DEVICE AND METHOD FOR TREATING THE EPIDERMIS

Abstract

A laser device for skin ablation treatment. The device includes a laser source (5) and a handpiece (9). The laser beam has a Gaussian distribution of the power density to obtain different effects in the various regions exposed to the laser beam.

Claims

1. A device for laser treatment of an epidermis comprising: a laser energy source; a laser energy focusing system, arranged and controlled to focus a laser beam generated by the laser energy source; a scanning and actuating system to address a laser beam towards a region of epidermis to be treated, said scanning and actuating system being controlled so as to sequentially direct the laser beam in a plurality of portions of the epidermis inside said region of epidermis to be treated, said laser beam having a variable energy density profile in a cross section of said laser beam, in a central area of said cross section an intensity of the laser beam being adapted to cause an ablation of the epidermis in a central portion of a volume exposed to the laser beam, and in an external annular area of said cross section the intensity of the laser beam being adapted to cause at least one of an hemostasis of blood vessels and shrinkage of collagen of the epidermis in an annular portion of the volume exposed to the laser beam, said annular portion surrounding said central portion.

2. The device as claimed in claim 1, wherein the scanning and actuating system is controlled to direct the laser beam according to a pre-settable pattern.

3. The device as claimed in claim 2, further comprising a control unit configured to select said pattern.

4. The device as claimed in claim 1, further comprising a control unit adapted to control the laser energy focusing system and the laser source to modulate a penetration depth of the laser beam in said epidermis.

5. The device as claimed in claim 1, wherein said scanning pattern is configured such that an entire surface of the epidermis in said region is treated with said laser energy.

6. The device as claimed in claim 1, wherein in a volume outside said annular area the laser energy density is adapted to cause a biostimulation of the tissues.

7. The device as claimed in claim 1, wherein said central area has a maximum cross dimension from about 40 to about 500 micrometers.

8. The device as claimed in claim 1, wherein said external annular area has an inner dimension corresponding to a dimension of the central area and a maximum external cross dimension greater by 6-200 micrometers than the cross dimension of the central area.

9. The device as claimed in claim 1, wherein said laser energy source has a wave length comprised between 532 and 13,000 nm.

10. The device as claimed in claim 9, wherein said laser energy source is a carbon dioxide laser with a 10600 nm emission.

11. The device as claimed in claim 1, wherein said laser energy source is a pulsed laser energy source.

12. The device as claimed in claim 1, further comprising a control unit adapted to control the emission of the laser beam and the laser energy focusing system such that a plurality of laser pulses are directed to each one of said portions of the epidermis.

13. The device as claimed in claim 1, further comprising a wave guide to convey the laser energy towards an applying handpiece, said scanning system being housed in said handpiece.

14. The device as claimed in claim 1, wherein the energy density profile of the laser beam has approximately a shape of a Gaussian curve, with a maximum arranged on an axis of the laser beam.

15. The device as claimed in claim 1, further comprising a radio frequency generator and at least one electrode arranged on a handpiece, said handpiece being connected to said laser energy source by a wave guide.

16. The device as claimed in claim 15, wherein said at least one electrode forms a spacer between said handpiece and tissue to be treated.

17. The device as claimed in claim 15, further comprising another electrode to provide two electrodes, said two electrodes being carried by said handpiece for propagating radio frequency emission.

18. The device as claimed in claim 15, further comprising a time control for temporarily coordinating application of the laser energy and the radio frequency emission.

19. The device as claimed in claim 1, wherein said central area has a maximum cross dimension from about 100 to about 400 micrometers

20. The device as claimed in claim 1, wherein said central area has a maximum cross dimension from about 120 to about 350 micrometers.

21. The device as claimed in claim 1, wherein said external annular area has an inner dimension corresponding to a dimension of the central area and a maximum external cross dimension greater by 80 to 120 micrometers than the cross dimension of the central area.

