NON-INVASIVE AND OPTIMIZED SYSTEM FOR THE REJUVENATION AND REMOVAL OF WRINKLES OF THE SKIN

Abstract

The invention relates to a system and method for the removal of wrinkles and/or provide the rejuvenation of the human skin by use of ultrasound. The method comprises determining a 3D image of a region of the skin using ultrasound, determining a focal depth of the ultrasonic beam for different locations of the skin based on the 3D image, performing the treatment by heating the skin at different locations using an ultrasonic beam, and adjusting the focal depth of the ultrasonic beam according to the determined focal depths during the process of heating the skin at different locations.

Claims

1. A system for treating wrinkles and rejuvenating skin on a human body, the system comprising a diagnostic component and a therapeutic component, an ultrasound probe, wherein the diagnostic component and the therapeutic component are connected to the ultrasound probe for diagnosis and therapy, a processor, and a memory, the processor running a program stored in the memory causing the system to perform the following steps: obtaining an image of a depth of the skin in a region of interest on the skin using the diagnostic component; and at each target point of a plurality of target points in the region of interest, determining how many ultrasound therapy foci to apply and the depths of each of the ultrasound therapy foci based on the image, and applying the ultrasound therapy foci at each of the depths using the therapeutic component.

2. The system of claim 1, wherein the ultrasound probe comprises one of: i) a single ultrasound transducer or transducer array that is used by both the diagnostic component and the therapeutic component; ii) separate transducers or transducer arrays used respectively for the diagnostic component and the therapeutic component, and angled so that diagnostic beams and therapeutic beams overlap in the skin; and iii) separate transducers or transducer arrays used respectively for the diagnostic component and the therapeutic component, the separate transducers or transducer arrays being mounted in an acoustic stack or an annular structure so that a diagnostic beam axis and a therapeutic beam axis overlap.

3. The system of claim 2, wherein the ultrasound probe transmits diagnostic ultrasound at a diagnostic frequency (DF) and therapeutic ultrasound at a therapeutic frequency (TF), wherein DF1.5.Math.TF.

4. The system of claim 1, wherein the processor running the program causes the system to further perform the steps: determining whether a skin thickness at the each target point is greater than a predetermined minimum thickness based on the image; if the skin thickness at the each target point is greater than a predetermined defined minimum thickness, then performing the steps of determining and applying at the each target point; and if the skin thickness at the each target point is not greater than a predetermined minimum thickness, then not performing the steps of determining and applying at the each target point.

5. The system of claim 1, wherein the processor running the program causes the system to further perform, during the step of applying, measuring variations in a tissue parameter at the location of the each of the ultrasound therapy foci using the diagnostic component, and ceasing the step of applying of the each of the ultrasound therapy foci when the variations in tissue parameter meet a predetermined value.

6. The system of claim 1, wherein the image is a 3D image of the depth in the region of interest.

7. The system of claim 1, wherein the image is a 2D image of the depth obtained along a line in the region of interest.

8. The system of claim 7, wherein the processor running the program further causes the system to move the transducer in a direction orthogonal to the line and repeat the steps of obtaining along additional lines to obtain a plurality of 2D images that are combinable to form a 3D image of the region of interest.

9. The system of claim 8, wherein the steps of determining and applying are performed for each of the additional lines.

10. The system of claim 8, wherein the steps of determining and applying are performed for each of the 2D images before a successive one of the 2D images is obtained.

11. The system of claim 8, wherein the transducer moves within the probe in the direction orthogonal to the line to obtain the plurality of 2D images.

12. The system of claim 7, wherein the transducer moves within the probe in the direction orthogonal to the line to obtain a plurality of 2D images.

13. The system of claim 8, further comprising a robotic arm on which the probe is mounted, the robotic arm capable of positioning and orienting the probe, the robotic arm moves the transducer in the direction orthogonal to the line to obtain the 3D image.

14. The system of claim 1, further comprising a holding fixture on which the probe is mounted, the holding fixture capable of maintaining the probe at a fixed position for at least one of obtaining the image and applying the ultrasound therapy foci in a locked position and manually adjustable to change an orientation or position of the probe in an unlocked position.

