, which comprises one of the electrical pads 1190, its corresponding electrical line 1186, and one of the pressure/force sensing regions 1161 of ring 1160. The processor monitors changes in one or more electrical properties in the pressure/force sensing regions 1161 of ring 1160 (e.g., resistivity) as pressure is applied from a raised protrusion 1155 when contact is made between the protrusion 1155 and the skin of the patient.

[0145] Figure 11 D is a cross-sectional view, indicated by section line 11 D of Figure 11 A, of the details of each pressure sensing element associated with the protrusions 1155 extending from contact surface 1152. Cooling window 1120 at the center of Figure 11 D is surrounded by heatsink 1116 acts as a frame for cooling window 1120 and includes a groove 1167. In alternative embodiments (not shown) a cooling system may be omitted, and pulses may be delivered via an uncooled aperture that is surrounded by a frame other than heatsink 1116. In still further embodiments, a frame or heatsink 1116 may only partially surround the cooling window 1120 Referring again to Figure 11 D, ring 1181 of flexcircuit 1180, and ring 1160 fit in groove 1167. Although Figure 11A-11 D depicts a handpiece having six pressure sensing elements, in alternative embodiments any desired number of two or more elements (e.g., two, three, four, eight, or twelve) may be used. Flexcircuit 1180 is provided in the bottom of groove 1167. Although the ring includes both electrically conductive regions 1182 and non-conductive regions 1184, in the cross-section of Figure 11 D, only the electrically conductive regions 1182 are shown. Ring 1160 is located immediately above electrically conductive regions 1182 and is maintained in direct contact therewith. Each pressure/force sensing region 1161 of ring 1160 comprises three separate structures. First, a pressure-responsive element 1162, made of a material whose electrical properties (e.g., resistance) changes in a defined way with pressure or force, is maintained in direct contact with electrically conductive regions 1182 of flexcircuit 1180. Any of a variety of materials having changing electrical characteristics in response to an applied force may be used. In one embodiment, the pressure- responsive element 1162 may comprise Velostat, a carbon-infused polymer available from Desco Industries, Sanford, NC. A cover element 1166 located above each pressure-responsive element 1162, and a spacing element 1164 surrounding each pressure-responsive element, are provided for each pressure/force sensing region 1161 (Figure 11 B) of ring 1160. Cover element 1166 and spacing element 1164 isolate the pressure-responsive element 1162 from extraneous forces and prevent the handpiece from indicating that skin contact has occurred except when a force is applied to the press-responsive element. For a given pressure/force sensing region 1161 of ring 1160, when the handpiece 1100 contacts the skin of the patient, protrusions 1155 close the small gap separating the lower portion of the protrusion and the cover element 1166, then transmit force from the skin to the pressure- responsive element 1162. Each of the protrusions 1155 extends from contact surface 1152, which is part of shroud 1154. It will be appreciated that in alternative embodiments, separate structures may be provided for each of protrusions 1155, contact surface 1152, and shroud 1154, although they are depicted in the embodiment of Figures 11A-11 D as integrally formed. Together, protrusions 1155, pressure/force sensing regions 1161 , and electrically conductive regions 1182 of flexcircuit 1180 function as a plurality of contact sensing elements coupled to heatsink 1116 or a different frame.

[0146] Contact sensing unit 1150 may determine one or more of force or pressure at each of the contact sensing elements (e.g., corresponding to protrusions 1155), and may calculate one or both of the force and the pressure between the skin and the handpiece 1100. In one embodiment, the contact sensing unit may calculate forces as low as 0.1 newtons, although in preferred embodiments, the contact unit is capable of determining forces as low as 0.5 newtons.

[0147] Although not shown in Figures 11A-11 D, it will be appreciated that a laser source provides laser pulses to the handpiece 1100. In alternative embodiments (not shown) a contact cooling unit may be omitted, and the handpiece may comprise a pulse delivery region to deliver the laser pulses through a pulse delivery aperture that does not comprise a contact cooling unit.

