Systems and methods for electrosurgical incisions on external skin surfaces

Abstract

Systems and methods are provided for removing fatty tissue underlying a patient's epidermis (e.g., blepharoplasty, brow lifts, eyelid shortening procedures, and the like). These methods include positioning one or more active electrode(s) and one or more return electrode(s) in close proximity to a target site on an external body surface of the patient. A high frequency voltage difference is applied between the active and return electrode(s), and the active electrode(s) are translated across the external body surface to create an incision therein. The bipolar configuration controls the flow of current to within and around the distal end of the probe, which minimizes tissue necrosis and the conduction of current through unwanted paths in the patient. The residual heat from the electrical energy also provides simultaneous hemostasis of severed blood vessels, which increases visualization and improves recovery time for the patient.

What is claimed is:  
     
         1 . A method for removing fatty tissue underlying a patient's epidermis comprising: 
 positioning an electrode terminal and a return electrode in close proximity to a target site on an external body surface of the patient;    applying a high frequency voltage difference between the electrode terminal and the return electrode; and    during the applying step, translating the electrode terminal across the external body surface to create an incision in the body surface.    
     
     
         2 . The method of  claim 1  wherein the external body surface comprises a tissue structure in the papillary dermis or the epidermis.  
     
     
         3 . The method of  claim 1  further comprising removing a layer of the external body surface from the target site and removing a portion of the underlying fatty tissue.  
     
     
         4 . The method of  claim 1  further comprising effecting tissue hemostasis during the translating step.  
     
     
         5 . The method of  claim 1  further comprising delivering electrically conducting fluid to the target site, and contacting the electrically conducting fluid with the return electrode to provide a current flow path from the electrode terminal, through the electrically conducting fluid, and to the return electrode.  
     
     
         6 . The method of  claim 1  further comprising locating an electrically conducting gel on the external body surface to provide a current flow path from the electrode terminal, through the electrically conducting fluid, and to the return electrode.  
     
     
         7 . The method of  claim 1  further comprising positioning the return electrode proximal to the electrode terminal to induce current flow from the electrode terminal away from the target site.  
     
     
         8 . The method of  claim 1  further comprising directing electrically conducting fluid along a fluid path past the electrode terminal and the return electrode to generate the current flow path between the return electrode and the electrode terminal.  
     
     
         9 . The method of  claim 1  wherein the electrode terminal comprises a single, elongate electrode terminal having a sharp distal tip.  
     
     
         10 . The method of  claim 1  wherein further comprising applying a sufficient high frequency voltage difference between the return electrode and the electrode terminal to remove tissue through molecular dissociation or disintegration.  
     
     
         11 . The method of  claim 1  further comprising applying sufficient voltage to the electrode terminal in the presence of the electrically conducting fluid to vaporize at least a portion of the fluid between the electrode terminal and the external body surface.  
     
     
         12 . The method of  claim 11  further comprising accelerating charged particles from the vaporized fluid to said portion of the epidermis to cause dissociation of the molecular bonds within the tissue structures of said portion of the epidermis  
     
     
         13 . A method for performing a blepharoplasty procedure comprising: 
 positioning an electrode terminal in close proximity to a target site near a patient's eye;    applying a sufficient high frequency voltage to the electrode to volumetrically remove tissue at the target site;    during the applying step, translating the electrode terminal across the external body surface to create an incision in the body surface; and    removing fatty tissue underlying the incision.    
     
     
         14 . The method of  claim 1  further comprising delivering electrically conducting fluid to the target site, and contacting the electrically conducting fluid with a return electrode to provide a current flow path from the electrode terminal, through the electrically conducting fluid, and to the return electrode.  
     
     
         15 . The method of  claim 1  further comprising locating an electrically conducting gel on the external body surface to provide a current flow path from the electrode terminal, through the electrically conducting fluid, and to a return electrode.  
     
     
         16 . The method of  claim 1  further comprising positioning a return electrode proximal to the electrode terminal to induce current flow from the electrode terminal away from the target site.  
     
     
         17 . The method of  claim 1  further comprising directing electrically conducting fluid along a fluid path past the electrode terminal and a return electrode to generate the current flow path between the return electrode and the electrode terminal.  
     
     
         18 . The method of  claim 1  wherein the electrode terminal comprises a single, elongate electrode terminal having a sharp distal tip.  
     
     
         19 . The method of  claim 1  wherein further comprising applying a sufficient high frequency voltage to the electrode terminal to remove tissue through molecular dissociation or disintegration.  
     
     
         20 . The method of  claim 1  further comprising applying sufficient voltage to the electrode terminal in the presence of the electrically conducting fluid to vaporize at least a portion of the fluid between the electrode terminal and the external body surface.  
     
     
         21 . The method of  claim 20  further comprising accelerating charged particles from the vaporized fluid to said portion of the epidermis to cause dissociation of the molecular bonds within the tissue structures of said portion of the epidermis.  
     
     
         22 . An apparatus for creating an incision in an external body surface of a patient comprising: 
 a shaft having proximal and distal end portions and an elongate electrode terminal extending from the distal end portion;    a return electrode on the shaft spaced from the elongate electrode terminal;    a power supply coupled to the electrode terminal and the return electrode for applying a sufficient high frequency voltage difference between the electrode and the return electrode to volumetrically remove tissue on the external body surface.    
     
     
         23 . The apparatus of  claim 22  wherein the elongate electrode terminal has a distal tip configured for creating an incision in an internal body surface, and the return electrode is proximally spaced from the elongate electrode terminal.  
     
     
         24 . The apparatus of  claim 22  the shaft comprises a disposable tip configured for removable coupling to a handle in an electrosurgical system.  
     
     
         25 . The apparatus of  claim 22  further comprising a fluid lumen configured for delivering electrically conducting fluid to the electrode terminal.  
     
     
         26 . The apparatus of  claim 22  wherein the return electrode is axially spaced from the electrode terminal a distance sufficient to prevent current arcing therebetween.  
     
     
         27 . The apparatus of  claim 22  wherein the return electrode is axially spaced from the electrode terminal a distance of about 1.0 to 20 mm.