[3 Intensive Irradiations in One Visit] R0 Tattoo Removal

Tattoo Removal Using the R0 Technique

Immediate Repetitive Laser Application Technique Using PFD Solution

The primary method for tattoo removal using lasers has involved breaking down pigment with nanosecond lasers, such as Q-switched Nd:YAG (1064nm).

However, the traditional method required a recovery period of 6-8 weeks after each laser session before the next treatment could be performed. Typically, the total number of sessions averaged over 10, requiring a considerable amount of time.

One new approach aiming to improve upon these traditional challenges is the R0 technique.

What is the R0 Method?

R0 is a tattoo removal technique that involves applying the laser to the same area up to four times during a single visit.

A crucial aspect of this technique is the use of a special liquid drug called ‘PFD (Perfluorodecalin)’.

When the laser is applied, white bubbles called ‘frosting’ appear on the skin's surface.

These bubbles scatter light, significantly reducing the effectiveness of subsequent laser applications. 

In the past, one had to wait for tens of minutes for these bubbles to dissipate naturally, but they never fully disappeared. Alternatively, it was common to postpone the next treatment session.

However, applying PFD can eliminate frosting bubbles within seconds, and shortens the interval between laser applications to 1-2 minutes, allowing for repetitive treatments.

This means that pigments can be effectively reduced with treatments performed over a much shorter period compared to traditional methods.

Related Research Cases

• Biesman et al., 2013
• In patients using the R0 technique, the number of treatment sessions could be reduced by approximately 30-50% compared to traditional methods.
• Furthermore, it was confirmed that it is possible to repeat the treatment immediately after the laser application.
• Kauvar et al., 2020
• For patients who underwent the R0 method approximately three times, the total number of laser sessions was approximately 10 (or about 3 sessions with the R0 method),
• As a result, over 70-90% of the pigment could be removed,
• and the incidence of side effects like post-inflammatory hyperpigmentation (PIH) was reported to be low.

However, why is only 3 repetitive applications recommended in the R0 method, rather than 4?

While the R0 technique is generally known to allow for up to four repetitive laser applications,

in actual practice, most treatments are completed with 2-3 repetitive applications.

There are several reasons:

1. Characteristics of Asian Skin

Asian skin is prone to melanin cell reactivity, and has a relatively higher chance of developing post-inflammatory hyperpigmentation (PIH) after inflammation.

Especially for individuals with Fitzpatrick skin types III-IV,

if the laser is applied too frequently, it may not only remove pigment but also over-stimulate the skin, potentially leading to more severe hyperpigmentation.

2. Balance Between Treatment Sessions and Safety

While repetitive applications can be performed up to three times, observing the skin's reaction,

exceeding four applications significantly increases the risk of damage to normal skin tissue, pain, red spots (erythema), and minor burn reactions.

3. Limitations of Laser Treatment Efficiency

Even with PFD, there is a certain limit to the amount of pigment particles the laser can reach.

If the laser is applied about three times during a single visit, the efficiency of the treatment begins to decrease thereafter,

and even if the laser intensity is increased, the expected therapeutic effect is not significant, potentially leading only to an increased risk of side effects.

In conclusion, the technical possibility of ‘up to four times’ and ‘the safest and most appropriate number of sessions for the patient’ can be viewed differently.

Therefore, we prioritize the patient's skin safety and treatment effectiveness, making three repetitive applications a fundamental principle.

So, why don't all medical institutions use the R0 method?

This method does not solely offer advantages from the perspective of a medical institution.

• PFD medications are costly and difficult to secure reliably.
• Determining the appropriate application time and repeated laser passes for PFD medication requires the experience and judgment of the medical staff.
• Tattoo removal treatment time can be 2-3 times longer than conventional methods.

Therefore, clinics that prioritize fast treatment processing (turnover) tend not to prefer this method.

However, we prioritize the ‘completeness’ of the treatment along with ‘reducing the patient's burden’.

Therefore, we cannot overlook the efficient aspects offered by this treatment method.

We perform laser passes only as much as necessary, without excessive irradiation.

We prioritize patient skin safety and continuously research to enhance satisfaction with tattoo removal results.

We strive for highly satisfactory improvements by increasing treatment efficiency, reducing the burden of treatment sessions, and considering skin safety.