[0148] In preferred embodiments, a contact indicator, which may comprise a user interface similar to user interface 955 (Figure 9A) may be provided. The contact indicator may provide one of a force feedback parameter and a pressure feedback parameter to a user. The feedback may indicate to a system user, based on force and/or pressure, one or more of the following feedback parameters: an indication of whether or not each of the plurality of contact sensing elements is in contact with the skin; an indication of one of the variation in pressure and the variation in force at each of the different locations of the contact sensing elements; an indication one of the variation in pressure and the variation in force between two or more of the contact sensing element locations; an indication that the pressure at each of the plurality of different locations exceeds a minimum pressure threshold; an indication that the pressure at each of the plurality of different locations is less than a maximum pressure threshold; an indication of the force at each of the different locations; an indication of the variation in force between two or more of the different locations; an indication that the force at each of the plurality of different locations exceeds a minimum pressure threshold; and an indication that the force at each of the plurality of different locations is less than a maximum pressure threshold. [0149] I some embodiments, the system may also include a safety interlock preventing the laser source from generating the therapeutic laser pulse unless a desired force and/or pressure feedback parameter is provided by the contact indicator. In addition to the foregoing feedback parameters, the safety interlock may prevent the laser source from operating unless one of the following is provided: an indication that the pressure difference between the highest and lowest pressures among the different locations is less than a maximum pressure difference threshold, an indication that the difference between the highest and lowest applied forces among the different locations is less than a maximum force difference threshold; and an indication that desired cooling time has elapsed; and indication that a laser pulse has not exceeded a maximum pulse duration.

[0150] Figure 12A illustrates one embodiment of a handpiece 1200 (which may be the handpiece of Figures 9A-9F), in accordance to some embodiments herein. The handpiece 1200 may include both a contact sensing unit 1250 for ensuring sufficient contact between a cooling window 1220 and the skin during treatment and a force sensing unit 1251 to ensure adequate pressure. The handpiece 1200 includes similar structures to those in Figures 9A-9F, including a housing 1210 (shown in partial cut away) having an optical aperture or port 1253 through which laser pulses exit the housing 1210, and a contact cooling unit 1215 comprising the cooling window 1220. The handpiece 1200 has a distal end 1204 at which the contact cooling unit 1215, the contact sensing unit 1250, and the force sensing unit 1251 are generally located. Like the handpiece 900, the handpiece 1200 has a proximal end (not shown) coupled to an optical cable (not shown) through which the laser pulses are delivered to the handpiece 1200. Structures of the handpiece 1200 that are also present in the handpiece 900 of Figures 9A-9F will have similar functions, and further discussion is omitted here for brevity.

[0151] Figure 12B is a partially exploded and partially cutaway view of the distal end 1204 of the handpiece 1200 and interrelated parts. The placement and interaction of the components of the handpiece 1200 may be more readily appreciated by simultaneous reference to Figures 12A-I2B. The cooling window 1220 has a generally planar and circular shape, and contact sensing unit 1250 includes a ring-shaped contact surface 1256 that is generally coplanar with the cooling window 1220. The contact surface 1256 may be part of a shroud (not shown). [0152] It will be appreciated by those skilled in the art having benefit of the present disclosure, that while the contact cooling window 1220 and contact surface 1256 are generally circular in the embodiment of Figures 12A-B, other geometries (e.g., squares, ellipses, rectangles, etc.) could be used, including non-planar surfaces. The contact surface 1256 includes a plurality of optical units 1255 that pass light from a plurality of optical transmitters/sensors 1257 through the optical units 1255 and onto the skin of the patient. Accordingly, light delivered from the optical transmitters/sensors 1257 reflects off the patient’s skin and returns to the optical transmitters/sensors 1257, which monitor the magnitude of the reflected light. Those skilled in the art will appreciate that the magnitude of the reflected light will increase to a maximum value as the contact surface 1256 and optical units 1255 come into contact with the surface of the patient’s skin.

