Systems, methods and devices for creating an effect using microwave energy to specified tissue are disclosed. A system for the application of microwave energy to a tissue includes a signal generator adapted to generate a microwave signal having predetermined characteristics, an applicator connected to the generator and adapted to apply microwave energy to tissue. The applicator includes one or more microwave antennas and a tissue interface, a vacuum source connected to the tissue interface, a cooling source connected to the tissue interface, and a controller adapted to control the signal generator, the vacuum source, and the coolant source. The tissue includes a first layer and a second layer, the second layer below the first layer. The controller is configured so that the system delivers energy such that a peak power loss density profile is created in the second layer.