Energy Treatment and Cooling of Tissue

Abstract

Embodiments included herein are directed to systems and methods for treating and cooling tissue with energy. System embodiments may include an energy generator configured to generate a signal. The system may further include at least one antenna configured to receive and transmit the signal. The system may further include a cooler at least partially exposed to the housing, or a cooling fluid exposed to the housing of the at least one antenna. The system may further include at least one field expander corresponding to the at least one antenna. The system may further include a cooling plate configured to cool the epidermis and dermis.

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. Provisional Patent Application No. 63 / 427,546, filed November 23, 2022, the entire contents of which are incorporated herein by reference. [Background technology]

[0002] Energy therapies, such as tissue treatments, can be applied to tissues throughout the body to achieve various therapeutic and / or aesthetic results. For example, hyperhidrosis, or hyperhidrosis, can be a common condition that can cause excessive sweating in the underarm, face, back, chest, and / or foot areas of the body. Hyperhidrosis may be treatable with energy therapies. Energy therapies can provide varying levels of success in treating hyperhidrosis, but can also cause adverse side effects, including discomfort. It would be desirable to improve energy therapies to provide better therapeutic results while limiting adverse side effects, such as discomfort. Summary of the Invention [Means for solving the problem]

[0003] As described in more detail below, embodiments of the present disclosure are directed to systems and methods for treating and cooling tissue with energy. System embodiments may include an energy generator configured to generate a signal. The system may further include at least one antenna configured to receive and transmit the signal. The system may further include a cooler at least partially exposed to the housing, or a cooling fluid exposed to the housing of the at least one antenna. The system may further include at least one field expander corresponding to the at least one antenna. The system may further include a cooling plate configured to cool the epidermis and dermis.

[0004] One or more of the following features may be included. The system may include a thermal storage structure surrounding the at least one antenna. The field expander may be made of ceramic or ceramic-filled plastic. The system may further include a switch configured to receive a signal and output the signal to the at least one antenna. The system may further include an applicator. The applicator may be configured to house the at least one antenna, the switch, the thermal storage structure, the at least one field expander, and a cold plate. The system may further include a console housing the energy generator. The system may further include a power supply configured to provide power to the energy generator, control circuitry to control the energy generator, and a display. The energy generator may be a microwave energy generator. The microwave energy generator may be configured to generate a microwave signal having a frequency of approximately 5.8 GHz. The at least one antenna may be a waveguide antenna. The at least one antenna may be a phased array of four waveguide antennas. The cooler may be a thermoelectric cooler. The cold surface of the thermoelectric cooler may be in contact with a housing or a fluid, which in turn is in contact with a heat storage structure surrounding the at least one antenna. At least one field expander may be made of a dielectric ceramic or a ceramic-filled plastic. At least one field expander has a known dielectric constant. At least one field expander is a ceramic-filled plastic field expander. A structure made of at least two materials with different dielectric constants can expand an energy field. The difference between a first dielectric constant corresponding to at least one field expander and a second dielectric constant corresponding to a pair of field expanders including a dielectric ceramic expands the power density associated with a signal.

[0005] In one embodiment, a system for energy-based tissue treatment and cooling may include a microwave energy generator configured to generate a microwave signal. The system may further include a waveguide antenna configured to receive and transmit the microwave signal. The system may further include a cooling mechanism at least partially exposed to a heat storage structure in contact with a cooling plate. The system may further include first and second field expanders disposed near ends of the waveguide antenna. The system may further include a cooling plate configured to cool the epidermis and dermis. The first and second field expanders are dielectric ceramics or ceramic-filled plastics, and a difference between a first dielectric constant corresponding to the first field expander and a second dielectric constant corresponding to the second field expander expands the power distribution associated with the microwave signal.

[0006] In one embodiment, a method for treating and cooling tissue with energy may include generating a microwave signal with a microwave energy generator. The method may further include receiving and transmitting the microwave signal with at least one waveguide antenna. The method may further include cooling the epidermis using a thermal storage structure housing the at least one waveguide antenna and a thermoelectric cooler at least partially exposed to a cooling plate. The method may further include outputting a microwave energy field corresponding to the microwave signal through at least one field expander disposed near an end of the at least one waveguide antenna. The method may further include expanding the microwave energy field using a difference between a first dielectric constant corresponding to at least one field expander and a second dielectric constant corresponding to another field expander. The method may further include treating tissue with the microwave energy field.

[0007] The details of one or more example implementations are set forth in the accompanying drawings and the following description. Other possible example features and / or possible example advantages will become apparent from the description, drawings, and claims. Some implementations may be free of such possible example features and / or possible example advantages, and such possible example features and / or possible example advantages may not be necessary for some implementations.

[0008] This Summary is provided to introduce some concepts that are further described below in the Detailed Description. This Summary does not identify essential features of the claimed subject matter, nor is it intended to be used as an aid in limiting the scope of the claimed subject matter.

[0009] Embodiments of the present disclosure will be described with reference to the following drawings.

[0010] Like reference numbers between the drawings may be considered to indicate like elements. [Brief explanation of the drawings]

[0011] [Figure 1A] 1 illustrates an exemplary device for delivering energy to tissue according to the present disclosure. [Figure 1B] 1 illustrates an exemplary device for treating tissue with energy according to the present disclosure. [Figure 1C] 1 shows a cross-sectional view of an exemplary device for delivering energy to tissue in accordance with the present disclosure. [Figure 1D] 1 shows time-temperature curves corresponding to treating tissue according to the present disclosure. [Figure 1E] 1A and 1B schematically illustrate the underside of an exemplary applicator according to the present disclosure. [Figure 1F] 1 shows a diagram of an exemplary applicator having an exemplary handle according to the present disclosure. [Figure 2] 1 illustrates an exemplary system according to the present disclosure. [Figure 3]1 shows an exemplary block diagram of a system for energy treatment and cooling, according to an embodiment of the present disclosure. [Figure 4] 1A and 1B show diagrams of an exemplary housing and an exemplary antenna, according to an embodiment of the present disclosure. [Figure 5] ~ [Figure 6] 1 illustrates an exemplary procedure according to an embodiment of the present disclosure. [Figure 7] 1 illustrates an exemplary field expander, according to an embodiment of the present disclosure. [Figure 8A] ~ [Figure 8B] 1 illustrates a simulation related to an exemplary embodiment of the present disclosure. [Figure 9] 1 illustrates an exemplary cold plate and exemplary microwave connections according to an embodiment of the present disclosure. [Figure 10] 1 illustrates an exemplary applicator according to an embodiment of the present disclosure. [Figure 11] 10 illustrates an example of applying microwave energy according to an exemplary embodiment of the present disclosure. [Figure 12] 1 is a flowchart illustrating an exemplary method of treating and cooling tissue with energy, according to an embodiment of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0012] The following description is directed to particular implementations. It should be understood that the following description is intended only to enable one of ordinary skill in the art to make and use any subject matter defined herein or later by the patent "claims" in any issued patent herein.