22. A method for treating a region of epidermis of a patient, the method comprising: generating a laser beam with a laser source; guiding the laser beam through a scanning system towards said epidermis; sequentially applying laser energy in a plurality of portions of epidermis according to a scanning pattern in said region of epidermis, with a distribution of energy in each portion which causes an ablation of the epidermis in a central area of each portion of said epidermis and at least one of an hemostasis of blood vessels, a cauterization of the blood vessels and a collagen shrinkage in an annular area of said portion of epidermis, surrounding said central area.

23. The method as claimed in claim 22, further comprising biostimulating, through said laser energy, a tissue area surrounding said annular area in each of said portions of epidermis.

24. The method as claimed in claim 22, wherein said scanning pattern is configured such that the entire surface of the epidermis in said region is treated with said laser energy.

25. The method as claimed in claim 22, wherein said laser energy is pulsed and each portion of said epidermis is irradiated with a plurality of laser pulses.

26. The method as claimed in claim 22, wherein said laser energy has a wave length comprised between 532 and 13,000 nm.

27. The method as claimed in claim 26, wherein said laser source is a carbon dioxide laser source with a wave length of 10600 nm.

28. The method as claimed in claim 22, wherein the scanning pattern is such that sequentially treated areas of the epidermis partially overlap.

29. The method as claimed in claim 22, wherein the laser beam has a Gaussian energy density distribution.

30. The method as claimed in claim 22, further comprising the step of combining a radio frequency emission with said laser energy.

31. The method as claimed in claim 30, wherein said radio frequency emission is applied in the epidermis at a greater depth than a depth of propagation of the laser energy.

32. A method for treating a region of epidermis of a patient, the method comprising: selecting a laser treatment pattern; generating a laser beam with a laser source; guiding the laser beam towards said epidermis; sequentially applying a laser beam to a plurality of portions of epidermis according to said laser treatment pattern under the control of a scanning system, wherein said laser beam has a cross-sectional energy distribution profile such that in each of said plurality of portions of epidermis said laser beam causes an ablation of the epidermis in a central area of each portion of epidermis and at least one of an hemostasis of blood vessels, a cauterization of the blood vessels and a collagen shrinkage in an annular area of said portion of epidermis, surrounding said central area.

33. The method as claimed in claim 32, wherein the laser treatment pattern is defined by a plurality of sequential positions of the laser beam on the epidermis, and selecting the laser treatment pattern includes at least selecting a mutual distance of said sequential positions.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0033] In the drawings:

[0034] FIG. 1 is a view of a device which embodies the present invention;

[0035] FIG. 2 is a detailed view of the handpiece of the device of FIG. 1;

[0036] FIG. 3 is a view of a curve representing the power density as a function of the distance from the beam axis in a beam with substantially circular section;

[0037] FIG. 4 is a schematic view showing a way of applying laser energy;

[0038] FIG. 5 is a schematic view showing another way of applying laser energy;

[0039] FIG. 6 is a view of power density curves of adjacent laser beams to treat adjacent volumes of the epidermis in an application mode;

[0040] FIG. 7 is a view of power density curves of adjacent laser beams to treat adjacent volumes of the epidermis in another application mode;

[0041] FIG. 8 is a view of a scanning system for scanning the laser beam;

[0042] FIG. 9 is a view of a system for subdividing a main laser bean into a plurality of adjacent or consecutive laser beams;

[0043] FIG. 10 is a schematic view showing an improved handpiece for the laser/radio frequency combined treatment;

[0044] FIG. 11 is a view of the handpiece of FIG. 10;

[0045] FIG. 12 is a view of time graphs illustrating the combination of the laser radiation and of the radio frequency; and

[0046] FIG. 13 is a view of time graphs illustrating the combination of the laser radiation and of the radio frequency.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0047] FIGS. 1 and 2 show a device, wherein the present invention may be embodied. In general, the device 1 comprises a base 3, inside which at least one laser source 5 is housed. The device further comprises a control unit 6, comprising one or more processors and associated memory. The laser source 5 can be a continuous laser, but preferably a pulsed laser is used. According to some embodiments of the present invention, the laser source can have an emission wave length comprised between 532 and 13,000 nm and more in particular a wave length of 10,600 nm, corresponding to the CO.sub.2 laser emission. In fact, the laser source is preferably a CO.sub.2 laser.

