Methods and apparatus for skin treatment

• US 20030120269A1
• Filed: 11/08/2002
• Published: 06/26/2003
• Est. Priority Date: 11/08/2001
• Status: Active Grant

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Pacek, James L., Bessette, Andre P.
• Granted Patent: US 6,920,883 B2
• Time in Patent Office: Days
• US Class Current: 606/32
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/1815 using microwaves
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2018/00464 Subcutaneous fat, e.g. liposuction, lipolysis
• CPC Class Codes: A61B 2018/1467 using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: C08L 2201/12 Shape memory

Abstract

Methods and apparatus for electrosurgically treating human skin. The skin may be treated by applying thermal energy to the dermis to shrink the skin following liposuction, or to induce collagen deposition at the site of a wrinkle for wrinkle reduction or removal. In another embodiment, a method involves electrosurgically removing or modifying tissue in the head or neck to provide a face-lift or a neck-lift. In one embodiment, the working end of an electrosurgical instrument is positioned in at least close proximity to the dermis by approaching the dermis from the underside (reverse side) of the skin.

Claims

1. A method for shrinking the skin at a target site of a patient'"'"'s face or neck, comprising:

a) providing a probe, the probe including a shaft having a shaft distal end, an active electrode at the shaft distal end, and a return electrode spaced from the active electrode;

b) subcutaneously accessing the patient'"'"'s dermis on the face or neck with the shaft distal end, wherein the active electrode is positioned within the dermis at the target site; and

c) applying a sub-ablation voltage between the active electrode and the return electrode, wherein the sub-ablation voltage effects contraction of the skin in the vicinity of the target site.

2. The method of claim 1, wherein the sub-ablation voltage is a high frequency voltage in the range of from about 20 volts RMS to 90 volts RMS.

3. The method of claim 1, further comprising:

d) prior to said step b), removing excess tissue from the patient'"'"'s face or neck.

4. The method of claim 3, wherein said step d), comprises excising a quantity of excess skin from the patient'"'"'s face or neck.

5. The method of claim 4, wherein at least a portion of the excess skin is excised electrosurgically.

6. The method of claim 1, wherein the voltage of said step c) is applied from a high frequency power supply adapted for operation in the sub-ablation mode and the ablation mode.

7. The method of claim 3, wherein said step d) comprises removing a quantity of adipose tissue from the vicinity of the target site.

8. The method of claim 7, wherein said step d) comprises performing liposuction in the vicinity of the target site.

9. The method of claim 7, wherein said step d) comprises:

e) positioning the active electrode in at least close proximity to the adipose tissue; and

f) applying a second voltage between the active electrode and the return electrode, wherein the second voltage is sufficient to ablate or modify the adipose tissue.

10. The method of claim 9, wherein the second voltage is in the range of from about 200 volts RMS to 1000 volts RMS.

11. The method of claim 9, wherein the second voltage is sufficient to liquefy the adipose tissue.

12. The method of claim 1, wherein said step b) comprises electrosurgically channeling through the epidermis of the patient'"'"'s skin.

13. The method of claim 12, wherein said electrosurgical channeling comprises:

g) positioning the active electrode in at least close proximity to the epidermis; and

h) applying a high frequency voltage between the active electrode and the return electrode.

14. The method of claim 1, wherein said step b) comprises:

i) advancing the shaft distal end through the skin from the epidermis toward the subcutis until the shaft distal end is at a subcutaneous location; and

j) passing the shaft distal end through the subcutis toward the dermis.

15. The method of claim 1, further comprising:

k) moving the active electrode with respect to the skin.

16. The method of claim 15, wherein said step k) comprises moving the active electrode during said step c).

17. A method for removing or reducing wrinkles on the skin of a patient, comprising:

a) providing a probe, the probe including a shaft having a shaft distal end, an active electrode at the shaft distal end, and a return electrode spaced from the active electrode;

b) advancing the probe through the epidermis toward the dermis such that the active electrode is positioned within the dermis at the location of a target wrinkle; and

c) applying a sub-ablation voltage between the active electrode and the return electrode, wherein the sub-ablation voltage is sufficient to induce collagen deposition at the location of the wrinkle, whereby the wrinkle is removed or reduced.

18. The method of claim 17, wherein the sub-ablation voltage is a high frequency voltage in the range of from about 20 volts RMS to 90 volts RMS.

19. The method of claim 17, wherein the wrinkle is on the face or neck.

20. The method of claim 17, wherein the wrinkle is around the eye or around the mouth.

21. The method of claim 17, wherein said step b) comprises electrosurgically channeling through an outer layer of the skin at the location of the target wrinkle.

22. The method of claim 17, wherein said electrosurgical channeling comprises ablating the skin in the vicinity of the active electrode.

