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1. (WO2006127467) SUBDERMAL CRYOGENIC REMODELING
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WHAT IS CLAIMED IS:

1. A method for improving a cosmetic appearance of a patient, the patient having a skin surface, the method comprising inserting a probe through the skin surface and cooling a target tissue below the skin surface such that the target tissue is remodeled and the remodeling of the target tissue alters a shape of the sldn surface.

2. The method of claim 1, wherein the skin surface prior to the cooling exhibits undesired lines or wrinkles, and wherein the remodeling is performed so as to inhibit lines or wrinkles and effectively smooth the lines or wrinkles.

3. The method of claim 1, wherein the skin surface comprises a region of the face, wherein the target tissue comprises a muscle of the face, an associated nerve, an associated connective tissue, or an associated nerve/muscle junction, and wherein the cooling inhibits contraction of the muscle of the face so as to improve an appearance of the patient.

4. The method of claim 3, wherein the cooling inhibits contraction of a muscle selected from the group consisting of: frontalis pars medialis, frontalis pars lateralis, corrugator supercilii, procerus, depressor supercilii, levator palpebrae superioris, orbicularis oculi pars orbitalis, orbicularis oculi pars palpebralis, levator labii superioris alaquae nasi, levator labii superioris, zygomaticus minor, zygomaticus major, levator anguli oris, buccinator, depressor anguli oris, depressor labii inferioris, mentalis, incisivii labii superioris, incisivii labii inferioris, risorius, platysma, orbicularis oris, masseter, temporalis, internal pterygoid, digastric, nasalis, maxillae, quadratus labii superioris and inferioris.

5. The method of claim 1, further comprising inhibiting cooling-induced injury to the skin surface so as to selectively cool the target tissue.

6. The method of claim 5, wherein cooling-induced injury to the skin surface is inhibited by applying warming energy along the skin surface.

7. The method of claim 6, wherein the energy is applied along the skin surface by engaging the skin surface with an applicator of the probe and heating the skin surface with the applicator during the cooling of the target tissue.

8. The method of claim 5, wherein cooling-induced injury to the skin surface is inhibited by a cooling injury inhibiting material disposed along the skin surface during the cooling.

9. The method of claim 8, wherein the cooling injury inhibiting material comprises a heated biocompatible fluid or a biocompatible cryoprotectant.

10. The method of claim 5, wherein cooling-induced injury to the skin surface is inhibited by applying a cooling injury enhancing material to the target tissue, the cooling injury enhancing material being separated from the skin surface sufficiently that cooling of the skin surface is limited.

11. The method of claim 5, wherein cooling-induced injury to the skin surface is inhibited sufficiently to avoid permanently altering a color of the skin surface.

12. The method of claim 1 , wherein the shape of the skin surface comprises an uneven cellulite-induced texture, and wherein the remodeling smoothes the cellulite-induced texture.

13. The method of claim 1 , wherein the cooling is performed so as to induce a reduction in tissue mass after removal of the probe from the patient, the cooling-induced reduction in tissue mass providing a desired change in the shape of the skin surface.

14. The method of claim 13, wherein the target tissue comprises an adipose tissue, and wherein a healing response to the cooling decreases a mass of the adipose tissue.

15. The method of claim 13, wherein the cooling reduces muscle mass.

16. The method of claim 1 , wherein the target tissue is cooled to a temperature in a range from about 10 C to about -50 C.

17. The method of claim 1 , wherein the target tissue is cooled to a temperature in a range from about 0 C to about -15 C.

18. The method of claim 1, wherein the target tissue is cooled so as to induce apoptosis in the target tissue, and wherein the apoptosis alters the shape of the skin surface.

19. The method of claim 1 , wherein the cooling is performed so that the remodeling of the target tissue is temporary.

20. The method of claim 1 , wherein the cooling is performed so that the remodeling of the target tissue is permanent.

' 21. The method of claim 1 , further comprising selecting a duration for the remodeling effect, and wherein characteristics of the cooling are determined in response to the selected duration.

22. The method of claim 1 , further comprising inserting a plurality of tissue-penetrating probes through the skin surface with a separation between the probes such that the cooling effects the remodeling of the target tissue disposed between the probes.

23. The method of claim 1 , wherein the probe comprises an element of a subdermal cryogenic remodeling probe system, the probe system further comprising a cooling fluid supply cartridge coupled with the probe by a cooling fluid path per a controller, and further comprising limiting use of the probe system to treatment of a single patient and disposing of the probe system after treatment of the patient.

24. A method for improving a cosmetic appearance of a patient, the patient having a skin surface with a muscle therebelow, the muscle having an associated
nerve/muscle contractile chain comprising the muscle, a nerve, a connective tissue, and a nerve/muscle junction, the method comprising directing energy or cooling from a probe to a component of the nerve/muscle contractile chain such that the component is remodeled and the remodeling inhibits contraction of the muscle so as to improve the cosmetic appearance of the skin surface.