[0153] During treatment of a patient, uniform heating of the target skin area may be achieved by ensuring that the contact surface 1256 is coplanar with the target skin area. The use of a plurality of the optical transmitters/sensors 1257 enhances the positioning of the handpiece 1200 to achieve this coplanar relationship. In one embodiment, the controller 640 (see Figures 6A and 6B) receives information from the optical transmitters/sensors 1257 over electrical connectors 1258. Under the control of software or hardware, the controller 640 compares the signals from each of the plurality of transmitters/sensors 1257 and interrupts or prevents the delivery of laser pulses when these signals are not substantially balanced. Those skilled in the art will appreciate that if, for example, the signals from two of the optical transmitters/sensors 1257 match, but the signal from the third optical transmitter/sensor 1257 is substantially less, then the handpiece 1200 is misaligned and not coplanar with the target skin area of the patient. This misalignment may lead to uneven heating of the target skin area. Accordingly, the controller 640 signals the operator that misalignment exists, prompting the operator to reposition the handpiece 1200. In one embodiment, the handpiece 1200 includes visual and/or audio cues regarding misalignment, such as by energizing a green LED when coplanar alignment exists and/or energizing a red LED when coplanar alignment does not exist.

[0154] It will be appreciated that the problem of uneven heating of the target skin area based on variations from the coplanar orientation is exacerbated as the size of the target skin area increases. Relatively minor misalignment of the handpiece 1200 from the desired coplanar orientation can result in significant variations in the energy of the laser at various locations in the target skin area. The size of the target skin area can be significantly increased by applying the laser as a series of pulses dispersed over a preselected target area. For example, FIG 13 stylistically illustrates a target area 1300 that is generally circular in shape. In this embodiment the laser is aimed at a series of six targets 1310-1360 that roughly approximates the vertices of a hexagon and a seventh target 1370 at about the geometric center of the hexagon. This pattern distributes the energy of the laser pulses substantially evenly to achieve a substantially even distribution of the heat resulting from each laser pulse within the circular target area 1300. In one embodiment, each laser pulse produces light having a diameter of about 3mm with a spacing of about 0.5mm, but can be varied, depending upon the physical characteristics of the patient’s skin, such as by determining a Fitzpatrick score. In one embodiment, the series of seven laser pulses are each about 30msec in duration with pauses of about 15 msec therebetween.

[0155] Returning to Figures 12A and 12B, the force sensing unit 1251 is flexibly connected and spring biased to the distal end 1204 such that when the operator positions the handpiece 1200 in contact with the patient’s skin and presses it thereagainst, movement occurs that is indicative of the pressure applied being of a sufficient magnitude to permit proper heating of the patient’s target skin area via laser pulses. The force sensing unit 1251 includes an arm 1260 fixedly connected to the handpiece 1200 at a region 1261 by, for example, a plurality of bolts 1262. A distal end 1263 of the arm 1260 is pivotally connected to the distal end 1204 of the handpiece 1200 via a conventional pin (not shown) extending through bore holes 1264, 1265. A conical coil spring 1266 extends between the arm 1260 at region 1267 and the distal end 1204 of the handpiece 1200 at region 1246. Thus, the spring 1266 urges the distal end 1204 of the handpiece 1200 to rotate counterclockwise, and a force applied to the contact surface 1256 urges the distal end 204 of the handpiece 1200 to rotate clockwise when the force applied to the contact surface 1256 exceeds the force of the conical spring 1266.

[0156] A generally T-shaped bracket 1267 is affixed to the distal end 1204 of the handpiece 1200 at a region 1248 such that the T-shaped bracket 1267 moves with movement of the distal end 1204 of the handpiece 1200. A two-piece position sensor 1268, 1269 is located between the T-shaped bracket 1267 and the optical aperture or port 1253. It will be noted that movement of the distal end 1204 of the handpiece 1200 in a clockwise direction, such as by pressing the contact surface 1256 against the patient’s skin, will separate the two-piece position sensor 1268, 1269 if the force exerted on the patient’s skin is sufficient to overcome the force exerted by the conical spring 1266. Separation of the components of the two-piece position sensor 1268, 1269 produces an electrical signal indicative of such a force being applied to the contact surface 256, which is delivered to the controller 640 over an electrical conductor 1270.

[0157] The controller 640 uses the signal from the force sensing unit 1251 over the conductor 1270 to interrupt or prevent the delivery of laser pulses when the force sensing unit 1251 indicates that the handpiece 1200 is not pressed against the patient’s skin with sufficient force. Accordingly, the controller 640 signals the operator that the handpiece 1200 is not pressed sufficiently hard against the patient’s skin, prompting the operator to press with additional force. In one embodiment, the handpiece 1200 includes visual and/or audio cues regarding sufficient force, such as by energizing a green LED when the force is adequate and/or energizing a red LED when the force is inadequate.