[0013] In particular, claimed combinations of features are not limited to the embodiments and / or implementations and examples contained herein, but are intended to encompass portions of those implementations and modifications of those implementations, including combinations of elements of various implementations within the scope of the claims that follow. Of course, in developing any such actual implementation, as with any engineering or design project, various implementation-specific decisions (e.g., compliance with system-related and business-related constraints) must be made to achieve the developers' respective goals, which may vary from implementation to implementation. Moreover, it should be understood that such development efforts may be complex and time-consuming, but would nevertheless be routine for one of ordinary skill in the art to design, assemble, and manufacture to have the benefit of this disclosure. Nothing in this application is considered critical or essential to the claimed invention unless expressly designated as "critical" or "essential."

[0014] Furthermore, although terms such as "first," "second," etc. may be used herein to describe various elements, it should be understood that these elements are not limited by these terms. These terms are used only to distinguish one element from another. For example, a first object or step may be referred to as a second object or step, and similarly, a second object or step may be referred to as a first object or step, without departing from the scope of the present invention. Although a first object or step and a second object or step are each an object or step, they are not considered to be the same object or step.

[0015] Skin (e.g., human) can have three major layers, including the subcutaneous tissue, the dermis, and the epidermis, and can also have internal structures (e.g., as shown in FIG. 5), all of which are treatable. Disclosed herein are methods, devices, and systems for non-invasive delivery of energy therapy to one or more of these layers, or to other parts of the body. In various embodiments, the energy therapy can be microwave therapy based on ceramic-based (or dry) application of microwave energy for skin treatment. The energy therapy can be delivered to various target tissues to achieve various therapeutic and / or aesthetic results. Treatment of target tissues and / or structures using one or more of the techniques and features described herein can affect the target tissue and / or structure in one or more of the following ways: modification, inactivation, neutralization, denervation, injury, electroporation, apoptosis, necrosis, coagulation, ablation, thermal alteration, and destruction. In one or more embodiments of the present disclosure, the temperature of the target tissue and / or target structure therein can be raised to at least about 50°C or higher to achieve the desired treatment effect. For example, sufficient thermal energy can be delivered to heat the target tissue to about 60° C. or greater, resulting in thermal ablation of the target tissue.

[0016] It would be desirable to focus treatment within specific regions (e.g., "target tissue") of the dermal and subcutaneous tissue (also referred to herein as hypodermis) where target histological structures may be present, while minimizing damage to tissue above the target tissue in the epidermis and dermis (e.g., "superficial non-target tissue") and tissue structures within the hypodermis (e.g., "deep non-target tissue"). For example, it would be desirable to treat eccrine sweat glands. Eccrine sweat glands may be coiled tubular glands that may be found in the deep dermis and / or upper subcutaneous tissue. There may be roughly millions of glands on the surface of the skin (particularly on the palms and soles, hairless areas, and axillae). It would also be desirable to treat apocrine glands. Apocrine glands may be found, for example, in the axillae, perianal and pubic areas, scrotum, labia majora, and around the nipples. They may be found mainly in the deep dermis and subcutaneous tissue, and their ducts may end in hair follicles.

[0017] The target tissue region, depending on the location on the body, can begin anywhere from about 0.5 mm to about 4 mm below the skin surface and end anywhere from about 1 mm to about 10 mm below the skin surface in some embodiments. Furthermore, the superficial non-target tissue region, depending on the location on the body, can begin at the skin surface and end anywhere from about 0.5 mm to about 4 mm below the skin surface in some embodiments. Furthermore, the deep non-target tissue region, depending on the location on the body, can begin anywhere from about 1 mm to about 10 mm below the skin surface in some embodiments.

[0018] The specific type of tissue structure that can be selected for therapy may depend on the specific therapy or therapies required. For example, microwave therapy described herein can be delivered to eccrine or apocrine sweat glands to reduce a patient's sweating (e.g., as shown in Figures 5 and 6). Also, apocrine glands can be treated to achieve reduced body odor (e.g., as shown in Figures 5 and 6). In another example, microwave therapy described herein can be used to reduce collagen in the skin for skin tightening, wrinkle reduction, and / or body sculpting. Microwave therapy can also be used to treat hair follicles, acne, cellulite, the vasculature (such as varicose veins and telangiectasias), and various other structures. Therefore, it may be necessary to adjust the location of target and non-target tissues based on the specific therapy required.

[0019] Various non-limiting examples of anatomical structures and clinical indications treatable by the systems and methods disclosed herein include, but are not limited to, hyperhidrosis (excessive sweating), skin wrinkles, bromhidrosis (especially foul-smelling sweat), chromhidrosis (abnormally colored sweat), acne, cellulite (skin depressions), unwanted hair growth, varicose veins, telangiectasias, benign or malignant skin lesions and infections, and hyperesthesia (e.g., resulting from neurological disorders). In some embodiments, multiple structures / conditions can be treated in the same treatment session.

[0020] It should be noted that although microwave energy for tissue treatment is discussed herein, other energy modalities may be used to achieve the intended therapy. For example, the systems and methods disclosed herein may be configured to deliver one or more of the following modalities: electromagnetic waves, x-rays, RF, DC, AC, microwaves, ultrasound (including high intensity focused ultrasound (HIFU)), radiation, near-infrared, infrared, and / or light / laser.

[0021] In combination with the thermal treatments disclosed herein, protective treatments may be used to prevent damage or pain to non-target tissue. For example, thermal protective treatments such as surface cooling may be applied to protect the epidermal and some dermal layers of the skin while allowing deeper regions of the skin tissue to be heated by energy delivery. Various types of active and passive cooling may be configured to provide this thermal protection to non-target tissue.

