An Rf energy applicator with a working end that carries a bi-polar Rf electrode system for creating a Rf-tissue interaction or ionothermal effect in subsurface tissue (a first ionothermal system) which effect is focused by concurrent actuation of a photonic tissue-sensitizing system or photoconductance system (a second ionothermal system). The photonic energy system is adapted to create a "lens electrode" in subsurface tissue that enhances the targeted tissue's conductance of Rf current which serves as a means of focusing Rf ionothermal effects at a subsurface level. A dosimetry control system is provided that controls the dose and timing of Rf energy delivery as well as the dosimetry of photonic energy delivery. The ionothermal applicator has a handle portion coupled a tubular extending member. The distal termination of the probe has at least one pair of opposing conductive electrodes in a spaced relationship around a perimeter of the distal termination of the extending member. A remote Rf source (or generator) is connected to the device for delivering bi-polar Rf energy to the paired electrodes. An optical fiber (or fiber optic bundle) is provided in a central channel of the extending member which is capable of delivering a photonic (light) beam from a light source, such as a pulsed laser (or continuous wave (CW) diode laser).

The present invention provides a method for strengthening collagen in collagenous tissue which uses the controlled application of heat to induce shrinkage or contraction of the collagen in the tissue and a cross-linking means which cross-links the shrunken collagen in the tissue thereby stabilizing and strengthening collagenous tissue. In particular, the present invention provides an in vivo method for treating joint instability problems, controlled manipulation of skin structure and properties, and other problems involving collagen-containing tissues. The present invention further provides an in vitro method for stabilizing collagenous tissue for use in vivo or in vitro. Further, the present invention provides a method for treating collagenous tissue and testing the strength and stability of the treated tissue.

A method and apparatus for treating skin includes applying pulsed light to the skin to heat and shrinking collagen within the skin, thereby reviving the elasticity of the collagen and of the skin. The epidermis and outer layers of the skin may be protected by cooling with a transparent substance, such as ice or gel, to the skin. The temperature distribution within the skin is controlled by controlling the delay between the time the coolant is applied, and the time the light is applied, by controlling the pulse duration and applying multiple pulses, and by filtering the light and controlling the radiation spectrum, preferably, the spectrum includes light having a wavelength in the range of 600-1200 nm. The pulsed light may be incoherent, such as that produced by a flashlamp, or coherent, such as that produced by a Nd(Yag) laser or a ruby laser, and may be directed to the skin using a flexible or rigid light guide. Also, a method and apparatus for cutaneous resurfacing including directing Er:YAG laser light to the skin. The light may be pulsed, preferably with a delay of about 0.5-10 msec between pulses. In one embodiment the pulses have energy fluences of preferably about 100 J/cm.sup.2.

A method and apparatus that will alter the fibrous strands in the fatty layers of the skin to reduce the appearance of cellulite. Electromagnetic energy is used to selectively shrink or alternatively loosen the collagen in the constricting bands of connective tissue that causes the dimpled appearance of cellulite while avoiding damage to the surrounding fatty cells.

Radiation is delivered to a wound in a series of sufficiently short pulses, with adequate cooling between individual pulses, to produce cumulative thermal denaturation and welding of the skin edges at the immediate area of the wound site, while avoiding unnecessary thermal damage to surrounding healthy tissue.