[0158] In preferred embodiments, a contact indicator and a force indicator, which may comprise a user interface similar to user interface 955 (Figure 9A) may be provided. The contact indicator may provide one of a force feedback parameter and a pressure feedback parameter to a user. The feedback may indicate to a system user, based on force and/or pressure, one or more of the following feedback parameters: an indication of whether or not each of the plurality of contact sensing elements is in contact with the skin; an indication of pressure and force; an indication of the force.

[0159] In some embodiments, the system may also include a safety interlock preventing the laser source from generating the therapeutic laser pulse unless a desired indication is received from the force sensing unit 1251 , the contact sensing unit 1250, or both.

[0160] In various embodiments, the present invention relates to the subject matter of the following numbered paragraphs.

[0161] 101. A system for treating the skin of a patient with one or more therapeutic laser pulses, the system comprising: a) a laser source adapted to generate at least one therapeutic laser pulse for application to a target skin area; b) a handpiece optically coupled to the optical source to receive the at least one therapeutic laser pulse from the laser source and to direct the at least one therapeutic laser pulse to the target skin area along a first optical path, the handpiece comprising:

1) a first optical element comprising a reflective element and having a first open area through which said first optical path passes, wherein the first open area comprises one of an aperture and a slot;

2) at least a second optical element comprising at least one of a refractive element and a reflective element, wherein the first optical path engages the at least a second optical element; c) a temperature determination unit for determining a surface temperature of the target skin area based on infrared energy radiated from the target skin area through the cooling window along a second optical path sharing a common optical axis with the first optical path for at least a portion of the first and second optical paths, the temperature determination unit comprising:

1) a temperature sensing element for sensing infrared energy radiated through the cooling window along the second optical path, the temperature sensing element generating a first signal indicative of the infrared energy radiating along the second optical path, wherein the infrared energy radiating along the second optical path engages the at least a second optical element and is reflected by the first optical element to be detected by the temperature sensing element; and

2) a processor adapted to determine the surface temperature of the target skin area at one or more timepoints before, during, or after the application of one or more of therapeutic laser pulses based on the infrared energy detected by the temperature sensing element.

[0162] The particular embodiments disclosed and discussed above are illustrative only, as the invention may be modified and practiced in different but equivalent manners apparent to those skilled in the art having the benefit of the teachings herein. Embodiments of the present invention disclosed and claimed herein may be made and executed without undue experimentation with the benefit of the present disclosure. While the invention has been described in terms of particular embodiments, it will be apparent to those of skill in the art that variations may be applied to systems and apparatus described herein without departing from the concept and scope of the invention. Examples are all intended to be non-limiting. It is therefore evident that the particular embodiments disclosed above may be altered or modified and all such variations are considered within the scope of the invention, which are limited only by the scope of the claims.

Claims

CLAIMS What is claimed is:

1 . A system for treating the skin of a patient, the system comprising: a) a laser source for providing a plurality of therapeutic laser pulses for application to one or more locations within a first skin area of the patient; b) a handpiece comprising:

1) a handpiece body comprising an aperture, the handpiece body optically coupled to the laser source and having a pulse delivery region adapted to deliver the therapeutic laser pulses to the one or more locations within the first skin area through the aperture;

2) a contact sensing unit, comprising:

A) a frame surrounding at least a portion of the aperture;

B) a plurality of sensing elements adjacent the frame at spaced-apart locations, each sensing element being capable of providing an indication of contact between the handpiece and the skin of the patient at one of the spaced- apart locations; and c) a controller for preventing the delivery of the plurality of laser pulses in response to less than a predetermined number of the plurality of contact sensing elements providing an indication of contact between the handpiece and the skin of the patient.

2. The system of claim 1 further comprising a contact indicator for providing a first parameter to a system user based on less than a predetermined number of the plurality of contact sensing elements detecting contact between the handpiece and the skin of the patient.

3. The system of claim 1 wherein the contact sensing unit further comprises a force sensor for sensing one of a force and a pressure between the handpiece and the skin of the patient.

4. The system of claim 1 wherein the aperture comprises a contact window adapted to contact the first skin area, and each sensing element is capable of providing an

52 indication of contact between a portion of the contact window and the skin of the patient adjacent one of the spaced-apart locations.