[0022] Referring to FIG. 1A, a device 110 is shown having an energy applicator 111 that non-invasively delivers microwave energy 112 to a target tissue layer 105 and a microwave generator 113 that supplies the microwave energy 112 to the applicator 111 via a conduit 114. The energy applicator 111 may include at least one antenna for delivering the microwave energy 112 to the target tissue 105. The antenna may be configured to heat and treat the target tissue 105 and target structures within the target tissue 105 when the device is placed against or near a patient's skin. The treated target tissue 105 may be left intact to be reabsorbed by the body's immune system and wound healing response, or may be extracted using any number of minimally invasive techniques. A cooling plate 115 is also shown to prevent damage to superficial non-target tissue 103.

[0023] Microwave energy 112 can be absorbed by the target tissue 105 through a process called dielectric heating. Molecules within the tissue (e.g., water molecules) can be electric dipoles, with a positive charge on one end and a negative charge on the other. When microwave energy 112 induces an alternating electric field, the electric dipoles can rotate in an attempt to align with the electric field. This molecular rotation can generate heat as molecules collide with each other, causing further motion. This heating can be particularly efficient for liquid water molecules, which have a relatively high dipole moment.

[0024] 1B , an apparatus for treating target tissue with microwave energy may be configured to include a microwave generator 113 connected to a processor, a vacuum system configured to maintain a cooling plate in contact with the skin, and a device 117 operatively coupled to the generator. The device 117 may further include an energy delivery applicator 111 or an energy delivery element (e.g., an antenna that delivers energy to the target tissue). A cable 114 (e.g., a feedline) may electrically connect the device to the microwave generator 113. In embodiments, the processor, the device, and / or the microwave generator 113 may be wirelessly connected (e.g., by radio frequency signals). The microwave generator 113 may be located remotely from the energy applicator 111, and the microwave generator 113 may be stationary or portable. Alternatively, the applicator 111 and the microwave generator 113 may be coupled to each other to form a portable unit. Further alternatively, the applicator 111 and microwave generator 113 may be combined into a single unit.

[0025] 1B is an isometric view illustrating one embodiment of a non-invasive energy delivery device 117 including multiple microwave antennas 120 that may be electrically connected to a microwave generator 113. The antennas 120 may be housed or housed in a generally planar applicator plate 115, which may be sized for application to a target area of ​​a patient's skin. The device 117 and the applicator plate 115 therein may be sized and configured to generally match the area of ​​tissue to be treated. Additionally, a vacuum system may be embedded in the energy delivery applicator 111 to maintain contact between the patient's skin and a cooling, thermally conductive plate (e.g., cooling plate 115).

[0026] Referring to FIG. 1C, a cross-sectional side view of the device 117 of FIG. 1B is shown delivering energy 112 into the skin. In such multi-antenna embodiments, it may be useful to orient antennas 120 along the same plane in the same longitudinal direction to deliver energy in a planar manner. As shown in FIGS. 1B and 1C (respectively), four or five microwave antennas 120 may be arranged parallel to one another. In other embodiments, fewer or more microwave antennas 120 may be provided, such as 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 or more. Such a planar configuration may allow energy 112 to be delivered more uniformly to a wider area of ​​tissue in a single treatment. Each antenna may be energized individually, or multiple antennas may be energized simultaneously, to provide coherent energy delivery to areas that may not be directly beneath one or more of the antennas.

[0027] The amount of energy 112 delivered to the target tissue 105 and the resulting extent of the treatment effect can be adjusted based on the number of antennas 120, their specific configuration, and the power supplied to each antenna 120. For example, a microwave energy output frequency in the range of 300 MHz to 20 GHz may be appropriate to power the energy delivery device. Furthermore, a microwave signal anywhere from about 915 MHz to about 2450 MHz may be effective in providing a treatment effect on the tissue. In some embodiments, signals having frequencies in the range of about 2.5 GHz to about 10 GHz may also be useful. Furthermore, solid-state amplifiers, traveling wave tubes, and / or magnetrons may optionally be used as components to facilitate the delivery of microwave energy.

[0028] In some embodiments, the system may include one or more waveguide antennas, which may have a resonant frequency between about 915 MHz and 15 GHz, more specifically between about 2.4 GHz and 9.2 GHz, for example, between about 2.45 GHz and 5.8 GHz in some embodiments. The waveguide antenna may have a cross-sectional size configured to achieve a desired operating frequency and field shape of the waveguide. Generally, the lowest-order transverse electric (TE) mode (e.g., TE10) is available, but other modes (e.g., transverse magnetic (TM) modes, evanescent modes, or hybrid modes) are also possible. For example, the width and height (if rectangular) or diameter (if circular) of the waveguide geometry correlates with the operating frequency and field shape of the waveguide. Other parameters (e.g., filler, feed type and placement, and use of mode filtering) may also affect the operating frequency and field shape of the waveguide. A transverse mode of a beam of electromagnetic radiation may be a particular intensity pattern of the radiation measured in a plane perpendicular (i.e., normal) to the beam's direction of propagation. Transverse modes can occur in microwaves confined to a waveguide. All modes are time-varying.

[0029] Transverse modes can arise due to boundary conditions imposed on the wave by the waveguide. Compatible modes can be found by solving Maxwell's equations for the boundary conditions of a given waveguide. Transverse modes can be classified into various types. TE modes (transverse electric modes) have no electric field in the direction of propagation. TM modes (transverse magnetic modes) have no magnetic field in the direction of propagation. TEM modes (transverse electromagnetic modes) have neither electric nor magnetic fields in the direction of propagation. Hybrid modes can be modes that have both electric and magnetic field components in the direction of propagation. Evanescent fields can be time-varying fields whose amplitude decreases monotonically as a function of transverse radial distance from the waveguide but without a phase shift. Evanescent fields can be coupled (i.e., confined) to electromagnetic waves or modes propagating within the waveguide.

[0030] The length of the waveguide may be adjusted so that the physical length of the waveguide matches an electrical length that is half the guide wavelength at the desired operating frequency. This may allow for efficient matching from the waveguide feed into the load. Furthermore, the waveguide may have a variety of geometric cross-sectional shapes depending on the desired clinical objective and the geometry of the particular anatomical region to be treated. In some embodiments, the geometric cross-sectional shape of the waveguide is rectangular, circular, elliptical, or hexagonal. Waveguide applicators may be arranged in a phased array configuration for simultaneous or sequential treatment of multiple sites. Furthermore, there may be the potential for advantageous phased operation (constructive effects of in-phase fields) of waveguide arrays (similar to twin coaxial slot antennas).

