A tissue ablation system facilitates lesioning deep tissue while preventing damage to superficial tissue and includes a probe having a distal end portion, at least one transducer carried on the distal end portion, and at least one acoustically transparent heat removal element thermally coupled to a target tissue within the beam path of the transducer. The transducer delivers acoustic energy to the tissue through the heat removal element in order to ablate the tissue the heat removal element removes sufficient thermal energy from the tissue volume to prevent thermal necrosis in superficial tissue. The heat removal element may be a heat sink or a convective element. An optional temperature sensor provides advisory data to a practitioner and/or is coupled to a feedback control system operable to control delivery of acoustic energy to the tissue and/or a rate of thermal energy removal therefrom.
