1 . type “ a ” skin resurfacing system . referring to fig2 - 3 , an exemplary instrument system 5 is shown for removing superficial skin layers . the instrument system 5 includes : ( i ) a hand - held body 18 with a working end 20 that defines a skin interface surface portion indicated at 25 in fig2 - 3 . an opening portion 26 transitions into an interior passageway 28 that extends through the body to communicate with a negative (−) pressure source ( or aspiration source ) indicated at 30 that operates as vacuum means for aspirating skin debris from a targeted skin surface treatment site ts . of particular interest , fig3 - 4 show views of the working end 20 with the skin interface 25 being configured with a particular irregular or ridged surface structure indicated at 32 . the ridged surface structure 32 further has a particular minimum width dimension w to accommodate from the ridge shape with as many as about 25 ridges on each side of opening 26 depending on the overall dimensions of the working end 20 . more particular aspects of the irregular or ridged surface structure 32 will be described below . in this preferred embodiment , the working end 20 is of any suitable material , such as a transparent medical grade plastic . the transparency of the working end will assist the operator in localizing treatment in a particular targeted skin treatment area . the overall transverse dimension of the working end 20 of fig2 - 3 may be from around about 5 . 0 mm . to about 50 . 0 mm . with a larger dimensioned end being adapted for treating a larger skin area ( e . g ., arms , back legs and decolletage ). a typical dimension is from about 5 . 0 mm . to 15 . 0 mm . for a skin treatment site area ts around a patient &# 39 ; s face . the invention allows the area ( e . g ., in mm . 2 ) of opening 26 be in any selected shape but preferably is an elongate shape in the center of the working end 25 . the open distal end 26 comprises the distal termination of passageway 28 and the proximal end of the passageway in handle 18 is connected to a flexible aspiration tube 33 that extends to a remote collection reservoir 35 intermediate to the actual aspiration source 30 . the aspiration source 30 thus is adapted to draw the working end 20 and more particularly the skin interface 25 against the skin treatment site ts to perform the method of the invention as will be described below . the aspiration source or negative (−) pressurization source 30 may be any suitable vacuum source known in the art . between the aspiration source 30 and remote collection reservoir 35 may be a filter 38 subsystem that is known in the art for collecting aspirated skin detritus and spent crystalline agents ca that are captured in the open distal end of passageway chamber 28 . the collection reservoir 35 and filter 38 are preferably of inexpensive plastic and other materials that are disposable . the aspiration source 30 may be provided with an adjustable valve means 40 for adjusting the pressure level setting to any suitable range . the physician will learn from experience how to balance the pressure level to attain the desired level of suction against the patient &# 39 ; s skin . a trigger or switch component 42 is provided as a foot - switch ( fig2 ) but any suitable finger switch in the body 18 also may be used . the working end 20 also carries means for introducing abrasive crystals into the working end or distalmost end of passageway 28 to allow individual loose crystalline agents ca to thereafter be captured between the skin interface 25 and the patient &# 39 ; s skin . in this embodiment , two channels 44 a - 44 b are provided together with flexible tubes 46 a - 46 b to introduce the loose crystalline agents ca into the working end ( see fig2 - 4 ). each distal portion 47 ( collectively ) of the channels 44 a - 44 b may comprise a small dimension aperture to limit the rate of flow of crystalline agents ca into the working end . the number of such channels ( i . e ., 44 a - 44 n ) may range from one to about ten and fall within the scope of the invention . any singular or plural number of channels can serve the purpose of slowly introducing crystal into the working end , referring to fig2 - 3 , the crystalline agent ca delivery source 50 comprises a reservoir 55 that holds a suitable volume of abrasive crystals for a single treatment or a number of treatments . a flexible supply tube 56 extends between a remote the reservoir 55 , and in this embodiment the tube is split to connect to the two channels 44 a - 44 b . preferably , the remote reservoir 55 that carries the crystalline agent ca is unpressurized but carries air intake relief valve 58 such that any slight negative pressure created by the aspiration source 30 when the skin interface is in contact with a patient &# 39 ; s skin will draw crystals to the working end . it should be appreciated that reservoir 55 may be built into handle body 18 and fall within the scope of the invention . the crystal delivery source 50 may carry crystals ranging in size from about 1 μm to about 50 μm in maximum cross - sectional dimension , ( for example , aluminum oxide crystals ). preferably , the crystals are from about 5 μm to about 30 μm in maximum cross - sectional dimension to allow a very fine abrasion of the epidermis . it has been found that by a slight negative pressure environment the open end 26 and passageway 28 , the crystalline agent will be caused to dribble into , or be sucked into , the passageway 28 in the working end 20 . thereafter , the movement of the working end 20 in a sideways movement over the skin causes a portion of the crystalline agent ca volume to be captured temporarily in the irregular or corrugated surface structure of the skin interface 25 . in this process of moving the skin interface 25 over the targeted treatment site ts , it has been found that the sharp - edged crystalline agents are rolled over and over while being pressed into the surface of the skin and thereby abrade and remove the skin surface in a controllably gentle manner that is below any threshold of significant pain . after the spent crystals are rolled over and over by the skin interface when moving in a first lateral direction across