[0031] Additionally, the coaxial feed may be anywhere along the waveguide insertion depth up to the height of the waveguide, and this placement may be optimized for efficient power transfer from the coaxial feed to the waveguide.

[0032] To achieve a desired energy density in the region of the target tissue 105, the antenna 120 may be located within 0.5-5 mm (e.g., within about 1.5-2 mm, e.g., within about 1.75 mm) of the skin, or may be located within a few wavelengths of the skin at a given operating frequency. This distance is sometimes referred to herein as the antenna standoff height. Varying the standoff height can affect the spread of microwave radiation. A very large standoff can achieve a focused energy density over a larger volume. Conversely, a near-zero or zero standoff height can achieve a very high overall energy density over a smaller volume. Achieving therapeutic energy density levels with a large standoff may require significantly higher input power levels. The absorption pattern of microwave energy in deeper tissue is strongly affected by the standoff, which can directly affect the relative safety margin between the target tissue 105 and non-target (deep) tissue 104. Finally, the standoff height can significantly change the loading conditions of the waveguide, and a change in standoff will change the reflected power level seen by the waveguide antenna.

[0033] Dielectric fillers may allow waveguides of various cross-sectional areas to be utilized and propagate at specific desired frequencies. The cutoff frequency of a fixed-size waveguide can be lowered by utilizing a material with higher electrical conductivity. For example, for a desired treatment size and a specified frequency range of 2.4 to 9.2 GHz, a dielectric filler with a dielectric constant K between 2 and 30 may be utilized. Increasing the K value of the dielectric filler allows the dielectric constant to be closer to that of tissue, potentially reducing the overall reflection between the applicator and tissue interface. Some examples of dielectric constants are skin K = 35-40, fat K = 5-10, muscle K = 50, and water K = 80. In implementations that include a cooling element (e.g., cooling plate 115) or other barrier, the dielectric filler may be selected based on its dielectric constant being well-compatible with the cooling element and skin.

[0034] In thermal treatment of tissue, it may be advantageous to protect non-target tissue from unnecessary and potentially harmful thermal destruction. This may be particularly true for subcutaneous treatments, as excessive energy delivered to the epidermal 102 and dermal 101 layers of skin can result in pain, discomfort, dryness, charring, and edge effects. Furthermore, dryness, charring, and edge effects in surrounding tissue can potentially compromise the effectiveness of the treatment, as the impedance of dry tissue may be too high, preventing energy from reaching deeper regions of the tissue.

[0035] To prevent thermal destruction of non-target tissue and associated complications, the energy delivery device may include a cooling element consisting of a heat reservoir 150 and a cooling plate 115 to provide a cooling effect to the superficial non-target tissue 103 (e.g., the epidermis 102 and a portion of the dermis 101). The cooling element consisting of the heat reservoir 150 and the cooling plate 115 can establish a zone of thermal protection 103 for the superficial non-target tissue by conductively and / or convectively cooling the epidermis 102 and allowing the cooling effect to penetrate into the dermis 102. The cooling element provides this zone of protection 103, allowing the target tissue 105 to be treated while minimizing the risk of thermal damage to the non-target tissue 103, 104. A method for maintaining contact between the skin and the cooling plate (e.g., applying a vacuum to the treatment zone) may be used.

[0036] 1D, a time-temperature graph 130 illustrates skin temperatures above which burns are expected to occur (i.e., curve B) and below which no discernible injury occurs (i.e., curve A). Thus, during energy treatment, the cooling system is configured to maintain non-target skin surface temperatures (measurable with a temperature sensing element) below curve B, and potentially below curve A, for a given treatment duration.

[0037] To further reduce the risk of pain and / or other discomfort associated with thermal treatment, the cooling element, comprised of the thermal mass 150 and cooling plate 115, can further cool the superficial non-target tissue 103 to induce a numbing effect. The cooling treatment and resulting cooling and / or numbing effect may be applied before, during, and / or after thermal treatment, depending on the type of thermal treatment used and the associated need for supplemental cooling. Protective cooling may be applied alternately with thermal treatment to maximize energy delivery while minimizing adverse effects on non-target tissue 103, 104.

[0038] The cooling element, consisting of the heat storage structure 150 and the cooling plate 115, can take a variety of forms. For example, the cooling element can be a passive heat sink that conductively cools the skin, such as a layer of static chilled liquid (e.g., water, saltwater) or solid coolant (e.g., ice, ceramic plate), a selected phase change liquid that changes to gas, or some combination thereof (e.g., a cylinder filled with chilled water). The cooling element can also provide active cooling in the form of a spray or flow of gas or liquid, or aerosol particles for convective cooling of the epidermis 102. As described in more detail below, skin cooling can be achieved using the heat storage structure 150 adjacent to a thermally conductive ceramic plate. The cooling plate is a ceramic plate that contacts the patient. Cooling between the heat storage structure 150 and the cooling plate 115 is achieved by conduction. The heat storage structure 150 is cooled by contact with the flowing chilled liquid. In some embodiments, a thermoelectric cooler (TEC) or Peltier device can also be an effective active cooling element. Alternatively, the active cooling element may be a heat transfer element adjacent to which a circulating fluid carries away heat.

[0039] The cooling element may be incorporated into the device as an internal cooling component that conductively cools non-target tissue 103, 104. For example, the energy delivery device may combine a cooling component consisting of a heat storage body 150 and a cooling plate 115 with an energy applicator, where the cooling component plate 115 can passively conduction cool adjacent tissue. In the case of active cooling, the cooling component consisting of a heat storage body 150 and a cooling plate 115 may include a heat conducting element 150, in which case a chilled liquid (e.g., water, dry ice, alcohol, antifreeze) is circulated through the internal structure of the element. For example, in a microwave energy delivery device that includes a dielectric, the dielectric itself may be the cooling component. In another example, the cooling component plate 115 may be incorporated into the antenna 120 so as to be adjacent to the dielectric.

[0040] The cooling component consisting of the thermal mass 150 and the cold plate 115 may be incorporated into an energy delivery device 117 including at least one microwave antenna 120, as described above. For example, a fluid may be used to cool adjacent skin tissue 119. This type of convective cooling may be enhanced by a coolant circulator 118, which may optionally be incorporated into the microwave generator 113, coupled to the microwave generator 113, or located remotely from the microwave generator 113. For example, the coolant circulator 118 may be located remotely from both the microwave generator 113 and the cold plate 115. The properties and characteristics (e.g., medium, flow rate, temperature) of the circulating fluid (gas or liquid) may be selected and modified to achieve a desired cooling effect in terms of the amount and flow rate of energy delivered to the target tissue.