15. The system of claim 1, further comprising a robotic arm on which the probe is mounted, the robotic arm capable of positioning and orienting the probe, wherein the robotic arm moves the transducer for at least one of obtaining the image and applying the ultrasound therapy foci.

16. The system of claim 1, wherein the diagnostic component is used during the step of applying the ultrasound therapy foci to correct for body movements.

17. The system of claim 5, wherein the variations in the tissue parameter include changes in an elastic stiffness of the tissue.

18. The system of claim 5, wherein the variations in the tissue parameter include changes in an optical property of the tissue.

19. The system of claim 17, wherein the elastic stiffness is measured using an acoustic radiation force (ARF) mode of the diagnostic component to displace the skin.

20. The system of claim 1, wherein the probe includes an acoustic standoff providing acoustic contact to a region of a multi-curved skin surface with low absorption so that a high ultrasound intensity is obtained in a subcutaneous focus region.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0137] In the drawings,

[0138] FIG. 1 is a cross-sectional view of human skin;

[0139] FIG. 2 is a cross-sectional view of human skin showing a prior art ultrasound probe;

[0140] FIG. 3 is perspective view of a human face and a side sectional view showing line placement and location of Trigeminal nerve;

[0141] FIG. 4 shows a chair and robotic arm according to an embodiment of the present invention;

[0142] FIG. 5 is a perspective view of a computer simulation of a face mapping a Region of Interest according to an embodiment of the present invention;

[0143] FIG. 6a shows various transducer array shapes that can be used according to the present invention;

[0144] FIG. 6b is a diagrammatic view showing a transducer according to the present invention;

[0145] FIG. 6c shows schematic diagrams depicting various embodiments of the transducer according to the present invention;

[0146] FIG. 7 shows a simulation of the heat deposition in the tissue according to an embodiment of the present invention;

[0147] FIG. 8 shows a simulation of the heat deposition in the tissue according to another embodiment of the present invention;

[0148] FIG. 9 is a schematic block diagram of an embodiment of the system of the present invention; and

[0149] FIG. 10 is a schematic diagram showing the locations of therapy foci (energy deposits) according to an embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

[0150] A patient is typically placed in a relaxed and fixed position in a chair or on a bench, related to (rejuvenation) treatment. The face and neck are supported, enabling the head and upper torso to stay in a fixed position for a defined duration of time. As an example, FIG. 4 describes a chair with an adjacent fixture or robotic arm which can support diagnostic and therapeutic units. The fixture or robotic arm and/or the diagnostic and/or therapeutic unit(s) can be fitted with positions sensor(s).

[0151] In other treatment modi, like the treatment of diseases like thrombi or cancers, the patient can favorably be placed in a bed or in other positions. (Approximate) real time treatment is a preferred modus operandi, but recording of and/or the analysis or definition(s) of ROI*s can be performed before the actual treatment or application or deposit of energy, with or without the application of drugs.

[0152] One or several regions of interest (ROI) is/are defined on the skin to be treated. The ROI can be drawn by a digital pen, accompanied by one or several reference points and/or other positioning devices. Preferably, the digital pen leaves a visual marking on the skin.

[0153] A computer (and/or PU) calculates the surface x, y, z contour of the defined ROI. A diagnostic device is utilized. The diagnostic device can be represented by combinations of digital or analogous diagnostic imaging devices like X-ray, Computer Tomography, Magnetic Resonance Imaging, Positron Emission Tomography, ultrasound imaging and the like. Stereometric coordinates to one or several of the various skin layers, from the epidermis to muscle tissues or beyond, including the SMAS layer, are recorded with the use of the diagnostic device, and analyzed and mapped by a PU, and subsequent skin volumes x, y, z contour(s) are established and labeled ROI*. The stereometric coordinates of the (multiple) ROI*(n), n=1, 2, 3 . . . are established by a PU with encompassing algorithms and software. FIG. 5 indicates the mapping of a surface contour. In combination with a diagnostic unit, a PU calculates stereometric coordinates of a skin volume.

[0154] In embodiments the diagnostic unit(s) and the energy unit(s) are combined into one device mounted on a fixture. In preferred embodiments the diagnostic and therapeutic units are represented by at least one ultrasound array.