5. The system of claim 1 wherein the contact sensing unit senses contact based on detecting an optical condition of the patient’s skin adjacent each sensing element.

6. The system of claim 1 , wherein the contact window is a contact cooling window adapted to cool the first skin area.

7. The system of claim 1 further comprising a contact indicator for providing a first parameter to a system user based on all of the plurality of contact sensing elements detecting contact between the contact sensing unit and the skin of a patient.

8. The system of claim 1 , wherein the plurality of sensing elements each comprises: a light transmitter for directing light onto the target skin area of the patient source; and a light receiver capable of providing a signal indicative of the magnitude of the light reflected from the target skin area of the patient, wherein the controller is capable of identifying contact between each of the sensing elements and the skin of the patient based on the magnitude of the light reflected from the target skin area.

9. A system for treating the skin of a patient with a therapeutic laser pulse, the system comprising: a) a laser source for generating a plurality of therapeutic laser pulses for application to a first skin area of the patient; b) a handpiece comprising:

1) a handpiece body optically coupled to the laser source and having a pulse delivery region adapted to deliver the therapeutic laser pulses to one or more locations within the first skin area;

2) a contact window adapted to contact the first skin area, wherein the therapeutic laser pulses are delivered to the one or more locations through the contact window;

3) a contact sensing unit, comprising:

A) a frame surrounding at least a portion of the contact window;

53 B) a plurality of sensing elements coupled to the frame at spaced-apart locations, each sensing element being capable of producing a signal indicating contact between a portion of the contact window and the skin of the patient adjacent one of the spaced-apart locations; c) a contact indicator for providing a first parameter to a system user based on less than all of the plurality of contact sensing elements detecting contact between the portion of the contact window and the skin of the patient; and d) a controller for preventing the delivery of the plurality of laser pulses in response to receiving the first parameter.

10. The system of claim 9, wherein the contact indicator provides a second parameter to a system user based on all of the plurality of contact sensing elements detecting contact between a portion of the contact window and the skin of the patient, wherein the controller permits delivery of the laser pulses in response to receiving the second parameter.

11. The system of claim 10, wherein the first parameter comprises a first visual indication that less than all of the plurality of contact sensing elements are detecting contact between a portion of the contact window and the skin of the patient, and the second parameter comprises a second visual indication, different from the first visual indication, that all of the plurality of contact sensing elements are detecting contact between a portion of the contact window and the skin of the patient.

12. The system of claim 9, wherein the plurality of sensing elements each comprises: a light transmitter for directing light onto the skin of the patient at one of the spaced- apart locations; and a light receiver capable of providing a signal indicative of the magnitude of the light reflected from the skin of the patient at said one of the spaced-apart locations, wherein the controller is capable of identifying contact between a portion of the contact window and the skin of the patient at said one of the spaced-apart locations based on the magnitude of the light reflected from the skin at said one of the spaced-apart locations.

13. The system of claim 9, wherein the controller provides at least one feedback parameter selected from:

54 1) an indication of whether or not each of the plurality of contact sensing elements is in contact with the skin;

2) an indication of one of the pressure and the force at each of the spaced apart locations;

3) an indication of one of a variation in pressure and a variation in force between two or more of the spaced apart locations;

4) an indication of a variation in reflected light between two or more of the spaced apart locations

5) an indication that the pressure at each of the plurality of spaced apart locations exceeds a minimum pressure threshold;

6) an indication that the pressure at each of the plurality of spaced apart locations is less than a maximum pressure threshold;

7) an indication of the force at each of the spaced apart locations;

8) an indication of the variation in force between two or more of the spaced apart locations;

9) an indication that the force at each of the plurality of spaced apart locations exceeds a minimum pressure threshold;

10) an indication that the force at each of the plurality of spaced apart locations is less than a maximum pressure threshold; and

11) an indication that the total force between handpiece and the skin of the patient exceeds a minimum pressure threshold.

14. The system of claim 9, wherein the controller comprises an interlock preventing the laser source from generating the therapeutic laser pulses unless at least one desired feedback parameter is provided by the contact indicator.