[0041] The cooling plate may be thermally conductive, allowing for control of the rate of heat transfer between the tissue and the cooling fluid. Furthermore, the cooling plate may be thin compared to the wavelength of the microwave signal (e.g., about 2 mm or less, and in some cases, e.g., 1 mm, 0.75 mm, 0.5 mm, 0.25 mm, or 0.20 mm or less) and have low electrical conductivity to maximize the efficiency of power transfer into the tissue and keep the waveguide close to the skin to minimize standoff height. The cooling plate may also be rigid enough to conform to the skin while not bending (through constant contact with the skin and a uniform flow profile) to maintain uniform cooling. Furthermore, the cooling plate may be made of a material that is transparent (e.g., non-reflective) to microwave energy. The cooling plate may be made of any suitable material, for example, in some embodiments, glass or a ceramic composite containing about 96% alumina, aluminum nitride, or pyrolytic carbon. Additionally, the cooling plate may have an embedded thermocouple that measures the temperature at the contact between the cooling plate and the skin (note that this is the case in the "G4" system, but the cooling plate is a different material with a higher thermal conductivity, which allows for cooling by conduction through the metal structure rather than a direct connection to water).

[0042] Low-loss cold plate materials that meet a certain dielectric constant range may be desirable. For example, ceramics such as alumina (K=10), zirconia, silica, aluminum silicate, or magnesia may be used. Additionally, polymers such as silicone rubber (K=3) or ceramic-polymer composites may be utilized. While specific materials are mentioned, those skilled in the art will understand that applications are not limited to those listed. Cold plates may also be thin enough to minimize unwanted microwave reflections. For example, the thickness of the cold plate may be only about 10 mm, 9 mm, 8 mm, 7 mm, 6 mm, 5 mm, 4 mm, 3 mm, 2 mm, 1 mm, 0.75 mm, or 0.5 mm or less.

[0043] Controlled energy delivery can help prevent unnecessary damage (e.g., desiccation, charring, etc.) to the target tissue 105 and non-target tissue 103, 104 as a result of overheating. Controlled energy delivery can also result in a more uniform, more predictable, and more efficient overall treatment. Therefore, it would be advantageous to incorporate a controller with programmed instructions for delivering energy to tissue into the energy delivery system. Furthermore, these programmed instructions may include algorithms that automate controlled energy delivery. For example, the controller may be incorporated into or coupled to the generator, in which case the controller may direct the generator according to pre-set algorithms that include temperature and / or power profiles. These profiles may define parameters that may be used to achieve a desired treatment effect in the target tissue. Such parameters may include, but are not limited to, power and time increments, maximum allowable temperature, and ramp rates (i.e., rate of increase of temperature / power). Feedback signals, including real-time or delayed physiological and diagnostic measurements, may be used to adjust these parameters and the overall energy delivery. Among the measurements that can be obtained, temperature, impedance, and / or reflected power at the treatment site and / or target tissue 105 can be particularly useful.

[0044] These measurements can be useful for monitoring the effectiveness of energy delivery at the treatment site and target tissue during the procedure. The energy controller may have fixed coefficients, or the controller coefficients may vary depending on the sensed tissue response to energy delivery. Additionally, algorithms including safety profiles may be used to limit energy delivery or to limit sensed tissue temperatures. These algorithms can shut off or adjust energy delivery. Additionally, in procedures where thermal protection is used, such as active cooling systems, the protective cooling may be adjusted based on the monitored data.

[0045] Treatment may be managed by taking temperature measurements into account in energy delivery to achieve the desired treatment effect while preventing unnecessary complications of the treatment. For example, energy delivery to the target tissue 105 may be steadily (i.e., at a constant rate) increased until a desired threshold temperature of the target tissue is reached, the threshold temperature being the temperature necessary to achieve the treatment effect. Once the threshold temperature is reached, power increases or energy delivery may be stopped entirely to prevent damage to non-target tissue 103, 104 due to unnecessary overheating. In some embodiments, the temperature of the target tissue may be monitored indirectly and non-invasively by measuring the temperature of superficial non-target tissue 103 (e.g., at the surface of the skin) and extrapolating the temperature measurement to the target tissue temperature. Adjustments may be made for each patient's skin thickness. For example, it may be desirable to keep the temperature of superficial non-target tissue 103 below approximately 45°C.

[0046] Temperature measurements may be made using any number of sensors, including thermocouples and thermistors, which may be incorporated into the energy delivery element, energy delivery device, and / or energy delivery system. For example, a thermocouple may be embedded in the energy applicator, or may be located proximate to the antenna as part of the energy delivery device, or may be located remotely from the device and wired directly to the generator. The measured temperature may be the temperature of the tissue immediately adjacent to the device, or the temperature of the target tissue, or any other tissue temperature that may provide a useful temperature measurement. If the energy delivery element is in thermal communication with the surrounding tissue (e.g., by conduction), a sensor incorporated into the energy delivery element may measure the temperature of the element itself.

[0047] Referring to FIG. 1E, the underside of the waveguide applicator 161 is shown schematically. The waveguide 145 is shown, which may be operatively connected behind a cooling plate 166 and two vacuum ports 167, one on each side of the cooling plate 166. Referring to FIG. 1F, a diagram of the microwave applicator 161 is shown, which includes a handle 169 for the waveguide antenna system. Also shown is a biochip 168 (e.g., a suction chamber). Each of the illustrated elements may preferably be housed within the biochip 168 to facilitate efficient energy delivery, cooling, and suction to the specific location being treated.

[0048] Thermal protection measures may be used in conjunction with the thermal treatments described above. As shown in Figures 1B and 1C, an applicator plate 115 housing or accommodating an antenna 120 may be connected to a microwave generator 113 by a conduit 114, through which a cooling fluid (e.g., water) passes from a coolant circulator 118 to a thermal storage structure 150 on the applicator plate and from there to the coolant circulator 118. As shown in Figure 1A, the cooling fluid can create a protection zone 103 within the patient's epidermis 102, thereby treating the target tissue 105 below the protection zone. A protection zone 104 is also shown in Figure 1C.

[0049] 2 illustrates an exemplary system 200 according to the present disclosure. System 200 may be a "G4" system, available, for example, from the assignee of the present disclosure. System 200 may use, for example, 5.8 GHz microwaves to ablate sweat glands. While sweat gland ablation is described as a capability of the systems and methods described herein, this is for illustrative purposes only, and other procedures, including but not limited to those referenced herein, are also within the capabilities of the systems and methods of the present disclosure.