[0155] The skin type and/or parameters of certain tissues or any treatment parameters can be exogenously stated. Exogenous is defined by factors which are caused, stated, produced or synthesized outside the organism or system under consideration. The ROI* can be located deep into a human or animal body representing thrombi, cysts, tumors, can be represented by fat tissues or the like. Interleaved imaging beams between therapy beams can be provided by diagnostic and/or therapeutic energy units to correct for potential body movements.

[0156] FIG. 6a outlines array shapes, dependent on where they are to be applied. Minor arc shaped arrays or transducers can be applied around the eyes or the mouth. Larger elliptically shaped arrays or transducers can be applied on the cheeks. A gel padding can be an integral part of the array, to provide added acoustic contact. An additional layer of gel can be applied between the gel padding and the skin.

[0157] The arrays and elements can be of a general type, for example annular arrays, phased or switched arrays, matrix arrays, linear arrays with division in both azimuth and elevation direction.

[0158] FIG. 6b outlines an example of a combined therapeutic and imaging transducer. The numbers stated on the figure represent, but are not limited to, the following; [0159] 601Transducer aperture. Radiating surface. Therapeutic and Imaging. Imaging and therapy transducers are either further divided into two areas or stacked. [0160] 602Transducer baffle. [0161] 603Transducer backing. Non-active area. [0162] 604Gel-membrane. In contact with the skin. [0163] 605Gel-filled volume allowing direct contact to ROI.

[0164] FIG. 6c shows four other arrangements of the diagnostic and therapeutic transducers. The transducers are mounted in a fluid-filled compartment (610) with front dome material (611) that is in acoustic contact with the skin surface, according to known methods. The retraction of the transducer from the dome simplifies the design of high power transducers with low f-number focusing that gives a short (Re Eq. (1)) and narrow beam focus, both for diagnosis and therapy, according to known methods.

[0165] The Figure shows from top to bottom 4 attractive arrangements, where the left column figure sets show a cross section of the fluid filled compartments, the diagnostic, and the therapeutic arrays, while the right column figure sets show the diagnostic and therapeutic arrays seen from above. For illustration purpose linear arrays are shown, while it is clear to anyone skilled in the art that other types of transducers, such as single element transducers, annular arrays, curved linear arrays, phased arrays, 1.5 D arrays, 1.75 D arrays, and matrix arrays can be used, all known to anyone skilled in the art. For simplicity we shall refer to all forms of arrays as the transducer, which is a common term for a device that converts between acoustic and electric energies.

[0166] In the upper arrangement, the same transducer (612) is used both for diagnosis and therapy. Ultrasound transducers are band-limited, and this solution restricts the difference between the frequencies for diagnosis and therapy that can be used. There are also different restrictions in the optimization of the transducers for wide band imaging and high-power therapy, which in total produces a less than optimal performance with this solution.

[0167] The 2.sup.nd upper arrangement shows a different transducer for diagnosis (613) and therapy (614) mounted side by side, and angled so that the beams overlap in the skin region (615). In the 3.sup.rd arrangement from above, two therapeutic arrays (614) are mounted on each side of the diagnostic array (613). In the bottom arrangement, the diagnostic array (613) is stacked in front of the therapeutic array (614) with an acoustic isolation section between. Such a solutions described in U.S. Pat. No. 7,727,156 and U.S. Pat. No. 8,182,428 patents.

[0168] The advantage of the three lower arrangements is that the diagnostic and therapeutic arrays can be separately optimized both for frequency, aperture/focus, bandwidth and power, for optimal imaging and therapy. It is generally an advantage to use a higher diagnostic frequency (DF) than the therapeutic frequency (TF). If the same transducer is used for diagnosis and therapy as in the upper arrangement of FIG. 6c, the limited bandwidth allows DF/TF1.5. However, when separate diagnostic and therapeutic arrays are used as in the three lower arrangements of FIG. 6c, one has a larger freedom in selecting DF and TF up to say DF/TF5, where other practical concerns might force the ration down to DF/TF2. The weakness with the 2.sup.nd and 3.sup.rd upper arrangements in FIG. 6c, is that the angling of beams provides god beam overlap in a limited depth range. Two therapeutic arrays on each side of the diagnostic array in the 3.sup.rd upper arrangement provides a narrow main-lobe of the therapeutic beam, with increased side-lobes. Solution of stacked diagnostic and therapeutic arrays in the lowest arrangement provides for optimizing both frequency, aperture/focus, bandwidth and power, with a common beam axis (616) for both imaging and therapy.