the skin , and after the working end is then is reversed in directional movement across the skin , a portion of the spent crystals and abraded skin debris necessarily roll into the central opening portion 26 wherein the negative pressure environment captures and aspirates the abraded materials to the remote collection reservoir 35 . to facilitate the process described above , the invention is provided with novel aspects that relate to the irregular or ridged surface structure 32 mentioned above . the entire skin interface 25 may be of any suitable plan form ( e . g ., round , oval , rectangular etc .) and fall within the scope of the invention . more in particular , the interface 25 defines a 1 st outer periphery 25 a and a 2 nd inner periphery 25 b that generally are in apposition to one another and are spaced apart by width w with the inner periphery about the edge of opening 26 ( see fig3 ). in a preferred embodiment shown in fig3 - 4 , the concept of 1 st and 2 nd peripheries 25 a and 25 b in apposition thus comprise peripheries that are dual and side - by - side as shown in fig4 and are thus adapted for side - to - side lateral or sideways movement while performing the technique of the invention , for example which is a natural movement of a human hand over a patient &# 39 ; s skin . thus , the direction of the ridges 60 extend generally transverse relative to a line drawn that indicates the direction of movement of the working end 20 in performing the method of the invention . that is , in the exemplary working end of fig4 , the working end is generally optimized for side - to - side or lateral movement . thus , the ridge alignment is generally transverse to the direction of movement in operations indicated by arrow a . ( in a circular working end that is adapted generally for movement is any direction , the direction of the ridges 60 may be generally transverse to any direction of movement by being concentric relative to a central opening 26 ( not shown )). the terms irregular or ridged shape structure 32 as used herein mean that a series of at least one projecting edge portion 62 a projects distally as a ridge within the skin interface portion 25 . the irregular shape structure 32 further typically carries recessed portions or valley portions 62 b that are recessed in the proximal direction intermediate to any plurality of projecting edge portions 62 a . these surface configurations for convenience are herein termed the primary shape structure ( or ridge and valley elements ). the width of the skin interface 25 containing shape structure 32 may be from about 2 . 0 mm . to 25 . 0 mm . or more and preferably is from about 3 . 0 mm . to 10 . 0 mm . the number of ridges preferably are from about 1 ridge to 25 ridges on each side of the opening 26 . the height h of any ridge from the apex of the projecting portion 62 a to the depth of the valley portion 62 b may be from about 0 . 25 mm . to about 5 . 0 mm . and is preferably from about 0 . 5 mm . to about 2 . 0 m . it has been found that various ridge height dimensions are optimal depending on the patient &# 39 ; s skin type . further , but optionally , it has been found that secondary shape structure of notches or recessed grooves 66 configured across the primary shape structure of ridge and valley elements may help introduce loose crystals to regions of the skin interface 25 in contact with the skin which is desirable . such secondary grooves 66 are shown in fig4 and are preferably somewhat in alignment with an axis of channels 44 a - 44 b that introduce crystals into the working end 20 thus allowing the crystals to be suctioned into the valleys 62 b of the primary shape structure . while the series of primary ridge and valley elements together the secondary grooves seems to be optimal for the method described below , it should be appreciated that the method also may be performed with a skin interface that has ( i ) only primary ridge and valley elements ; ( ii ) or only a particular surface roughness that is appropriate for partially capturing loose crystals as will be described below - as long as the skin interface has a minimum width of about 3 . 0 mm . which was described as a preferred width dimension previously . fig4 further shows that at least some of the crests or apexes of some of the ridge portions 62 a together with the outermost periphery of the skin interface 25 define an overall tissue - receiving shape 64 that may range from flat to concave and is shown in a preferred concave configuration . the alternative shapes 64 a - 44 b are intended to indicate an approximate range of shapes that are suitable . the apexes of ridges 62 a need not all be at the same height to define shape 64 . the purpose of the concave shape is to cause the outer periphery of the working end to be in firm contact with the tissue surface while the negative pressure from aspiration source 30 draws the skin into firm contact with tissue interface 25 . 2 . practice of the method of the invention . now turning to fig5 , a sectional view of working end 20 shows the technique of the present invention in exfoliating or removing skin surface layers . fig5 shows the working end 20 after actuation of the negative (−) pressure source 30 with the skin surface 70 initially being drawn into the concave shape 64 . the operating negative pressures may be in any suitable range that is determined by investigation . it has been found by experimentation that optimal pressure levels vary greatly depending on ( i ) the type of skin targeted for treatment , ( ii ) the dimensions across the working end , and ( iii ) the dimensions of opening 26 . next , the operator moves the skin interface 25 across a treatment site ts which is a path on the patient &# 39 ; s skin while still actuating moves the trigger 42 thereby maintaining the negative pressure environment in the passageway 26 . the negative pressure environment within the working end causes crystalline particles and entrained in air to be drawn into passageway 28 proximate to the skin surface and into the shape structure 32 of the skin interface 25 . the sideways or lateral movement of the skin interface 25 captures a portion of the crystals between the interface and the skin surface , in part by over - rolling them . the continued rolling of the sharp - edged crystals trapped between the instrument and the skin surface 70 causes an abrasion and removal of the skin surface in a controllable manner . as working end is moved in a reverse direction , the negative pressure environment in the passageway 28 captures and aspirates the spent crystals and skin debris to the remote collection reservoir 35 . at the end of a particular lateral movement of the working end , the operator may release the trigger 42 which terminates the crystal agent delivery and further allows the operator to easily lift the working end from the patient &# 39 ; s skin . the treated path can be easily seen and the operator then can exfoliate another slightly overlapping or adjacent path by repeating the above steps until surface removal is completed over the targeted treatment area . 