[0050] The system 200 can use a cooling fluid, such as water, to both cool the top layer of skin and assist in expanding a microwave field corresponding to the microwaves. The system 200 can include a console 210 (which can house an energy generator, such as a microwave energy generator), an applicator 220 (e.g., a handpiece), and a biochip 230. The biochip 230 can be removably attached to the applicator 220. The biochip 230 can be bonded or glued to the applicator 220 or can be detached from the applicator 220. Furthermore, the biochip 230 can provide a layer between the applicator 220 and the patient using a thin membrane that is permeable to both microwaves and / or thermal cooling. The biochip 230 can also create a vacuum-tight seal between the patient's treatment site and the head of the applicator 220. This vacuum capability can be used to pull the patient's skin up into contact with a cooling plate. Additionally, biochip 230 may include a hydrophobic membrane that prevents liquids such as blood and lubricants from entering the vacuum tubing of applicator 220 .

[0051] Embodiments of the present disclosure are directed to systems and methods for energy-based tissue treatment and cooling that do not use cooling fluids (e.g., water), liquids, or incorporate cooling fluid systems. For example, the techniques and features described in this disclosure may be implemented to simultaneously achieve energy-based tissue ablation and liquid-free cooling with a thermoelectric cooler (TEC). In other words, the systems and / or devices described herein are capable of ablating subcutaneous tissue using applied energy while simultaneously cooling the top layer of tissue without the use of liquid coolant.

[0052] 3 , an exemplary system 300 according to an embodiment of the present disclosure may include a console 310. The console 310 may include or house an energy generator (e.g., a microwave energy generator and / or a microwave amplifier 312), a power supply, a controller or control circuit (e.g., as described above), and a display 330 (e.g., which may be located on the console 310, integrated into the console 310, or remote from the console 310). The power supply may be configured to provide power to the energy generator (and / or microwave amplifier) ​​312. Further, the control circuit (or controller) may be configured to control the energy generator 312 or other components of the system 300. The energy generator (and / or microwave amplifier) ​​312 may be configured to generate a signal. For example, the energy generator 312 may be a microwave energy generator that may be configured to generate a microwave signal having a frequency of approximately 5.8 GHz, although microwave signals generated by the microwave energy generator at other frequencies (e.g., higher and / or lower than 5.8 GHz) are also within the scope of the present disclosure.

[0053] The system 300 may further include (or be configured to include) an applicator 320 (e.g., a handpiece). The applicator 320 may include or house (or be configured to house) one or more energy application antennas, which may be housed in a thermal storage structure 322 with an antenna. The applicator 320 may further include or house (or be configured to house) a TEC 324, which may be used to provide cooling (e.g., instead of a liquid or fluid cooling system as described above). The system 300 may also include a switch 326 (e.g., a microwave switch), which may be configured to receive a signal (e.g., a microwave signal) generated by the energy generator (and / or microwave amplifier) ​​312 (e.g., a microwave energy generator) and output the signal to at least one antenna (e.g., housed in a thermal storage structure 322 with an antenna). The switch 326 may be included in or housed in the applicator 320. Referring to FIG. 10, an exemplary applicator 1000 according to an embodiment of the present disclosure is shown.

[0054] System 300 may also include cabling 340 (e.g., umbilical cable) for providing one or more of microwave transmission, vacuum, cooling fluid, and / or electrical power from console 310. Referring to Figure 9, an exemplary microwave connection 920 according to an embodiment of the present disclosure is shown. System 300 may further include a biochip (e.g., as described above with respect to Figure 2) to provide a barrier between the patient and the system / device (e.g., applicator 320).

[0055] In embodiments, system 300 may be used to treat human tissue and may enable localized heating at the skin-fat junction of the dermis without the use of coolant throughout the microwave path. System 300 may further include one or more field expanders (e.g., as part of applicator 320), which may comprise or consist of a dielectric ceramic, ceramic-filled plastic, or air, to expand energy (e.g., microwave energy) to a desired location / size. System 300 may be a "G5" system, which may become available from the assignee of the present disclosure. Eliminating a coolant system from the microwave path, or (for example) eliminating the coolant function from a conventionally designed applicator, may also be achieved, at least in part, by packing the energy / signal (e.g., microwave signal) with a ceramic or ceramic-filled plastic having a comparable dielectric constant to expand the energy / signal (e.g., microwave signal) so that the correct width and / or length of the lesion size is covered by the corresponding energy field.

[0056] Additionally, system 300 may include at least one antenna configured to receive one or more signals generated by energy generator 312. A cooler (e.g., TEC 324) may be at least partially exposed to the housing of the at least one antenna (e.g., antenna-bearing thermal storage structure 322). As described in more detail below, system 300 may further include at least one field expander corresponding to the at least one antenna.

[0057] The system 300 may also include a cold plate 328 (e.g., as part of the applicator 320) configured to cool at least one of the epidermis and the dermis. Referring to FIG. 9, an exemplary cold plate 910 according to an embodiment of the present disclosure is shown. In some embodiments, the cold plate 910 may be made of a low-loss ceramic, which may have a relatively high heat transfer coefficient (e.g., compared to alumina, which may also be used). The cold plate 910 may be in contact with a shroud, which may be cooled by the cold surface of the TEC, as described above. Additionally, the material from which the cold plate is made may allow the cold plate to transmit microwaves, which may also cool the skin.

[0058] Referring to FIG. 4 , an exemplary housing 400 with an exemplary antenna according to an embodiment of the present disclosure is shown, which may include a heat storage structure 150 (cooling element 150 of FIG. 1B ) with an input cooling fluid conduit 404 and a return cooling fluid conduit 406. As previously described, to provide cooling, the TEC may cool fluid within the console and pump it to the heat storage structure 150 surrounding the waveguide as shown in FIG. 4 . The heat storage structure may be thermally and mechanically attached to a cold plate and may transfer heat away from the patient's skin. The heat storage structure may be used to cool the cold plate used as part of shaping and shielding microwave energy. A cooling fluid return path (return cooling fluid conduit 406) may carry cooling fluid that carries away heat and returns to the TEC, where it re-cools the fluid.