15. The system of claim 14, wherein the interlock prevents the laser source from generating the therapeutic laser pulses unless the contact indicator provides at least one signal selected from:

1 ) an indication that all of the plurality of contact sensing elements are detecting contact between a portion of the contact window and the skin of the patient;

2) an indication that the pressure at each of the spaced apart locations exceeds a minimum pressure threshold;

55 3) an indication that the pressure at each of the spaced apart locations is less than a maximum pressure threshold;

4) an indication that the pressure difference between the highest and lowest pressures among the spaced apart locations is less than a maximum pressure difference threshold;

5) an indication that the applied force between the handpiece and the skin of the patient exceeds a minimum force threshold;

6) an indication that the applied force between the handpiece and the skin of the patient is less than a maximum force threshold; and

7) an indication that the difference between the highest and lowest applied forces among the spaced apart locations is less than a maximum force difference threshold.

16. The system of claim 9 wherein the plurality of contact sensing elements comprises from two to eight contact sensing elements.

17. The system of claim 9 wherein the handpiece body comprises a proximal end optically coupled to the laser source and a distal end comprising the pulse delivery region, and wherein the contact window comprises a contact cooling window having a contact surface to contact and cool a first skin area comprising the one or more locations to which the plurality of laser pulses are delivered.

18. The system of claim 9, wherein the handpiece further comprises at least one of:

3) a contact cooling unit comprising the contact window and located at the pulse delivery region of the handpiece body, the contact window having

A) a contact surface adapted to contact and cool a first skin area comprising the one or more locations, and

B) a periphery; wherein the handpiece comprises the contact cooling unit and the contact sensing unit comprises:

A) a frame comprising one of a ring and a partial ring surrounding at least a portion of the contact cooling window periphery;

B) two contact sensing elements on the frame to sense force or pressure; and C) an indicator to provide a force or pressure parameter

19. A system for treating the skin of a patient with a therapeutic laser pulse, the system comprising: a) a laser source for generating therapeutic laser pulses for application to a target skin area; b) a handpiece comprising:

1) a handpiece body having a first region optically coupled to the laser source and a second region adapted to deliver the therapeutic laser pulses to the target skin area;

2) a contact cooling unit located at the second region of the handpiece body, the contact cooling unit comprising a contact cooling window having

A) a contact surface adapted to contact and cool a first skin area comprising the target skin area, and

B) a periphery; and

3) a contact sensing unit for contacting the skin of the patient, comprising:

A) a frame surrounding at least a portion of the contact cooling window periphery;

B) a first contact sensing element at a first location on the frame and being capable of producing a signal indicating contact between a portion of the contact window and the skin of the patient adjacent to the first location; and

C) at least a second contact sensing element at a second location on the frame and being capable of producing a signal indicating contact between a portion of the contact window and the skin of the patient adjacent to the second location; and c) a contact indicator for providing at least one first parameter to a system user based on the first contact sensing element and the at least a second contact sensing element indicating contact between the contact window and the skin of the patient.

20. The system of claim 19, wherein the contact indicator provides at least one of a contact feedback parameter, a force feedback parameter, and a pressure feedback parameter selected from 1) an indication of whether or not the first contact sensing element and the at least a second contact sensing element are in contact with the skin;

2) an indication of the pressure at the first location and the second location;

3) an indication of the pressure difference between the pressure at the first location and the pressure at the second location;

5) an indication that the pressure at each of the first and second locations exceeds a minimum pressure threshold;

6) an indication that the pressure at each of the first and second locations is less than a maximum pressure threshold;

7) an indication that the pressure difference between the pressure at the first location and the pressure at the second location is less than a maximum pressure difference threshold;

8) an indication of the applied force at the first location and the second location;

9) an indication of the difference in the applied force at the first location and the applied force at the second location;

10) an indication that the total applied force at the first and second locations exceeds a minimum force threshold;

11)an indication that the total applied force at the first and second locations is less than a maximum force threshold;

12) an indication that the difference in the applied force at the first location and the applied force at the second location is less than a maximum force difference threshold.

58

21 .The system of claim 19, further comprising: d) an interlock preventing the laser source from generating the therapeutic laser pulses unless a desired feedback parameter is provided by the contact indicator.

