An apparatus and method used for medical and/or cosmetic treatment of a tissue, such as skin tightening, skin laxity and/or wrinkle reduction and or other skin flaws, including an energy source, a vacuum chamber and rollers which may facilitate easy sliding of the apparatus from one treated area to another. The rollers may also prevent excessive friction of the skin during the treatment. The energy source can be configured to emit energy based on the position of the apparatus on the skin (i.e., the position of the rollers), as well as the pressure within the vacuum chamber. The vacuum level and energy emission can be changed or pulsed based on the treatment regime.