[0059] 5 and 6, an exemplary procedure according to an embodiment of the present disclosure is shown. This exemplary procedure may involve ablation of eccrine and / or apocrine glands. The system (e.g., system 300) may operate by generating a 5.8 GHz microwave signal and transmitting it through an umbilical cable (e.g., cable 340) via microwave channel cable 345 to a microwave switch (e.g., microwave switch 326). The microwave signal may be redirected through the microwave switch to one or more waveguide antennas (e.g., antenna-containing thermal storage structure 322). The microwave signal may pass through one or more of the waveguide antennas and through the output of one or more field expanders of the antennas (as described in more detail below), which may have different dielectric constants and serve to expand the microwave signal into a broader field pattern. The microwave signal may then pass through a cooling plate (such as cooling plate 328), pass through the epidermis (502) and dermis (504), and be absorbed or reflected by the fat layer (506) to create a heated zone (602), where eccrine glands (508) and apocrine glands (510) may reside. The cooling plate (such as cooling plate 328, represented by the reference numeral labeled system 300 near the top of Figures 5 and 6) may cool the epidermis (502) and dermis (504) (for example) within cooling zone (604) to prevent superficial burns.

[0060] An advantage of having a cooling system that does not pass cooling fluid through the microwave path is that it allows for a variety of fluid types to be used as cooling fluids, since varying fluid dielectric properties will affect microwave performance. Another advantage is that the system is not affected by any air bubbles that may enter the cooling fluid. Using the cooling techniques and features described in this disclosure, the cooling zone achieved on the skin may be comparable to that achieved with liquid / water cooling through the microwave path, but water-based cooling systems may not be capable of achieving temperatures below 0°C. This is because water-based systems may freeze at 0°C, while non-water-based systems may experience temperatures below 0°C.

[0061] In embodiments, a change in dielectric constant across a boundary can be implemented to expand a microwave field (e.g., corresponding to a microwave signal described above) thereby increasing the treatable range and reducing the strength of the corresponding microwave signal. As noted above, one or more of the field expanders of the systems described herein can be ceramic, ceramic-filled plastic, or air. Referring to FIG. 7 , exemplary field expanders 702, 704, 706, and 708 are shown in accordance with embodiments of the present disclosure. One or more of field expanders 702, 704, 706, and 708 can be composed of a dielectric ceramic, ceramic-filled plastic, or air. Furthermore, ceramic, ceramic-filled plastic, or air field expanders can be implemented at the end of one or more waveguides (e.g., a waveguide antenna). One or more of field expanders 702, 704, 706, and 708 can have a dielectric constant of approximately 10. Furthermore, the dielectric ceramic can have a dielectric constant between 1 and 100.

[0062] Referring to FIGS. 8A and 8B, graphs 800A and 800B (respectively) are shown illustrating simulations associated with exemplary embodiments of the present disclosure. These simulations may correspond to microwave expansion and localized energy at the skin-fat boundary. These simulations may demonstrate that insulating a field expander with a dielectric constant of 10 with a dielectric ceramic with a dielectric constant of 100 expands the power density of a microwave signal. Graph 800A in FIG. 8A illustrates a cross-sectional plot of power loss density (heating zone). Graph 800B in FIG. 8B illustrates a side-sectional simulation of power loss density where maximum power loss (heating) is below the top layer of skin (e.g., a simulation of subcutaneous heating where maximum heating is approximately 2 mm below the top layer of skin). Graphs 800A and 800B demonstrate that the power loss density output using the cooling system designs described herein may be comparable to cooling systems that use liquid / water flowing through the microwave path.

[0063] 11 , an example of applying microwave energy according to an exemplary embodiment of the present disclosure is shown. For example, image 1110 shows tissue result 1112 at time T=0 seconds after applying microwave energy with a liquid-free (e.g., waterless) microwave field extension (e.g., as described herein with respect to system 300). Furthermore, image 1120 shows tissue result 1122 at time T=3 seconds after applying microwave energy with a liquid-free (e.g., waterless) microwave field extension (e.g., as described herein with respect to system 300). Furthermore, image 1130 shows tissue result 1132 at time T=21 seconds after applying microwave energy with a liquid-free (e.g., waterless) microwave field extension (e.g., as described herein with respect to system 300). Each image in FIG. 11 shows tissue (in this example, pork) being heated with microwaves from a liquid-free / waterless cooling system design as described herein. The cooling system used in the example of FIG. 11 may have seven antennas (e.g., four waveguide antennas and three phased antennas (using two adjacent waveguide antennas simultaneously or nearly simultaneously)) that, when energized (e.g., one at a time), provide treatment coverage equivalent to the liquid / water cooling system described above. That is, a phased array of waveguide antennas with field-expanding ceramics can shape the microwave signal to treat areas outside of each individual antenna. These images show that a dielectric material used in place of liquid / water in the cooling system can expand the microwaves to heat tissue over a range equivalent to the liquid / water cooling system described above.

[0064] 12, a flowchart illustrating an exemplary method or process 1200 for treating and cooling tissue with energy is shown, in accordance with an embodiment of the present disclosure. In one embodiment, the process 1200 for treating and cooling tissue with energy may include generating (1202) a microwave signal with a microwave energy generator (e.g., microwave energy generator 312). The process 1200 may further include receiving (1204) the microwave signal with at least one waveguide antenna (e.g., thermal storage structure 322 with antenna). The process 1200 may further include cooling (1206) the epidermis using a TEC (e.g., TEC 324) at least partially exposed to a shroud (e.g., thermal storage structure 322 with antenna) that houses the at least one waveguide antenna and a cooling plate (e.g., cooling plate 328). Process 1200 may further include outputting (1208) a microwave energy field corresponding to the microwave signal via at least one field expander (e.g., one or more of field expanders 802, 804, 806, and 808) disposed near an end of the at least one waveguide antenna. Process 1200 may further include expanding (1210) the microwave energy field using a difference between a first dielectric constant corresponding to the at least one field expander (e.g., one or more of field expanders 802, 804, 806, and 808) and a second dielectric constant corresponding to another field expander. Process 1200 may further include treating (1212) tissue with the microwave energy field.