[0048] In some embodiments of the present invention, the most relevant parameters of the equipment can fall within the following ranges of values:

Type of laser: CO.sub.2, with wave length of 10.6 micrometers
Power irradiated to the tissue: up to 50 W
Repetition frequency of the pulse: from 5 to 100 Hz
Duration of the pulse: from 0.2 to 80 ms
Dimension of the scanning surface: maximum 1515 mm
Distance between two scanning dots: up to 2 mm (step 50 micrometers or less)

[0049] The laser can be controlled so as to provide a pulse for each position of the scanning mirrors, i.e. for each treated point. However, in other embodiments of the present invention it can be provided for shooting more than one laser pulse for each working position, i.e. at each treated point. For example, from two to five pulses can be provided for each position of the laser.

[0050] To obtain the Gaussian shape of the beam, the laser cavity is designed so as to insulate the main propagation mode and the focusing optical systems must be designed so as to contribute to maintaining the Gaussian shape of the energy distribution from the axis towards the outside. An adequate choice of the diameter of the cavity and an adequate radius of the mirrors of the laser source can give the generation of the oscillation mode TEM 00 that gives a Gaussian beam profile.

[0051] The laser beam can be conveyed through a wave guide 7 towards a handpiece 9. The guide can be designed in different manners, also depending upon the frequency and the emission power of the laser. In the illustrated example the wave guide is simply formed by hollow tubular elements, hinged to each other, inside which deflection mirrors for the laser beam are arranged, to deviate the beam along the axis of the various tubular portions of the guide.

[0052] Inside the handpiece 9 focusing and/or scanning systems for the laser beam are arranged, some of which are schematically represented in FIGS. 8 and 9. Preferably, inside the handpiece 9 a scanning system (FIG. 8) is contained, comprising for example two scanning mirrors 21 with corresponding actuators 23 electronically controlled by a control unit, not shown. The scanning mirrors control the movement of the laser beam F exiting from the handpiece 13, so that it follows a given path, according to criteria, better defined hereunder. In this case, a single laser beam F exits therefore from the handpiece and is addressed towards the surface of the epidermis to be treated, from which the handpiece can be maintained at a constant distance, for example through a spacer 11. On the handpiece 13 buttons, grips or other regulating and interfacing members, schematically indicated with 15, can be arranged, through which the operator can modify the shape of the beam and/or the dimension and the area of the scanning surface, the movement of the beam and other.

[0053] Through the handpiece 13 and the scanning system inside it, it is possible to control the movement of the beam F according to a defined and stored pattern, which can be modified by the user if required.

[0054] A focusing optical system is arranged in an adequate point of the path of the laser beam. In the diagram of FIG. 8, this optical system is indicated with the number 25 and is arranged in the handpiece, but it should be understood that this is not strictly necessary, and that other positions are possible. The optical system 25 has also the function of imposing to the beam a given power density distribution according to the radius, as it will be better explained hereunder.

[0055] In other embodiments of the present invention, inside the handpiece 15 focusing systems are arranged that subdivide the laser beam into a plurality of beams that are adjacent to each other and impart an energy density profile to each of the adjacent beams, depending upon the radius according to the criteria described hereunder.

[0056] The lens inside the handpiece, combined with the shape of the beam generated by the source, causes the Gaussian profile; the generated shape of the beam depends upon the purity of the propagation mode inside the laser cavity, which determines therefore the energy distribution transversally to the axis of propagation in the free space at the exit of the laser source.