[0169] Separate diagnostic and therapeutic arrays can also be obtained by an annular structure, where for example the outer elements are used for the therapy and the inner elements are used for the diagnosis. This allows separate optimization of the therapeutic and diagnostic frequencies for different frequencies and apertures with the same beam axis. One should know that a ring structure gives an increase in side-lobe level for the outer array, albeit with a narrow main lobe. A layered structure of the therapeutic and diagnostic arrays as in the lower panel of FIG. 6c, can also be used with annular arrays, with the same advantages as for the linear arrays.

[0170] A fixture, holder or a robotic arm can be mounted on the (right) side of the device. Distance to the body can be measured by combinations of pressure gradients within the gel-volume (605) and ultrasound imaging (601).

[0171] The beam can be steered electronically from the aperture (601), also in combination with mechanical movement of the aperture. A square aperture (601) can be electronically controlled in three dimensions (elevation, azimuth and depth). Alternatively, also in combination with mechanical movements, the transducer (601) can be moved mechanically by (601) or (601), (602) and (603). The invention provides a sub system or energy transmitter(s) to deposit energy and/or inducing hyperthermia within defined regions of the skin, comprising an energy transmitter having a fixed or variable intensity and/or variable frequencies; and a control unit arranged to control the energy transmitter. The control unit can be a PU.

[0172] It will be noted that several different heat sources could be used within this capacity of the invention. In some embodiments, the energy transmitter comprises an electromagnetic energy transmitter. By applying this energy source, it can in some instances be desirable to use frequencies up to terahertz regions, preferably the electromagnetic energy transmitter is arranged to operate in frequencies between 100 MHz and 10 THz.

[0173] Preferably the energy transmitter comprises an ultrasound transmitter. The ultrasound transmitter may be combinations of single transducers, an array of transducers or a phase array of transducers. Single transducers may be focused by shaping the transducer. Arrays of transducers allow beam forming and focusing techniques to be used, e.g. for electronically steered the targeting of a defined ROI*. Preferably, the therapeutic component comprises a HIFU transmitter, more preferably with electronically steered focus depth and direction.

[0174] In preferred embodiments, the ultrasound transmitter is arranged to operate with a center frequency in the range of 0.3 to 100 MHz. Various frequencies can be used for different purposes.

[0175] In alternative embodiments, multiband ultrasound transducers can be used. Such transducers can be driven in either of two or more different frequency bands and can provide a greater separation between the frequencies used in the two modes of operation.

[0176] In other embodiments where ultrasound is used, the ultrasound unit can be used to monitor temperature, either directly or indirectly (calculated based on changers in physical parameters).

[0177] The energy transmitting unit can be placed on a fixture or a robotic arm which can be manually and/or automatically controlled with the use of electronic, hydraulic and/or pneumatic means. In embodiments a robotically controlled arm with an energy transmitting device are controlled and guided, where data are processed by a PU with algorithms and subsequent software, to the desired locations where energy is/are to be deposited into the entire (multiple) ROI*s. The control unit, PU with algorithms and software, can deposit energy according to predetermined treatment programs or the actual treatment procedure, layout or design is manually or ad hoc defined for the treatment of the patient in question.

[0178] In most preferred embodiments, a combined ultrasound probe for imaging and treatment is located on a mechanical and/or electronically controlled robotic arm. The array for treatment operates in the 0.02 MHz to 250 MHz range, preferably in the 5 MHz to 75 MHz range. To induce cavitation to liquefy or destroy fat tissue in lip sculpturing applications, frequencies in the 20 kHz to 2 MHz are preferred. The phase array for imaging (diagnostic) operates in the 0.5 MHz to 3 GHz range, preferably in the 10 MHz to 100 MHz range.

[0179] An area of interest (ROI) is defined (mapped or drawn) on the patient (FIG. 5). The PU calculated a volume of interest (ROI*) based on input (thickness and structure of the skin or tissues in question) from the diagnostic or imaging unit, and from the mapping device and software, represented by an analog or digital placed device (pen), which is moved over the skin. The CPU will map the volume of interest (ROI*) by defining a mathematical mesh or defining digitally finite numbers of points or coordinates covering the ROI*. The coordinates can be 0.01 mm, 0.1 mm, 0.5 mm or other distances apart in the x, y, z directions.