[0065] Thus, the techniques and features described herein may be implemented as described above in connection with various embodiments of the present disclosure to reduce or eliminate complications resulting from liquid water leaks in tissue treatment systems having liquid cooling systems that may introduce air into the waterways. Furthermore, the techniques and features described herein may be implemented as described above in connection with various embodiments of the present disclosure to reduce or eliminate the possibility of biofilm buildup or debris / contaminants in the liquid / water of liquid cooling systems used in tissue treatment systems (which may impede energy delivery or reduce the thermal capacity of the cooling liquid). Furthermore, replacing a water-based cooling system with the microwave pathway of a tissue treatment system as described herein may simplify the manufacturing and / or assembly of the tissue treatment system, facilitate maintenance and cleaning of the tissue treatment system, and reduce the cost of manufacturing, assembly, and / or maintenance of the tissue treatment system.

[0066] It should be noted that while the techniques and features of the present disclosure may be applied to the ablation of sweat glands, scent glands, and / or hair follicles (e.g., as described above), this is not intended to be a limitation of the present disclosure, and other applications of the techniques and features described herein include, but are not limited to, fat ablation, acne reduction, and other skin treatments, including, but not limited to, those discussed herein. Furthermore, the techniques and features described in the present disclosure (e.g., associated coolers / field expanders, as described above) may be implemented in touch-up accessory devices and the like that may be used to touch up smaller areas of skin tissue.

[0067] The terminology used herein is for the purpose of describing particular embodiments and is not intended to be limiting of the disclosure. As used herein, the singular forms "a," "an," and "the" are intended to encompass the plural forms as well, unless the context clearly dictates otherwise. It should further be understood that the words "comprises" and / or "comprising," when used herein, specify the presence of stated features, integers, steps, operations, elements, and / or components, but do not exclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and / or groups thereof.

[0068] Corresponding structures, materials, acts, and equivalents of means-or-step-plus-function elements in the following claims are intended to encompass all structures, materials, or acts that, in combination with other claimed elements, perform the function as specifically claimed. The description of the present disclosure has been presented for purposes of illustration and description and is not intended to be exhaustive or to limit the disclosure to the form disclosed. Various modifications and variations will be apparent to those skilled in the art without departing from the scope and spirit of the present disclosure. The present embodiments have been chosen and described in order to best explain the principles and practical applications of the present disclosure and to enable others skilled in the art to understand the present disclosure in terms of various embodiments with various modifications suited to the particular uses envisioned.

[0069] While several exemplary embodiments have been described in detail above, those skilled in the art will readily appreciate that various modifications can be made to these exemplary embodiments without substantially departing from the scope of the present disclosure as set forth herein. Accordingly, such modifications are intended to fall within the scope of the present disclosure, as defined in the following claims. In the claims, means-plus-function clauses encompass structures described herein as performing the recited function and encompass equivalent structures, as well as structural equivalents. Thus, while nails and screws are not structurally equivalent in that nails employ cylindrical surfaces for fastening wooden parts together and screws employ helical surfaces, they are equivalent structures in the context of fastening wooden parts. It is Applicant's express intent that 35 U.S.C. 112(f) shall not apply to any limitations on any of the claims herein, unless the claim expressly uses the phrase "means for" or "step for" with the associated function.

[0070] Although the disclosure of the present application has been described in detail and by reference to embodiments thereof, it will be apparent that modifications and variations are possible without departing from the scope of the present disclosure as defined in the appended claims.

Claims

1. an energy generator configured to generate a signal; at least one antenna configured to receive and transmit said signals; a cooler at least partially exposed to the housing or a cooling fluid exposed to the housing of the at least one antenna; at least one field expander corresponding to said at least one antenna; a cooling plate configured to cool the epidermis and the dermis; A system including:

2. a heat storage structure surrounding said at least one antenna; The system of claim 1 further comprising:

3. The system of claim 1 , wherein the field expander is a ceramic or ceramic-filled plastic field expander.

4. a switch configured to receive the signal and output the signal to the at least one antenna; The system of claim 1 further comprising:

5. an applicator configured to accommodate the at least one antenna, the switch, the heat storage structure, the at least one field expander, and the cold plate; The system of claim 1 further comprising:

6. A console housing the energy generator The system of claim 1 further comprising:

7. a power source configured to provide power to the energy generator; a control circuit for controlling the energy generator; The display and The system of claim 1 , further comprising at least one of:

8. The system of claim 1 , wherein the energy generator is a microwave energy generator.

9. 9. The system of claim 8, wherein the microwave energy generator is configured to generate a microwave signal having a frequency of about 5.8 GHz.

10. The system of claim 1 , wherein the at least one antenna is a waveguide antenna.

11. The system of claim 1 , wherein the at least one antenna is a phased array of four waveguide antennas.

12. The system of claim 1 , wherein the cooler is a thermoelectric cooler.

13. The system of claim 12 , wherein a cold side of the thermoelectric cooler contacts the housing or the fluid, and the housing or the fluid contacts the heat storage structure surrounding the at least one antenna.

14. The system of claim 1 , wherein the at least one field expander comprises a dielectric ceramic or a ceramic-filled plastic.

15. The system of claim 1 , wherein the at least one field expander has a known dielectric constant.

16. 16. The system of claim 15, wherein the at least one field expander is a ceramic filled plastic field expander.

17. The system of claim 1 , wherein a structure made of at least two materials with different dielectric constants extends the energy field.

18. 15. The system of claim 14, wherein a difference between a first dielectric constant corresponding to the at least one field expander and a second dielectric constant corresponding to a pair of field expanders comprising a dielectric ceramic expands a power density associated with the signal.

19. 1. A system for energy tissue treatment and cooling, comprising: a microwave energy generator for generating a microwave signal; a waveguide antenna configured to receive and transmit the microwave signals; a cooling mechanism at least partially exposed to the heat storage structure in contact with the cold plate; first and second field expanders disposed near the ends of the waveguide antenna; a cooling plate configured to cool the epidermis and the dermis; Including, the first and second field expanders are dielectric ceramics or ceramic-filled plastics, and a difference between a first dielectric constant corresponding to the first field expander and a second dielectric constant corresponding to the second field expander expands a power distribution associated with the microwave signal; system.

20. 1. A method of energy tissue treatment and cooling, comprising: generating a microwave signal with a microwave energy generator; receiving and transmitting said microwave signals with at least one waveguide antenna; cooling the epidermis using a thermal storage structure housing the at least one waveguide antenna and a thermoelectric cooler at least partially exposed to a cooling plate; outputting a microwave energy field corresponding to the microwave signal via at least one field expander positioned near an end of the at least one waveguide antenna; expanding the microwave energy field using a difference between a first dielectric constant corresponding to the at least one field expander and a second dielectric constant corresponding to another field expander; treating the tissue with the microwave energy field; A method comprising:

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