R0 Tattoo Removal Method

Immediate Repetitive Irradiation Technique Using PFD

Tattoo removal using lasers has primarily involved breaking down pigments with nanosecond lasers like Q-switched Nd:YAG (1064nm).

However, with traditional treatment methods, a waiting period of 6 to 8 weeks for skin recovery was required after one laser pass before the next treatment could proceed. The total number of treatments also averaged over 10 sessions, meaning significant time could be needed to complete the process.

One new approach to reduce these time constraints is the R0 method.

What is the R0 Method?

R0 refers to a tattoo removal technique where laser is continuously irradiated up to 4 times on the same tattoo area during a single visit.

A key feature of this technique is the use of a special liquid substance called ‘PFD (Perfluorodecalin)’.

When a laser is applied to the skin, white bubbles known as ‘frosting’ appear on the surface.

These bubbles cause scattering of the laser light, significantly reducing the effectiveness of subsequent passes. 

Previously, one would wait tens of minutes for these bubbles to naturally disappear, but often they didn't completely vanish. Alternatively, postponing until the next session was a common approach.

However, applying PFD can remove frosting within seconds, and reduces the interval between laser passes to within 1-2 minutes, enabling multiple repeated irradiations.

Consequently, this means that tattoo pigment reduction can be achieved in a much shorter period than with traditional methods.

Related Research Findings

• Biesman et al., 2013
• In patients treated with the R0 method, the number of treatments could be reduced by approximately 30-50% compared to traditional methods, and
• It was confirmed that immediate repetitive irradiation is possible right after laser application.
• Kauvar et al., 2020
• For patients treated with the R0 method around 3 times, we examined the total number of laser passes, estimated at approximately 10 (around 3 sessions with the R0 method).
• As a result, over 70-90% reduction in tattoo pigment could be observed, and
• The incidence of side effects such as post-inflammatory hyperpigmentation (PIH) was also reported to be relatively low.

So why is it often only '3 times' instead of '4 times' for repeated irradiation?

Theoretically, the R0 method is known to allow up to 4 repetitions of irradiation, but,

In actual clinical settings, treatment is often stopped after 2-3 repetitions of irradiation.

There are several reasons for this decision:

1. Characteristics of Asian Skin

Asian skin has high responsiveness of melanin cells, and a relatively higher chance of developing post-inflammatory hyperpigmentation (PIH).

Especially for those belonging to Fitzpatrick skin types III~IV,

Excessive repeated irradiation can go beyond breaking down pigments, and over-stimulate the skin itself, increasing the risk of worsening hyperpigmentation.

2. Balance Between Irradiation Sessions and Safety

Usually, up to 3 repetitions are deemed possible while observing the skin's reaction.

However, if 4 repetitions are exceeded, the risk of damage to normal tissue, increased pain, erythema, or minor burn reactions can sharply increase.

3. Limitations of Irradiation Efficiency

Even with the use of PFD, there is a physical limit to the amount of pigment particles a laser can destroy.

After performing about 3 repetitions of irradiation in a single session, the efficiency of irradiation tends to gradually decrease from that point, and,

Even if the irradiation intensity is increased further, the effects obtained are limited, and only the risk of side effects may increase.

In other words, the technical possibility of 'up to 4 repetitions' and 'the optimal number of repetitions that is safe and effective for the patient' must be considered differently.

Therefore, our medical team plans treatments based on 3 repetitions in most cases, considering the patient's skin safety and satisfactory results.

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

This treatment method does not necessarily have only positive aspects from the perspective of medical institutions.

• PFD drugs come with a significant financial burden, and their stable supply is also challenging.
• The appropriate timing for PFD drug application and the plan for repeated laser irradiation require the professional judgment of experienced medical staff.
• Compared to typical tattoo removal procedures, the time required tends to be 2 to 3 times longer.

For these reasons, this treatment method may not be preferred by clinics that prioritize patient turnover.

However, we prioritize the completeness of the treatment and reducing the patient's burden,

we believe that the effective aspects this treatment method can offer cannot be overlooked.

At our clinic, we only perform repeated irradiation as needed, avoiding excessive laser exposure.

We always strive to prioritize your skin safety while achieving the most effective tattoo removal results.

We help improve treatment by enhancing procedure efficiency, reducing any burden you might feel, and prioritizing safety.