[Feels like multiple sessions in one] R0 Tattoo Removal

Tattoo Removal Using the R0 Technique

Immediate Repetitive Laser Treatment Using PFD

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

Previously, after one laser session, patients had to wait 6-8 weeks for recovery before the next treatment. This approach typically required more than 10 sessions, consuming a significant amount of time.

To improve upon these aspects, the R0 technique was introduced as one solution.

Explanation of the R0 Technique

R0 refers to a tattoo removal method where the laser is applied repeatedly up to four times on the same area during a single visit to the dermatology clinic.

The key characteristic of this treatment is the application of a special liquid substance called ‘PFD (Perfluorodecalin)’.

When the laser touches the skin, a white, foamy phenomenon called ‘frosting’ appears on the surface.

These bubbles scatter light, significantly hindering the effectiveness of subsequent laser treatments. 

Previously, one had to wait for tens of minutes for these bubbles to disappear naturally, but they often didn't vanish completely, or it was common to simply wait until the next session.

Applying PFD can eliminate the frosting phenomenon within a few seconds, thereby shortening the interval between laser applications to 1-2 minutes, allowing multiple consecutive passes.

As a result, treatment time is significantly reduced compared to previous methods, while still achieving satisfactory pigment removal effects.

Related Research Findings

• Biesman et al., 2013
• In a patient group using the R0 technique, the number of treatment sessions could be reduced by 30-50% compared to conventional methods, and
• it was confirmed that repetitive treatment was possible immediately after laser irradiation.
• Kauvar et al., 2020
• In patients who underwent approximately 3 applications of the R0 technique, with a total number of laser irradiations equivalent to about 10 sessions of the conventional method (approximately 3 sessions with the R0 method),
• pigment removal effects of 70-90% or more could be achieved, and
• the incidence of side effects like post-inflammatory hyperpigmentation (PIH) was reported to be low.

However, why is it recommended to only repeat the treatment up to '3 times' in practice, when theoretically a maximum of '4 times' is possible?

Theoretically, the R0 technique allows for repeating laser irradiation up to 4 times.

However, in actual practice, treatments tend to be concluded after 2-3 repeated irradiations.

There are several important reasons:

1. Characteristics of Asian Skin

Asian skin is characterized by melanocytes that react sensitively to stimulation, leading to a relatively higher risk of post-inflammatory hyperpigmentation (PIH).

Especially for individuals with Fitzpatrick skin types III-IV,

excessive repetitive treatments can go beyond the effect of pigment removal, carrying the risk of over-stimulating the skin and potentially worsening hyperpigmentation.

2. Consideration of Treatment Frequency and Safety

While repetitive treatments are possible up to 3 times with careful observation of skin reactions,

exceeding 4 sessions significantly increases the likelihood of risks such as damage to normal skin tissue, pain, redness, and minor burn reactions.

3. Limitations of Laser Efficiency

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

After approximately 3 repeated irradiations in a single session, the laser's efficiency gradually decreases thereafter.

Even if the treatment intensity is increased, the expected benefits are minimal, and often only the risk of side effects increases.

Therefore, there is a difference between the 'technical limit of up to 4 sessions' and the 'actual number of treatments that can achieve optimal results safely for the patient'.

Accordingly, our medical team prioritizes patient safety and satisfactory results, making 3 repeated irradiations the fundamental principle.

So, why isn't the R0 technique universally adopted by all medical institutions?

This treatment method doesn't only have advantages for medical institutions.

• PFD drugs are expensive and difficult to obtain.
• The timing of PFD drug application and the plan for repeated irradiation require the medical team's skilled judgment.
• Compared to general tattoo removal procedures, the treatment time can be two to three times longer.

Due to these characteristics, it may be difficult for clinics prioritizing high patient turnover to utilize this method.

Nevertheless, we consider the 'completeness' of the procedure and 'minimizing patient discomfort' as important values.

Therefore, the effective aspects offered by this treatment method cannot be overlooked.

Our medical team avoids excessive irradiation and repeats the treatment only as much as needed,

We always prioritize the safety of our patients' skin and seek methods that lead to effective tattoo removal results.

We strive to perform tattoo removal more efficiently and safely.