[0180] The transducer(s) [phase array] for treatment can, guided by the PU and algorithms, provide energy in a predetermined mode, at e.g. two locations within the dermis layer of the skin, at a z distance of e.g. 1 mm apart, and at one location within the SMAS layer.

[0181] FIG. 10 indicates the lines of treatment in the x-y and x-z planers and target points.

[0182] Each x-y location to be treated can be spaced (e.g.) 1 mm apart. When one line of treatment is completed, the PU will space (e.g.) 1 mm to the next line of treatment. It is possible to manually define the spacing between each treatment or target point, between each treatment line, the spacing or location between each point or volume to deposit energy, which are labelled therapy foci in FIG. 10 (in the x-z direction).

[0183] Generally, the energy source and/or therapeutic transducer(s) with variable focal depth and/or focal range (length), can endogenously or exogenously deposit heat at variable deposit points (therapy foci) or volumes (focal range) within tissues. Focal depth is the distance to from the active surface of the transducer(s) or the energy unit(s) to the center of the heat point (therapy foci). Focal range is the beam axis length. A display unit can in real time display the treatment in combinations of x-y, x-z, y-z planes and other cross-sectional directions. The PU will electronically move treatment from one treatment line to the next until the whole regionROI or total volume ROI* is treated.

[0184] The pattern of applying the energy deposits, can be squares, circles or any other geometric shape. The PU will by the use of quasi-static, transient, harmonic methods or others, apply energy until changes in elasticity properties are recorded to be in consistent with a temperature increase of approximately 65 degrees C., or lower or higher, if desired, or any other predetermined elasticity property value is achieved.

[0185] In an ablation mode of application, the temperature (increase) would normally be (up to) approx. 80 degrees C.

[0186] The system will automatically treat the entire ROI*.

[0187] Energy, ultrasound based, light, RF, can be combined with drugs; sonosensitizers or others, to treat wrinkles, to cause rejuvenation, and to treat diseases (acne, cysts, cancers, thrombi).

[0188] FIG. 9 shows a system according to the invention.

[0189] The system comprises a processing unit (PU), (901), that runs programs for steering the diagnostic and therapeutic processes. The PU takes user inputs from the user interface unit (902), for example from manual definition of therapeutic regions of interest (ROI), for example using a digital pen, or other user information such as specification of distance between target points, minimal thickness of dermis to be treated, etc. Based on this information, the PU steers the diagnostic (903) and the therapeutic (904) units that both connects to the ultrasound probe (905) for transmission and reception of diagnostic and therapeutic ultrasound signals from the probe into the patient skin (906). The ultrasound probe comprises at least one ultrasound transducer for transmission/reception of diagnostic and therapeutic ultrasound to the patient. The probe may in alternative embodiments also include an optical measurement system that senses optical tissue changes during treatment in a target point. The ultrasound transducer can be composed of a single element, and array of elements according to known methods, and as discussed in relation to FIG. 6c, and we shall in the following use the term transducer for all forms of conversion between electric and acoustic energies. In a preferred embodiment, separate transducers are used for diagnosis and therapy at different frequencies, as described in relation to FIG. 6c. In a preferred embodiment the transducer(s) are mounted in a fluid filled chamber of the probe retracted a distance from an acoustic layer (dome) that is in acoustic contact with the patient, according to known methods. The retraction of the transducer simplifies the design of high power transducers with low f-numbers that gives a short (Re Eq. (1)) and narrow beam focus, both for diagnosis and therapy, according to known methods.

[0190] In a simplest embodiment, the transducer is able to scan both the diagnostic and therapy foci along a line for 2D images of the skin with depth and perform therapy along an azimuth line (direction) of the skin surface. Mounting the transducer in a fluid filed chamber allows the use of single element or annular array transducers that require mechanical movement along the azimuth direction, according to known methods.

[0191] To form therapy across an area of the skin surface, the probe can for example be moved manually in an elevation direction normal to the azimuth line, or this movement can be done by a robotic arm as discussed below.

