Devices and methods having a cooling material and reduced pressures to treat biological external tissue using at least one energy source are disclosed. The cooling material may be water, ethyl alcohol, and/or any other material having a vapor pressure below atmospheric pressure. The energy source may be incoherent light, coherent light, a radio frequency, ultrasound, a laser, and/or any other type of energy that can be applied through the device. The features of various embodiments of the device include the generation of positive pressure and/or negative pressure through one or more pressure conduits, the application of an object within a recess of the device, and measurements through various sensors on the device. These sensors may be monitored and/or controlled through a display element having rows and columns of pixels on the device. The device may be a handheld device or an add-on to existing devices in some embodiments, and may include skin color sensors, temperature sensors, motion sensors, vapor pressure sensors, material sensors, and/or capacitance sensors.