[0057] In some preferred embodiments of the present invention, the laser beam or each laser beam has a substantially circular cross section. Characteristically, the laser beam or each laser beam as a profile of energy density variable according to the distance from the axis. In other words, the energy density of the beam varies from the center of the beam, where there is the greater density, towards the periphery of the beams, where there is the lower energy density. FIG. 3 shows a curve representing the energy density, assuming to have a beam with circular cross section. In this case on the axis of ordinates the energy density is shown and on the axis of abscissas the radius is shown, i.e. the distance from the axis A of the beam. It should be noted that the energy density is maximum at the center of the beam and tends quickly to decrease moving towards the periphery of the beam. In some embodiments of the present invention, the energy density profile follows a trend that can be represented substantially with a Gaussian curve, as shown in FIG. 3. By varying the distance in the space of two contiguous pulses generated by the laser, in which there is this control (spacing of the pulses in scanning) it is possible to control the entity of the superposition of the shoulders of the radiation profiles.

[0058] On the axis of ordinates four energy density values have been identified, indicated respectively with E1, E2, E3, and E4. The values E1, E2, E3 and E4 can vary in a highly significant manner, as in their determination many parameters intervene, resulting from the interaction between laser radiation and biological tissues. These parameters depend upon the type of skin (dry or oil skin; phototype, etc.) by the angle of incidence, and by the adjustments made by the doctor based upon the experience for the various cases.

[0059] The energy density levels comprised between E1 and E2 are such that the tissue irradiated with an energy density comprised between these two levels is affected by an ablation process, i.e. a process of removal of the tissue. The energy density greater than the energy level E2 is achieved only in points contained inside the cylindrical volume of the laser beam with radius R2.

[0060] The energy density comprised between the values E2 and E3 is not sufficient to cause tissue ablation, i.e. the removal of the irradiated tissues. However, for these intermediate values of energy density cauterization phenomena occurs in the irradiated tissues, i.e. phenomena of hemostasis of the blood vessels. This avoids bleeding in the regions where the ablation occurred. Furthermore, or alternatively, the energy density levels E2 and E3 define an interval within which the laser beam causes a shrinking of the collagen contained inside the irradiated volume of tissue. Therefore in the volume irradiated with an energy density comprised between E2 and E3 a beneficial effect occurs on the collagen fibers, which causes a toning up of the tissue of the epidermis and therefore a positive result in terms of decrease of the aging effects. As in the volume irradiated with energy density comprised between E2 and E3 the ablation does not occur, the tissue damage results to be particularly limited. In FIG. 3, R3 indicates the radius of the cross section of the beam, inside which the energy density is greater than the level E3. Therefore, the level of energy density causing cauterization or hemostasis and/or collagen shrinking, but not tissue ablation, is achieved in an annular area of the cross section of the beam with inner radius R2 and outer radius R3.

[0061] The most external annular region of the cross section of the beam comprised between an inner radius R3 and an outer radius R4 is characterized by an energy density comprised between the level E3 and the level E4. In this interval, the laser energy is no longer sufficient to cause significant shrinking of the collagen fibers and/or cauterization or hemostasis of the blood vessels, but it is still sufficient to cause significant effects of tissue biostimulation. Consequently, in the affected area there is an effect of the laser that contributes to the post-intervention recovery, stimulating the growth of the tissues subjected to ablation in the most internal region of the portion of epidermis exposed to the single laser beam. In some embodiments of the present invention the radii R2 and R3 can assume the following values:

R2: from 60 to 175 micrometers according to the set parameters
R3=R2+50 micrometers

[0062] According to the present invention, it is advantageously provided to invest a preset area of the skin with a plurality of laser beams, each of which has an energy density shape represented qualitatively by the curve of FIG. 3 or anyway with a shape characterized by a gradual reduction of the energy density as the distance from the axis A-A of the beam increases. This reduction can be stepwise, instead of continuous as represented in FIG. 3.

[0063] The beams, with which the portion of epidermis to be treated is irradiated, can be constituted by beams arranged side by side and generated with an optical system of the type represented in FIG. 9, or they can be simply represented by positions assumed in time sequence by a same laser beam, moved with a scanning system as represented in FIG. 8. In this latter case the laser beam is preferably turned on, i.e. actuated sequentially in each desired position according to a radiation pattern, whilst during the movement between one point and the other the laser is preferably turned off.

