Tattoo Removal using the R0 Method

Repeated Laser Irradiation Technique using PFD

For a long time, nanosecond lasers such as Q-switched Nd:YAG 1064nm have been primarily used for tattoo removal. This laser removes tattoos by breaking down the pigment into tiny fragments.

However, with conventional methods, the next session can only be performed after a recovery period of 6-8 weeks following laser irradiation. This often leads to a total of 10 or more treatment sessions, meaning that tattoo removal can take a considerable amount of time.

As a new treatment method to alleviate this inconvenience, the R0 method is gaining attention.

Meaning of the R0 Method

The R0 method refers to a tattoo removal technique that involves continuous laser irradiation on the same area up to four times during a single visit to the clinic.

In this treatment method, it is crucial to utilize a special liquid medication called ‘PFD (Perfluorodecalin)’.

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

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

Previously, it was necessary to wait tens of minutes for these bubbles to disappear on their own. However, even after waiting, the bubbles didn't completely vanish, and typically, waiting until the next treatment session was the common approach.

When PFD is applied, frosting bubbles quickly disappear within a few seconds. Thanks to this, it becomes possible to shorten the interval between laser shots to about 1-2 minutes, allowing for multiple repeated irradiations.

This method can help reduce the overall treatment duration and effectively diminish pigment compared to conventional methods.

Related Research Findings

• Biesman et al., 2013
• It was confirmed in patients who received R0 treatment that the total number of treatment sessions could be reduced by approximately 30-50% compared to conventional treatment methods, and
• it was revealed that it is possible to repeat the procedure immediately after laser irradiation.
• Kauvar et al., 2020
• In patients who underwent the R0 method approximately 3 times, the total number of laser irradiations was found to be equivalent to about 10 sessions of the conventional method (around 3 sessions with the R0 method),
• and through this, 70-90% or more of tattoo pigment removal could be expected.
• The incidence of side effects such as post-inflammatory hyperpigmentation (PIH) also appeared at a low level.

So, why is it that only about '3 times' of repeated irradiation are performed, rather than a maximum of '4 times'?

Theoretically, the R0 method is known to allow for up to four repeated irradiations in a single visit.

However, in practice, most cases complete the treatment after 2-3 repeated irradiations.

There are several reasons for this.

1. Characteristics of Asian Skin

Asian skin 's melanin cells can react sensitively to lasers, and there is a relatively higher chance of developing post-inflammatory hyperpigmentation (PIH).

Especially for skin types corresponding to Fitzpatrick Skin Type III~IV,

excessive repeated irradiation can go beyond pigment breakdown, potentially irritating the skin and worsening hyperpigmentation.

2. Consideration of Treatment Sessions and Safety

Typically, up to 3 repeated sessions can be performed while observing the skin's reaction, but

if irradiations are increased to 4 or more, the risk of damage to normal skin tissue increases, and the likelihood of reactions such as pain, redness, or minor burns also rises.

3. Limitations of Treatment Effectiveness

Even with PFD, there is a limit to the amount of tattoo pigment that the laser can access and destroy.

After completing about 3 repeated irradiations in a single session, the laser's efficiency may gradually decrease.

At this point, even if the treatment intensity is increased, the expected effect may not be significant, and often only the risk of side effects increases.

Therefore, even if it is technically possible up to ‘4 times’, the optimal number of treatment sessions that can be safely applied to actual patients may differ.

At our clinic, we prioritize patient skin safety and treatment effectiveness, and therefore, proceed with 3 repeated irradiations as a basic principle.

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

The R0 method does not always offer only advantages from the perspective of medical institutions.

• PFD drugs are expensive and supply can be unstable.
• Determining the timing of drug application and the number of repeated laser passes requires the medical team's deep experience and judgment.
• Compared to typical tattoo removal procedures, this treatment can take 2 to 3 times longer.

For this reason, it may not be preferred by clinics that prioritize patient turnover.

However, we prioritize improving the completeness of the procedure and reducing the burden on our patients.

From this perspective, we believe the efficiency of this method cannot be overlooked.

Our medical team performs repeated laser passes only within the necessary range, without excessive treatment.

We are constantly researching methods that can protect our patients' skin safety while maximizing the effectiveness of tattoo removal.

We strive to save our patients' time, carefully adjust the number of necessary treatments, and prioritize skin safety to achieve satisfactory treatment results.