3 . type “ b ” skin resurfacing system . referring to fig6 - 9 , another exemplary instrument system and treatment device 205 is shown for removing superficial skin layers . this system differs greatly from the type “ a ” embodiment in the mechanism of action that abrades the skin since the type “ b ” system uses a fluid media plus an abrading structure on the skin interface . still several features of the type “ b ” embodiment are similar to the type “ a ” embodiment and the two modalities of treatment may be used to complement one another . fig6 shows that a hand - held instrument 208 has a removable working end 220 that defines a skin interface surface portion indicated at 225 . handle portion 227 a mates with housing 227 b . a flexible tube 228 extends to a vacuum source 230 . a fluid reservoir 235 carrying a fluid skin treatment media is housed in the handle although it could also be a remote reservoir . referring now to fig7 - 9 , a first aperture arrangement consisting of at least one port or opening portion 240 of skin interface 225 that communicates with an interior passageway 242 that extends through housing 227 b to hose 228 and the vacuum or negative (−) pressure source . fig7 - 9 further show a second aperture arrangement in the skin interface consisting of at least one port or openings 250 that extend around an outer periphery of the skin interface 225 . these opening ( s ) of the second aperture arrangement are in fluid communication with the reservoir 235 and the treatment media therein . the skin interface has a series of primary ridge elements 255 a and valley elements 255 b together the secondary notches or grooves 260 as defined above with similar dimensional parameters . this embodiment differs however in that the apexes of ridge elements 255 a are substantially a sharp edge as are the edged of the notches 260 . thus , these primary surface elements 255 a and secondary surface elements thereby define teeth therebetween that seem well suited to abrading skin layers particularly after being hydrated by the fluid source of the system . experimentation has shown that the vacuum source and fluid source may be reversed between the first and second aperture arrangements 240 and 250 with the method of skin removal still working well . the vacuum system aspirates away skin debris and spent fluids as described previously . of particular interest , the method of the invention appears to work well because the suction on the skin treatment site very quickly hydrated , or puffs up , the skin which in turn make the surface layer susceptible to painless abrasion . the ability of the system to rapidly deliver fluids to subsurface tissues allows the use of any pharmacological agent known in the art for enhancing skin rejuvenation as a part of the skin treatment . the system can use sterile water or saline solution for a treatment to remove dermal tissue with the abrasive surface of the treatment device . the system can also use a fluid carrying a chemical agent of a suitable concentration be selected from a group of acids including tca ( trichloroacetic acid ), a glycolic acid including an alphahydroxy acid ( aha ), a lactic acid , a citric acid , or phenol as disclosed in co - pending u . s . patent application ser . no . 09 / 524 , 731 filed mar . 14 , 2000 which is incorporated herein by this reference . specific features of the invention may be shown in some figures and not in others , and this is for convenience only and any feature may be combined with another in accordance with the invention . while the principles of the invention have been made clear in the exemplary embodiments , it will be obvious to those skilled in the art that modifications of the structure , arrangement , proportions , elements , and materials may be utilized in the practice of the invention , and otherwise , which are particularly adapted to specific environments and operative requirements without departing from the principles of the invention . the appended claims are intended to cover and embrace any and all such modifications , with the limits only of the true purview , spirit and scope of the invention .
an instrument and technique for the removal of epidermal layers in a controlled manner utilizing a hand - held instrument with a working end that a vacuum aspiration system , a source for delivery of a sterile fluids or pharmacological agents to the skin ; and a skin interface surface in the working end that has specially shape structure for abrading surface layers of the patient &# 39 ; s epidermis as the working end is moved over the patient &# 39 ; s skin while at the same time causing rapid penetration of the fluids into the skin for therapeutic purposes . movement of the working end across the skin causes abrasion of the surface layers in a path over the patient &# 39 ; s skin . the method of the invention may be used in a periodic treatment for the removal of superficial skin layers that enhances the synthesis of dermal collagen aggregates by inducing the body &# 39 ; s natural wound healing response . the method of the invention creates more normal dermal architectures in skin with limited depths of skin removal by the series of superficial treatments that may be comparable to the extent of neocollagenesis caused by a deep skin removal treatment .