23. The method of claim 22, wherein said ablating the skin comprises applying an ablation voltage between the active electrode and the return electrode.

24. The method of claim 23, wherein the ablation voltage is a high frequency voltage in the range of from about 200 volts RMS to 1000 volts RMS.

25. A method for removing or reducing wrinkles on the skin of a patient, comprising:

a) providing a probe, the probe including a shaft having a shaft distal end, an active electrode at the shaft distal end, and a return electrode spaced from the active electrode;

b) subcutaneously accessing the patient'"'"'s dermis with the shaft distal end, wherein the active electrode is positioned in at least close proximity to a wrinkle targeted for treatment; and

c) applying a sub-ablation voltage between the active electrode and the return electrode, the sub-ablation voltage effective in removing or reducing the wrinkle targeted for treatment.

26. The method of claim 25, wherein said step b) comprises:

d) advancing the shaft distal end in a first direction through the epidermis toward the subcutis until the shaft distal end is positioned subcutaneously;

e) advancing the shaft distal end in a second direction from the subcutaneous position toward the epidermis; and

f) positioning the active electrode within the dermis.

27. The method of claim 26, wherein the shaft distal end is transformable between a linear configuration and a curved configuration, and wherein said step d) is performed with the shaft distal end in the linear configuration.

28. The method of claim 27, further comprising:

g) prior to said step e), transforming the shaft distal end to the curved configuration.

29. The method of claim 26, wherein the shaft distal end is steerable, and said step b) comprises steering the shaft distal end toward the dermis.

30. The method of claim 26, wherein said step f) comprises positioning the active electrode within the dermis at the location of the wrinkle targeted for treatment.

31. The method of claim 26, wherein said step d) comprises:

h) introducing an introducer needle into the skin; and

i) passing the shaft distal end through the introducer needle.

32. The method of claim 25, wherein said step b) comprises:

positioning the active electrode in the dermis beneath a first region of the wrinkle targeted for treatment.

33. The method of claim 32, further comprising:

j) after said step c), repositioning the active electrode in the dermis beneath an additional region of the wrinkle targeted for treatment, and thereafter repeating said step c).

34. The method of claim 25, wherein said step c) induces collagen deposition in the dermis at a location beneath the wrinkle targeted for treatment.

35. The method of claim 25, wherein the sub-ablation voltage has a frequency in the range of from about 50 kHz to 500 kHz.

36. The method of claim 35, wherein the sub-ablation voltage is at a level in the range of from about 20 volts RMS to 90 volts RMS.

37. The method of claim 25, wherein the wrinkle is on the face or neck.

38. The method of claim 25, wherein the wrinkle is around the eye or around the mouth.

39. A method for treating the skin of a liposuction patient, comprising:

a) providing a probe, the probe including a shaft having a shaft distal end, an active electrode at the shaft distal end, and a return electrode spaced from the active electrode;

b) after the liposuction has been performed, positioning the active electrode in at least close proximity to the dermis in the region of the liposuction; and

c) applying a sub-ablation voltage between the active electrode and the return electrode, the sub-ablation voltage effective in shrinking the skin in the region of the liposuction.

40. The method of claim 39, wherein the probe further includes an electrically insulating electrode support having a treatment surface, the active electrode disposed on the treatment surface.

41. The method of claim 40, wherein the treatment surface and the active electrode are arranged laterally on the shaft distal end.

42. The method of claim 40, wherein the active electrode comprises a plurality of electrode terminals, each of the plurality of electrode terminals flush with the treatment surface.

43. The method of claim 42, wherein each of the plurality of electrode terminals comprises a material selected from the group consisting of tungsten, stainless steel, gold, platinum, titanium, molybdenum, nickel, and their alloys.

44. The method of claim 42, wherein each of the plurality of electrode terminals comprises gold.

45. The method of claim 39, wherein said step b) comprises accessing the dermis subcutaneously.

46. The method of claim 39, wherein the sub-ablation voltage is a high frequency voltage in the range of from about 20 volts RMS to 90 volts RMS.

47. The method of claim 39, wherein said step c) effects contraction of collagen fibers in the dermis.

48. The method of claim 39, wherein said step c) effects localized heating of the dermis to a temperature in the range of from about 60°

C. to 70°

C.

49. A method for performing a face-lift or a neck-lift procedure on a patient, comprising:

a) removing a quantity of excess tissue from the face or neck

b) providing a probe, the probe including a shaft having a shaft distal end, an active electrode at the shaft distal end, and a return electrode spaced from the active electrode;

c) subcutaneously accessing the patient'"'"'s skin with the shaft distal end, wherein the active electrode is positioned in at least close proximity to the dermis or subcutis at a target site; and

d) applying a sub-ablation high frequency voltage between the active electrode and the return electrode, the voltage effective in shrinking the skin in the vicinity of the active electrode.