[0192] Placing the transducer in a fluid-filled chamber also allows lateral motion of the transducer in the elevation direction for scanning the diagnostic and therapeutic beams across a surface area of the skin for 3D imaging, where the probe contact to the skin is stationary. This is also the case for single element and annular array transducers that require mechanical movement of the array both for scanning in an azimuth direction along a line, and the elevation direction to scan the beam across a surface area.

[0193] The PU also connects to a display unit (907) to give inputs to the user, for example ultrasound images of the skin produced by the diagnostic unit, state parameters of the system and its operation, results of image analysis, etc.

[0194] Utilizing the user inputs, the PU at least

i) sets the system to acquire images with depth(z) of the skin, either in a 2D manner with scanning the diagnostic beam along an azimuth line (x) across the skin, or a 3D manner with additional scanning the diagnostic beam in an elevation direction (y) across a skin surface (x-y), and
ii) analyses the images to determine the dermis thickness in actual target points of treatment, and
iii) if the dermis thickness is above a set limit in a target point, the PU sets the system to transmit therapy beams in said target point, decides iiia) how many therapy foci and depths to be used in each target point and therapeutic power and maximum therapeutic time in each target point.

[0195] The PU also has the ability to

i) set the diagnostic unit to a mode to detect elastic changes in a treatment focus at intervals during the therapeutic transmission to set treatment focus, and cease the therapy transmission in said treatment focus when elastic changes reaches a limit, or
ii) utilize said optical system to observe optical changes in the treatment focus and cease the therapy transmission in said treatment focus when optical changes reach a limit.

[0196] For a more advanced embodiment, the ultrasound probe can be connected to a fixture (908), as exemplified in FIG. 4. The fixture can be locked and unlocked by the operator. In an unlocked state of the fixture, the probe can be moved by the operator to a desired position on the skin. Locking the fixture for this position of the probe, the fixture will keep the probe on the same position on the skin, as long as the patient does not move. To handle movement of the patient, motors can be added to the joint of the fixture so that it becomes a robotic arm that is able to follow movements of the patient. The robotic arm can also move the probe across the skin for treating a larger region of the skin, also with for example a probe that provides scanning of the diagnostic and therapy beams across a skin surface.

[0197] Endogenous effects and/or variables are caused by factors produced, established or synthesized within an organism or system.

[0198] In an additional embodiment a system and the use of such system, for the treatment of wrinkles and other diseases cause the removal of or provide the liquefying of fat tissues due to cavitation (lipo sculpturing) or causing the rejuvenation of the skin, within the human skin, comprising at least one diagnostic unit, at least one energy source, at least one central processing unit, wherein the system is characterized by: [0199] in real time, [0200] measurements of tissue area and depths and the 2D or 3D mapping of tissues constituting regions of interest.

[0201] The algorithms and/or computer (PU) can further provide; [0202] endogenously generated variable focal depths of therapeutic or diagnostic ultrasound probes, [0203] (ultrasound transmitters for providing ultrasound therapy beams with steerable direction and focus depth across a selected therapy-region of said image-region), [0204] endogenously generated measurements of variations in elasticity parameters of tissues between the surface of the skin and throughout the region of interest, [0205] endogenously generated application and the location of energy or heat deposit points or volumes within the region(s) of interest, [0206] cease the energy transmissions and/or heat deposits according to variations in elasticity parameters within or outside the regions of interest.

[0207] The system is further enabling to; [0208] the energy source and/or therapeutic transducer(s), with variable focal depth and/or focal range (length), can endogenously or exogenously deposit heat at variable selectable deposit points or volumes (focal range) within tissues. [0209] Interleaved imaging beams between therapeutic beams can be provided by diagnostic and/or therapeutic energy units to correct for potential body movements.