[0064] Sequentially targeting portions of epidermis with a scanning system has several advantages over using an optical system which generates a plurality of parallel laser beams.

[0065] Firstly, the pattern of the several portions of epidermis can be selected based for instance upon a treatment protocol, while when an optical system is used, which generates a plurality of parallel simultaneous beams, the illuminating pattern is fixed and cannot be adapted to needs. A scanning system can be controlled, for instance by control unit 6, such that the pitch between the centers of sequentially applied laser dots can be selected. Not only the pitch, i.e. the distance, can thus be changed, but also the distribution of the dots or spots, i.e. the shape of the pattern. For instance, the positions which the laser beam, and thus the laser spot, takes with respect to the epidermis during treatment can be arranged according to meshes of a net having variable dimensions and/or variable shape.

[0066] Independently of the system of generation of adjacent laser beams, it is possible to irradiate the epidermis for example by following a pattern as represented in FIG. 4. Here F1, F2, F3 . . . F9, represent the various laser beams in their projection on a portion of surface of the epidermis. Substantially, F1-F9 indicate the areas defined by the intersection between the laser beam and the outer surface of the epidermis. Each region F1-F9 has a substantially circular development if the laser beam has a circular section, but it should be understood that this is not strictly necessary, as each laser beam can have a cross section of elliptical shape or of any other adequate shape. In the example illustrated in figure A each region F1-F9 is delimited by an inner circumference C1 and by an outer circumference C2, wherein the circumference C1 has a radius R2 and the circumference C2 has a radius R3. Therefore, inside the circumference C1 the energy density of the beam is comprised between the levels E1 and E2 as defined above with reference to FIG. 3, and an ablation phenomenon occurs on the surface of the epidermis and in the tissues below corresponding to the circular area C1. The depth of the tissue ablation and therefore the dimension of the affected volume depends upon various factors, among which the absorption coefficients and the power of the beam. In the circular area comprised between the circumferences C1 and C2 the laser energy density is comprised between the levels E2 and E3 and therefore in this region there is a cauterization effect of the blood vessels and/or an effect of shrinking of the collagen fibers. Outside of the circumferences C2 of each beam F1-F9 there is an area exposed to an irradiation with a level of energy density comprised between E3 and E4 and therefore in this surface in the tissues below there is a biostimulation effect caused by the laser energy, but there is not shrinking of the collagen fibers and/or cauterization or hemostasis of the blood vessels, as well as ablation phenomena.

[0067] FIG. 5 shows a different irradiation pattern. Equal numbers indicate equivalent elements to that described with reference to figure A.

[0068] The difference between the pattern of figure A and the pattern of FIG. 5 is simply the different position of the points in which the axis of the beam is located in the scanning, i.e. the positions in which the various beams are positioned in the case of a multi-beam irradiation system. In this case again, circular areas C1 and areas C2 with annular section can be distinguished, where there are ablation phenomena and phenomena of cauterization/shrinking of the collagen fibers respectively. In the surface portions of the epidermis outside of the circumferences C2 a biostimulation effect occurs.

[0069] If a scanning system (FIG. 8) is used, the pattern of FIGS. 4 and 5 can be used selectively, by simply selecting the desired pre-settable matrix in the control unit 6. Alternatively, the operator may design his own pattern, by inputting pattern data into the control unit 6. For instance, the distance between the centers of the beams F1-F9 can be changed by the operator.

[0070] The embodiment of FIG. 8 further allows additional advantages. For instance, the focusing system 25 can be adapted to adjust the focusing distance, i.e. the focal point of the laser beam. In some embodiments this may be useful to adjust the penetration depth of the laser beam.

[0071] The laser effect on the epidermis can be adjusted and modulated e.g. by changing the number of laser shots fired in each one of the several positions defined by the treatment pattern. The number of laser shots can determine the depth of the ablative treatment in each dot, for instance. While in some embodiments the penetration of the ablative treatment can be the same for each dot, using a laser scanning system the device offers the possibility of varying and adjusting the degree of ablation, for instance the ablation depth, in each position independently from the other. In one and the same region treated different treatment depths can be used in different positions of the scanned laser beam.