25. A method for improving a cosmetic appearance of a patient, the patient having a skin surface with a tissue therebelow, the tissue having a mass, the method comprising directing sufficient tissue-remodeling energy or cooling from a probe through the skin surface to induce a reduction in the mass of the tissue such that the cosmetic appearance of the skin surface is improved.

26. A method for treating a patient, the patient having a skin surface and a muscle therebelow, the method comprising directing sufficient tissue remodeling energy or cooling below the skin surface so that contraction of the muscle is inhibited or a loss of elasticity is induced.

27. The method of claim 26, wherein the tissue remodeling energy or cooling is applied using a cosmetic treatment system, and further comprising disposing of the treatment system after treatment of a single patient.

28. A system for cosmetically reshaping an exposed skin surface of a patient, the system comprising:
a body having at least one cooling fluid supply path;
at least one probe extending distally from the body, the at least one probe having a distal tissue-piercing end and in thermal communication with the at least one cooling fluid supply path; and
a cooling fluid source coupled to the at least one cooling fluid supply path of the body to cool the at least one probe distally of the body so as to remodel adjacent tissue when the at least one probe is inserted through the skin surface such that the skin surface is reshaped.

29. The system of claim 28, wherein the cooling fluid path and the at least one probe are configured to remodel the adjacent tissue so as to enhance an appearance of the patient, the adjacent tissue comprising adipose tissue.

30. The system of claim 28, wherein the cooling fluid path and the at least one probe are configured to remodel the adjacent tissue so as to inhibit muscle contraction, the adjacent tissue comprising nerve, muscle, connective tissue, or nerve/muscle interface.

31. The system of claim 28, further comprising a controller coupled to the cooling fluid path so as to control at least one of a treatment time or a treatment temperature.

32. The system of claim 31 , wherein the controller is configured to provide a treatment temperature of between about 10 C and -50 C.

33. The system of claim 31 , wherein the controller is configured to provide a treatment temperature of between about 0 C and -15 C.

34. The system of claim 31 , further comprising an input for identifying a desired duration of the remodeling, wherein the controller determines a cooling characteristic in response to the desired duration.

35. The system of claim 25, further comprising an array of probes extending distally from the body.

36. The system of claim 35, wherein the body has a skin engaging surface adjacent a proximal end of the probes.

37. The system of claim 36, wherein a spacing between the probes of the array is sufficiently small to cool tissues disposed therebetween.

38. The system of claim 36, wherein the probes have a cooling region distal of the skin engaging surface, a plurality of cooling fluid paths being thermally coupled to the cooling regions for selectively cooling a target tissue adjacent thereto, and further comprising an applicator proximal of the cooling regions for applying energy or a material so as to inhibit cooling-induced injury along the skin surface.

39. The system of claim 36, wherein the applicator directs sufficient heated biocompatible fluid or biocompatible cryoprotectant adjacent the skin surface so as to inhibit injury to the skin surface.

40. The system of claim 36, wherein the probes have a cooling region distal of the skin engaging surface for selectively cooling a target tissue, and an insulated region disposed between the cooling region and the skin engaging surface so as to inhibit injury along the skin surface.

41. The system of claim 36, wherein the probes have a cooling region distal of the skin engaging surface for selectively cooling a target tissue, and further comprising an applicator near the cooling regions for applying a material to enhance cooling of the target tissue.

42. The system of claim 28, wherein the cooling fluid source comprises a single-use cartridge having a quantity of the cooling fluid which is insufficient for treatment of a plurality of patients.

43. The system of claim 28, wherein the single-use cartridge and the probe are supported by a system housing, the housing containing a cooling fluid path coupling the single-use cartridge to the probe and a controller coupled to the cooling fluid path so as to control the cooling fluid, wherein the housing is disposable.

44. A system for improving a cosmetic appearance of a patient, the patient having a skin surface with a tissue therebelow, the tissue having a mass, the system comprising a probe having a tissue engaging surface directing sufficient tissue-remodeling energy or cooling from the probe through the skin surface to induce a reduction in the mass of the tissue such that the cosmetic appearance of the skin surface is improved.

45. A system for treating a patient, the patient having a skin surface and a muscle therebelow, the system comprising a transmission surface for directing sufficient tissue remodeling energy or cooling below the skin surface so that contraction of the muscle is inhibited.

46. The system of claim 45, wherein the transmission surface comprises is supported by a housing and is coupled to a single-use source of the remodeling energy or cooling by a controller, the source and controller disposed within the housing, and wherein the system is disposable.

47. A system for treating a patient, the patient having a skin surface and a tissue therebelow, the system comprising a probe configured to selectively direct sufficient tissue-remodeling energy or cooling to the tissue to facilitate improvement of a cosmetic appearance of the skin surface.