Skin treatment apparatus comprising an energy applicator structure configured to establish heating or ablation at a predetermined and controllable (i.e. selectable) depth below a surface of skin tissue with which it is in contact. The applicator structure may receive a cooling medium and microwave frequency electromagnetic energy, which provide a combined treatment effect that results in heating or ablation in a zone beneath the skin surface. The applicator may be a waveguide (e.g. waveguide horn antenna) with internal shielding configured to provide a substantially uniform heating effect. The applicator may include a thermal camera to monitor treatment.