[0072] The penetration depth can be adjusted by modulating the laser energy and/or by varying the numbers of laser shots in each position determined by the scanning system.

[0073] FIG. 6 shows qualitatively the way in which the effects of the adjacent laser beams are combined so as to obtain in the tissue of the epidermis the three phenomena of ablation, cauterization/shrinking and biostimulation. More in particular, in FIG. 6 two energy density distribution curves are represented for two adjacent beams. In the region indicated with A the energy density achieves the ablation values; in the regions indicated with B the energy density achieves the levels of cauterization or hemostasis of the blood vessels and/or shrinking of the collagen fibers; in the regions indicated with C, outside the regions indicated with B, the sum of the energy density of the laser beams, energy densities are achieved, sufficient for biostimulating the tissue.

[0074] It should be understood that the greater or smaller overlapping can affect the dimension of the regions subjected to shrinking of the collagen fibers/hemostasis of the vessels and/or biostimulation, depending also upon the trend of the curves representing the power density. Substantially, it is possible to model the regions subjected to the three above mentioned effects by adequately shaping the energy density profile and/or dimensioning in an adequate manner the irradiation pattern, i.e. the positions in which the single beams are arranged, with which a portion of epidermis is simultaneously irradiated, or the positions taken sequentially by a single laser with a scanning system.

[0075] In some embodiments of the present invention it is also possible to shape the energy density curves and/or to arrange the axes of the beams, with which the portion of epidermis under treatment is irradiated, so as to reduce or to completely eliminate the regions in which there is the biostimulation and to obtain in the treated volume of tissue only two effects, respectively ablation and cauterization and/or shrinking of the collagen. Such a situation is schematically represented in FIG. 7 with the same representing criterion of FIG. 6. It should be noted in FIG. 7 that the two beams are so close to each other as to eliminate the region indicated with C in FIG. 6, and therefore the tissue below irradiated by the beam will have surface regions and corresponding underneath tissue volumes subjected to ablation (regions A) and surface portions with annular development with corresponding underneath volumes inside the tissue, wherein the energy density will causes a phenomenon of cauterization/ablation and/or shrinking of the collagen fibers (regions B).

[0076] In the practical application of the method described above, a region of epidermis to be treated will be defined, and on this region the laser beams will be addressed. In a case (with a system of the type illustrated in FIG. 9) more beams, in case generated by a single main beam, will be addressed simultaneously on contiguous regions of the epidermis. In another case a beam will be scanned according to a pattern using a system as in FIG. 8. In this case the beam will be preferably interrupted in the phase of moving its axis from an irradiation point to the other. Independently of the method used, which can also combine the two systems and/or which can use two or more scanned beams, all the surface of the epidermis is irradiated, simultaneously or sequentially, but with variable energy densities. Each irradiated region will be subjected to an ablation in the central portion, to a shrinking of the collagen fibers and/or an hemostasis of the vessels in the annulus outside of the ablation region and to a biostimulation effect in the external surface.

[0077] By shaping the energy density profile and the position of the beams it is possible to modify the dimensions and the positions of these three treatment areas. The beam penetrates below the surface of the epidermis and therefore to each circular surface, annular surface or intermediate surface between the annular surfaces corresponds an underlying volume in the tissue and in the epidermis. In general, the entire surface is therefore treated and all the tissue volume within a given depth, which can vary from point to point, is irradiated by the beam, living no regions devoid of treatment, but modulating the treatment, thus obtaining different effects from a region to the other. This surprisingly allows the advantage of lower invasivity of the intervention, much faster recovery times, but at the same time an effectiveness of the treatment much greater relative to that which can be obtained with beams of substantially constant energy density in all the section and spaced from each other so as to leave regions of epidermis not irradiated and therefore where the laser has no effect.