22. The system of claim 21 , wherein the interlock prevents the laser source from generating the therapeutic laser pulses unless the contact indicator provides at least one feedback parameter selected from:

1) an indication that each of the first contact sensing element and the at least a second contact sensing element are in contact with the skin;

2) an indication that the pressure at each of the first location and the second location exceeds a minimum pressure threshold;

3) an indication that the pressure at each of the first location and the second location is less than a maximum pressure threshold;

4) an indication that the pressure difference between the pressure at the first location and the pressure at the second location is less than a maximum pressure difference threshold

5) an indication that the total applied force at the first location and the second location exceeds a minimum force threshold;

6) an indication that the total applied force at the first location and the second location is less than a maximum force threshold;

7) an indication that the difference between the applied force at the first location and the applied force at the second location is less than a maximum force difference threshold.

23. The system of claim 19 wherein the at least a second contact sensing element comprises a plurality of contact sensing elements ranging from one to seven contact sensing elements, each located at a different location than the first location.

59

24. The system of claim 19, wherein the contact sensing unit comprises:

A) a frame comprising one of a ring and a partial ring surrounding at least a portion of the contact cooling window periphery, the frame comprising at least one groove therein;

B) a first contact sensing element at a first location in the at least one groove of the frame to sense one of the applied force at the first location when contact sensing unit is placed in contact with the skin, the first contact sensing element comprising:

1) a flexible material having a changing electrical resistivity based on the force applied thereto;

2) circuitry to sense changes in the electrical resistivity of the flexible material; and

3) a first cover element covering the flexible material;

C) at least a second contact sensing element at a second location in the at least one groove of the frame to sense the applied force at the second location when the contact sensing unit is placed in contact with the skin, the second contact sensing element comprising:

2) circuitry to sense changes in the electrical resistivity of the flexible material;

3) a first cover element covering the flexible material.

25. The system of claim 19, wherein the contact indicator comprises a part of the handpiece.

26. The system of claim 19, wherein the contact sensing unit further comprises a force sensor for sensing one of a force and a pressure between the handpiece and the skin of the patient.

27. The system of claim 1 wherein the contact sensing unit further comprises a force sensor for sensing one of a force and a pressure between the handpiece and the skin of the patient.

60

28. A method treating the skin of a patient with a therapeutic laser pulse, the system comprising: a) providing a laser source for generating therapeutic laser pulses for application to the skin of the patient; b) providing a handpiece comprising:

1) a handpiece body optically coupled to the laser source and having a pulse delivery region adapted to deliver the therapeutic laser pulses to the target skin area through a pulse delivery aperture;

2) a contact sensing unit for contacting the skin of the patient, comprising:

A) a frame surrounding at least a portion of the pulse delivery aperture;

B) a plurality of contact sensing elements coupled to the frame at different locations, each contact sensing element sensing at least one of contact, a force, and a pressure at one of the different locations when the contact sensing unit is placed in contact with the skin; and c) contacting the pulse delivery aperture to the skin of the patient; d) determining at least one of a contact, a force, and a pressure at each of the different locations using the plurality of contact sensing elements; e) providing at least one of a contact feedback parameter, a force feedback parameter, and a pressure feedback parameter to a system user based on the determined at least one of a force and a pressure at each of the different locations.

29. The method of claim 28, wherein providing at least one of a force feedback parameter and a pressure feedback parameter to a system user comprises providing at least one of

1) an indication of whether or not each of the plurality of contact sensing elements is in contact with the skin;

2) an indication of one of the pressure and the force at each of the different locations;

3) an indication of one of the variation in pressure and the variation in force between two or more of the different locations;

4) an indication that the pressure at each of the plurality of different locations exceeds a minimum pressure threshold;

61 5) an indication that the pressure at each of the plurality of different locations is less than a maximum pressure threshold;

6) an indication of the force at each of the different locations;

7) an indication of the variation in force between two or more of the different locations;

8) an indication that the force at each of the plurality of different locations exceeds a minimum pressure threshold; and

9) an indication that the force at each of the plurality of different locations is less than a maximum pressure threshold.

30. The method of claim 28, further comprising: f) providing an interlock preventing the laser source from generating the therapeutic laser pulses unless the step of providing at least one of a contact feedback parameter, a force feedback parameter, and a pressure feedback parameter indicates that a desired safety condition is satisfied.

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