[Reducing the number of visits] R0 Tattoo Removal

Tattoo Removal Using R0 Technique

Treatment Method: Multiple Laser Passes with PFD Medication

Laser tattoo removal traditionally uses nanosecond lasers, such as Q-switched Nd:YAG (1064nm), to break down pigment.

However, the conventional method required a 6-8 week interval after each laser session for skin recovery before the next treatment could be performed. Typically, more than 10 sessions were needed in total, making it a lengthy process.

One of the new treatment methods introduced to reduce this inconvenience is the R0 technique.

Understanding the R0 Treatment Method

The R0 treatment is a tattoo removal technique where the laser is applied to the same area up to four times during a single visit to the clinic.

A key feature of this treatment is the use of a special liquid medication called 'PFD (Perfluorodecalin)'.

When the laser is applied, white bubbles, known as 'frosting', appear on the skin.

When these bubbles form, the light scatters, which can significantly reduce the efficiency of subsequent laser passes. 

In the past, one had to wait for tens of minutes for these bubbles to dissipate naturally, but they would not disappear completely. It was also common to postpone further treatment until the next session.

However, when PFD is applied, the frosting disappears within seconds. This allows us to shorten the time between laser passes to 1-2 minutes, enabling multiple repeated treatments.

This method allows us to achieve a significant reduction in tattoo pigment within a much shorter period compared to traditional approaches.

Analysis of Research Cases

• Biesman et al., 2013 Study
• When using the R0 technique, the number of treatment sessions could be reduced by approximately 30% to 50% compared to conventional tattoo removal methods,
• and it was confirmed that repeated passes were possible immediately after the initial laser application.
• Kauvar et al., 2020 Study
• Patients who received approximately three applications of the R0 method showed that the total number of laser passes was equivalent to about 10 sessions with the conventional method. (Approximately 3 sessions with the R0 method),
• As a result, a pigment reduction of 70% to over 90% could be expected, and
• it was reported that the incidence of side effects, such as post-inflammatory hyperpigmentation (PIH), was also relatively low.

However, technically it's possible up to 4 passes, but why is it usually repeated only '3 times' in practice?

Theoretically, the R0 treatment can be repeated up to four times.

However, in actual clinical practice, it is often stopped after approximately 2 to 3 repeated passes.

There are several reasons for this.

1. Consideration of Asian Skin Characteristics

Asian skin can have melanin cells that react sensitively, and there may be a higher risk of post-inflammatory hyperpigmentation (PIH).

Especially for Fitzpatrick skin types III~IV,

excessive repeated passes can go beyond breaking down pigment and over-stimulate the skin, increasing the likelihood of worsening hyperpigmentation.

2. Consideration of Number of Sessions and Safety

Up to three passes, repeated laser application can be performed while closely monitoring the skin's reaction,

but exceeding four passes can suddenly increase the risk of damage to surrounding healthy tissue, pain, redness, and reactions such as minor burns.

3. Limitation of Laser Application Efficiency

Even with PFD application, there is a certain limit to the total amount of pigment particles that laser light can affect.

After approximately three repeated passes in a single session, the efficiency of laser application may gradually decrease thereafter,

At this point, increasing the laser intensity may yield minimal additional treatment effects, while conversely increasing the risk of side effects.

In other words, the technical potential of 'up to 4 passes' and the 'optimal number of safe and appropriate treatment sessions for each individual patient' can differ.

Therefore, our clinic carefully considers the patient's skin safety and treatment efficacy, generally adhering to the principle of performing three repeated passes.

So, why don't all medical institutions perform the R0 treatment?

This treatment method does not only have advantages from the perspective of a medical institution.

• For PFD drugs, there may be a financial burden, and they may not always be easily accessible.
• Applying the medication at the precise time and planning repeated laser treatments requires the professional judgment of experienced medical staff.
• This procedure may take 2 to 3 times longer compared to general tattoo removal procedures.

Therefore, it is also a difficult method to apply for practices that prioritize the number of procedures.

However, at our clinic,  because we prioritize the completeness of the procedure and minimizing the physical burden on our patients,

we believe the efficient aspects that this method can bring are difficult to overlook.

At our clinic, without excessive laser treatment, we perform repeated laser treatments as needed, tailored to each individual's skin condition,

prioritizing the skin safety of our patients, we seek methods that can deliver satisfactory tattoo removal results.

To ensure a more efficient process, we reduce the burden of the number of treatment sessions and prioritize skin safety.