Tattoo Removal Using the R0 Technique

Immediate Repetitive Laser Treatment Using PFD

Laser tattoo removal has commonly used nanosecond lasers, such as Q-switched Nd:YAG (1064nm), to microscopically break down pigment.

However, the traditional approach requires a recovery period of approximately 6-8 weeks after each session before the next treatment can be performed, and the total number of sessions typically exceeds 10, demanding considerable time.

One new method that has emerged to improve these inconveniences is the R0 technique.

What is the R0 Technique?

R0 refers to a tattoo removal method where a laser is applied continuously to the same area up to 4 times in a single visit.

The key to this procedure is the use of a special liquid medication called ‘PFD (Perfluorodecalin)’.

When the laser is applied, white bubbles, known as 'frosting,' are generated on the skin surface.

These bubbles scatter the laser light, which can significantly reduce the penetration effect of subsequent passes. 

Previously, it was common to wait for several tens of minutes for these bubbles to naturally disappear, but they often did not vanish completely, or the next treatment was postponed to a later session.

However, applying PFD causes the frosting phenomenon to subside within seconds, which allows for repetitive laser treatments by shortening the interval between laser passes to within 1-2 minutes.

This suggests that a significant level of pigment improvement can be achieved with a much shorter total treatment duration compared to conventional methods.

Clinical Study Results

• Biesman et al., 2013
• In patient groups treated with the R0 method, the number of treatment sessions could be reduced by approximately 30-50% compared to traditional methods,
• It was confirmed that repetitive treatments are possible immediately after laser application.
• Kauvar et al., 2020
• For patients who underwent the R0 technique approximately 3 times, the effect was comparable to about 10 total laser applications (or roughly 3 sessions with the R0 method),
• As a result, a pigment reduction of over 70-90% was expected, and
• the incidence of side effects such as post-inflammatory hyperpigmentation (PIH) was reported to be observed at low levels.

However, why do we perform repetitive applications up to '3 times' only, and not '4 times'?

Although the R0 method is theoretically known to allow for repetitive applications up to 4 times,

in actual practice, treatments are often stopped after 2-3 repetitive applications.

There are several reasons for this:

1. Characteristics of Asian Skin

Asian skin tends to have a high reactivity of melanin cells and a higher likelihood of developing post-inflammatory hyperpigmentation (PIH).

Especially for individuals with Fitzpatrick skin types III-IV,

if excessive repetitive applications are performed, beyond the effect of breaking down pigment, it can cause excessive irritation to the skin itself, potentially leading to darker hyperpigmentation.

2. Consideration of Treatment Sessions and Safety

Up to 3 applications, repetitive laser passes can be performed while closely observing the skin's reaction, but

if it exceeds 4 applications, the probability of side effects such as damage to surrounding normal tissue, increased pain, erythema, and minor burn reactions can sharply increase.

3. Limitations of Application Efficiency

Even with the use of PFD, there is a limit to the amount of pigment particles that the laser can effectively reach and destroy.

If repetitive applications are performed about 3 times during a single session, the application efficiency gradually decreases from that point onwards,

and thereafter, even if the application intensity is increased, the expected treatment effect is not significant, and instead, the risk of side effects often increases.

In conclusion, the technical possibility of ‘up to 4 applications’ and ‘the optimal number of applications that can be safely and effectively applied to the patient’s skin’ should be considered differently.

Therefore, during treatment, 3 repetitive applications are performed as a basic principle, prioritizing patient skin safety and effectiveness.

So, why don't all clinics use the R0 technique?

This method does not only have advantages from the perspective of medical institutions.

• PFD drugs tend to have high raw material costs, and securing a stable supply can be challenging.
• In this procedure, the medical team's extensive experience and expertise are crucial in determining the appropriate timing for PFD drug application and the number of repeated laser irradiations.
• This method may take 2 to 3 times longer for the procedure compared to general tattoo removal processes.

Therefore, this method might be considered somewhat burdensome in places that prioritize patient turnover.

However, at our clinic, we place greater importance on enhancing the completeness of the procedure and alleviating the burden felt by our patients.

The effective aspects provided by this treatment method cannot be overlooked.

Our medical team repeatedly irradiates the laser only as much as necessary to avoid excessive skin irritation,

We prioritize our patients' skin safety and constantly seek ways to achieve positive tattoo removal results.

Our medical team aims to reduce the number of treatments for patient convenience and achieve stable results without straining the skin.