[0078] According to improved embodiments of the present invention, the laser treatment is combined with a treatment by means of radio frequency application. FIGS. 10 to 13 illustrate this embodiment. FIG. 10 shows a handpiece 109, containing the same components as handpiece 9, in addition to a radio frequency generator, schematically illustrated with the number 110. The radio frequency generator is connected to a pair of electrodes 113. In some embodiments, the electrodes 113 are shaped so as to form a spacer between the handpiece 109 and the surface to be treated. The distance is set based upon the optical characteristics of the laser, whose radiation is conveyed to the handpiece 109 by means of a light guide 115 as in the previously described embodiment. On the handpiece 109 interface means are provided between the equipment and the user, such as for example one or more buttons or other, generically indicated with the number 117.

[0079] Using the electrodes as spacers, a particularly compact instrument is obtained, economical and easy to use.

[0080] With such a handpiece it is possible to combine in a synergic manner the effects of the laser and of the radio frequency on the treated tissues. More in particular, the radio frequency emission allows heating the tissues below the tissues exposed to the laser radiation, so that also the underlying collagen layers are subjected to heating, induced in this case by the radio frequency, and are subjected to a shrinking, which results in toning up the skin. When the electrodes 113 rest on the skin to be treated, for instance on the face of the patient, as shown in FIG. 11, the radio frequency field generated by the electrodes propagates in the tissues and generates induced currents, which heat the tissue of the derma at greater depths than the depths where the laser has effect.

[0081] The laser radiation and the radio frequency can be combined or temporarily overlapped in different manners. The diagram of FIG. 12 shows a time graph of the laser emission and of the radio frequency emission (RF). The pulsed laser radiation is emitted in the time interval between t1 and t2. The radio frequency emission is applied in an interval t1t1 and t2+t2, wherein

[0082] t1 can vary for example between 10 seconds and (t2t1)

[0083] t2 can vary for example between 10 seconds and (t2t1)

as graphically represented in FIG. 13. By imposing the condition

(t1t1)<(t2t2)

it is possible to vary the starting time and the ending time of the radio frequency emission relative to the interval of laser treatment. The variation can be continuous or discontinuous. For example, it is possible to provide for a stepped regulation with steps of 0.01 seconds or less. In this way it is possible to start the radio frequency emissions ten seconds before the laser treatment or in a subsequent time, which can be temporarily translated until at most it coincides with the end time of the laser emission, thus making the two treatments in time sequence instead of in overlapping, starting with the laser radiation and then prosecuting with the RF radiation. The ending time of the RF radiation can be from ten seconds after the end of the laser emission or it can be advanced until to coincide with the instant corresponding to that in which the laser emission starts. Also in this case the two treatments are performed in sequence, firstly the radio frequency treatment and subsequently the laser treatment.

[0084] When t1=t2=0, the two treatments (laser and RF) are temporarily overlapped and have the same time duration.

[0085] Example of values, which can be used in the combined laser+radio frequency electric field application, are the following: [0086] spacing between the pulses: 1 mm [0087] laser power: 30 W [0088] RF power: 10 W [0089] energy per pulse: 50 mJ

[0090] In general, the space between the pulses can vary between 0.01 and 5 mm and preferably between 0.1 and 3 mm. The laser power can vary between 0.5 and 70 W, preferably between 2 and 50 W and more preferably between 10 and 40 W. The power of the radio frequency field can be comprised between 0.1 and 30 W, preferably between 1 and 20 W and more preferably between 4 and 18 W. Lastly, the energy per pulse of the laser beam can be comprised between 1 mJ and 200 mJ, preferably between 10 mJ and 100 mJ and more preferably between 20 mJ and 100 mJ. It should be understood that the data indicated above are given exclusively by way of non limiting example and that it is possible to use also data outside these intervals. Furthermore, also intermediate intervals between that indicated are comprised in the present description, being understood that the present description relates to any intermediate value and to any intermediate interval between the indicated values.

[0091] While specific embodiments of the invention have been shown and described in detail to illustrate the application of the principles of the invention, it will be understood that the invention may be embodied otherwise without departing from such principles.