50. The method of claim 49, further comprising:

e) during said step d), moving the active electrode over the underside of the skin, wherein collagen fibers in the dermis undergo contraction.

51. The method of claim 49, wherein said step c) comprises positioning the active electrode at a first location on the underside of the skin, and the method further comprises:

f) after said step d), moving the active electrode to a subsequent location on the underside of the skin; and

g) repeating said step d) at the subsequent location.

52. The method of claim 49, wherein the shaft distal end is steerable.

53. The method of claim 49, wherein the shaft distal end is adapted for transformation between a linear configuration and a curved configuration.

54. The method of claim 49, wherein the probe further includes an electrically insulating electrode support disposed at the shaft distal end, the electrode support having a treatment surface, and the active electrode mounted within the treatment surface.

55. The method of claim 54, wherein the active electrode comprises a plurality of electrode terminals.

56. The method of claim 55, wherein each of the plurality of electrode terminals is flush with the treatment surface.

57. The method of claim 56, wherein the electrode support and the active electrode are arranged laterally on the shaft distal end.

58. The method of claim 49, wherein said step a) comprises removing excess skin or excess adipose tissue.

59. The method of claim 58, wherein said step a) involves electrosurgical ablation of at least a portion of the excess tissue.

60. The method of claim 59, wherein the probe is coupled to a high frequency power supply adapted for operation in an ablation mode, and said step a) comprises applying a second voltage between the active electrode and the return electrode, wherein the second voltage is effective in ablating the excess tissue.

61. The method of claim 49, wherein said step d) effects the contraction of collagen fibers in the dermis.

62. The method of claim 49, wherein said step d) effects heating of at least a portion of the dermis to a temperature in the range of from about 60°

C. to 70°

C.

63. The method of claim 49, wherein said step c) comprises:

h) forming an incision in the skin on the face or neck to provide a flap of skin; and

i) positioning the shaft distal end beneath the flap of skin.

64. The method of claim 63, further comprising:

j) prior to said step i), elevating the flap of skin away from the face or neck.

65. The method of claim 49, wherein said step c) comprises:

k) advancing the shaft distal end through the skin from the epidermis toward the subcutis until the shaft distal end lies beneath the dermis; and

l) guiding the shaft distal end back toward the dermis.

66. The method of claim 49, wherein the shaft comprises a needle-like rod, and wherein said step c) comprises:

m) electrosurgically channeling through the skin by applying an ablation level high frequency voltage between the active electrode and the return electrode.

67. The method of claim 49, wherein the probe further includes an aspiration unit for accommodating an aspiration stream, and the method further comprises:

n) aspirating unwanted materials from the surgical site via the aspiration stream.

68. The method of claim 67, wherein the probe further includes an aspiration electrode adapted for digesting tissue fragments present in the aspiration stream.

69. The method of claim 68, wherein the aspiration unit includes an aspiration lumen and the aspiration electrode is located within the aspiration lumen.

70. The method of claim 68, wherein the active electrode is electrically isolated from the aspiration electrode, and the return electrode is spaced proximally from the active electrode.

71. The method of claim 49, wherein the probe further includes a fluid delivery unit, and the method further comprises:

o) delivering an electrically conductive fluid to the shaft distal end or to the target site via the fluid delivery unit, wherein the electrically conductive fluid provides a current flow path between the active electrode and the return electrode.

72. The method of claim 49, wherein said step c) comprises:

p) introducing an introducer device into the skin; and

q) advancing the shaft distal end through the introducer device.

73. An instrument for electrosurgically treating the skin of a patient, comprising:

a shaft having a shaft distal end and a shaft proximal end; and

an electrode assembly at the shaft distal end, wherein the electrode assembly comprises an electrically insulating electrode support, an active electrode terminal on the electrode support, and a return electrode spaced from the active electrode terminal, and wherein the shaft distal end is adapted for penetrating the skin to a subcutaneous location, the shaft distal end is further adapted for adopting a curved configuration, and the instrument is adapted for guiding the active electrode terminal from the subcutaneous location to a sub-epidermal location within the skin.

74. The instrument of claim 73, wherein the shaft is adapted for transformation between a linear configuration and the curved configuration.

75. The instrument of claim 73, wherein the shaft distal end is further adapted for undergoing selective deflection.

76. The instrument of claim 73, wherein the shaft has a diameter in the range of from about 0.25 mm to 1.5 mm.

77. The instrument of claim 73, wherein the shaft is adapted for passage through a hypodermic needle.

78. The instrument of claim 73, wherein the active electrode terminal comprises an electrode array.

79. The instrument of claim 73, wherein the active electrode terminal comprises gold.