A device and method for utilizing optical radiation to treat tissue are described. In one aspect, the device is a dermatological treatment device. The device can be used, for example, for treatment of dermatological and cosmetic conditions. The device can include a sensor that indicates when the device is in contact with a subject's tissue. Operation of the device can, in some instances, be partially or fully automated. The device can further include a light source that is air cooled and a cooling plate that is chilled preferably to 5° C. The device can also include a window that is enlarged to reduce the power density and facilitate heating of tissue at depth.