[0210] The system is further enabling to; [0211] to directly or implicitly measure temperature changes in tissues and/or to provide adequate energy deposits data within the region of interest, [0212] comprising one of the detection of cavitation or drug dosage supply and/or control within the region(s) of interest,

[0213] The system is further enabling to and/or comprising at least one of; [0214] an ultrasound probe for transmitting and receiving imaging beams and transmitting therapy beams for a region of a skin surface, [0215] ultrasound transmitters and receivers for providing a 2D or 3D ultrasound image of an image region of a skin surface,
ultrasound transmitters for providing ultrasound therapy beams with steerable direction and focus depth across a selected therapy-region of said image-region, [0216] steering said ultrasound transmitters and receivers to generate 3D ultrasound images of the image region of the skin surface and transmitting therapy beams across a selected therapy region,

[0217] The system is further enabling to and/or comprising at least one of; [0218] analyzing the 3D images of said skin surface to determine depth of skin in said region, [0219] select said therapy-region and therapy beam directions within said therapy-region, [0220] select therapy beam focus for each therapy beam direction, and select transmit aperture of each said therapy beam directions, [0221] select the transmit frequency of each said therapy beam directions, determine a transmit intensity of each therapy beams, [0222] select a maximal transmit time for each therapy beam directions, [0223] setting up said therapy beams in an acoustic radiation force (ARF) mode to push the skin surface while measuring the skin displacement with imaging beams to monitor displacement of the skin to monitor changes in elastic stiffness of the skin, [0224] using changes in the measured elastic stiffness for each therapy beam direction as a measure to decide to stop the therapy beam transmission in said therapy beam direction,

[0225] The system is further enabling to and/or comprising at least one of; [0226] where said ultrasound probe comprises a soft acoustic standoff with that provides acoustic contact to a region of a multi-curved skin-surface and with low absorption so that a high ultrasound intensity is obtain in the sub-cutaneous focus that provides a high degree of nonlinear distortion that reduces the axial extension of the region of high heating in the therapy beam focus,

[0227] The system is further enabling to and/or comprising at least one of; [0228] where a set of therapy beams are directed with crossing directions and so that the foci of the individual beams overlaps to reduce the region of high intensity with high distortion of the ultrasound oscillation to reduce the region of high intensity acoustic heating.

[0229] System and/or method for cosmetic treatment of a region of skin (of a human) by use of ultrasound, representing combinations of;

[0230] Thickness measurements of various tissue layers, energy deposits and the application of ultrasound frequencies above 5 MHz. [0231] E1. A method for cosmetic treatment of a region of skin (of a human) by use of ultrasound, the method comprises: [0232] using ultrasound therapy beams radiated onto a selected therapy region of the skin, and [0233] estimating for each therapy beam direction the depth of skin tissue structures based on ultrasound measurement of skin tissue structures in selected 1st beam positions, an [0234] from the estimate of the skin structures, determining at least one set of transmit parameters for at least one therapy beam, where said transmit parameters comprises at least one of i) a transmit focus, ii) a transmit frequency, iii) a transmit pulse amplitude, iv) a transmit pulse length, v) a transmit pulse repetition frequency, vi) a treatment beam transmit duration, and [0235] setting up said transmit parameters for said at least one therapy beam and scanning therapy beams across the region of the skin to be treated. [0236] E2. A method according to E1, combining said measuring of the skin thickness and skin composition with apriori information about the individual and the skin for determining at least one set of parameters for at least one therapy beam. [0237] E3. A method according to E1, measuring beam parameters for each transmit beam position, or a group of transmit beam positions. [0238] E4. A method according to E1, at least two transmit foci of the therapy beams [0239] E5. A method according to E1, scanning 1st measurement beams across a skin region to determine treatment region and treatment parameters for treatment beams, before start of treatment for said treatment region. [0240] E6. A method according to E5, interrupting transmissions for at least one treatment beam with 2ndtype measurement beams to determine at least one of i) temperature and ii) degree of ablation (coagulation) of the skin region under treatment, to determine end of treatment for said treatment beams. [0241] E7. A method according to E6, using infrared methods to determine end of transmission for the treatment beams.

[0242] Method or system according to all previous claims in combination with optical temperature detection measures.

[0243] This invention covers the use of systems described herein. The system can operate in real or approximate real time.

[0244] The present invention is not limited to the described apparatus, system or algorithms, thus all devices and the use thereof that are functionally equivalent are included by the scope of the invention. Modifications of the patent claims are within the scope of the invention.

[0245] Drawings and figures are to be interpreted illustratively and not in a limiting context. It is further presupposed that all the claims shall be interpreted to cover all generic and specific characteristics of the invention which are described, and that all aspects related to the invention, no matter the specific use of language, shall be included. Thus, the stated references have to be interpreted to be included as part of this invention's basis, methodology, mode of operation and apparatus or system.