R0 Technique Tattoo Removal

Immediate Repetitive Laser Passes Using PFD

Tattoo removal using lasers has primarily involved breaking down pigments with nanosecond lasers, such as the Q-switched Nd:YAG 1064nm.

However, traditional treatment methods require a recovery period of 6-8 weeks after one laser pass before proceeding to the next step. As a result, the total number of treatment sessions often exceeded an average of 10, leading to prolonged treatment durations.

A new approach introduced to overcome these limitations is the R0 technique.

What is the R0 Method?

The R0 method refers to a tattoo removal technique that involves applying the laser to the same area up to 4 times during a single visit.

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

When a laser touches the skin, white bubbles called 'frosting' appear on the surface.

These bubbles scatter the laser light, becoming a primary reason for significantly reducing the effectiveness of subsequent laser passes.

In the past, it was common to wait tens of minutes for these bubbles to naturally disappear, or to postpone the next treatment session. However, often the bubbles would not completely disappear even after waiting.

However, applying PFD allows for rapid removal of frosting within seconds, and shortens the laser pass interval to about 1-2 minutes, enabling immediate repetitive passes.

This allows for a significant level of pigment reduction effect to be expected within a much shorter period than before.

Related Research Findings

• Biesman et al., 2013
• It was confirmed that in patient groups treated with the R0 method, the number of treatment sessions could be reduced by approximately 30-50% compared to traditional methods.
• Furthermore, it was reported that repetitive treatment is possible immediately after laser application.
• Kauvar et al., 2020
• In patients treated with the R0 method around 3 times, the total number of laser passes reached approximately 10 (or about 3 sessions with the R0 method),
• and in these cases, over 70-90% pigment removal effect could be observed.
• Additionally, the incidence of side effects such as PIH (Post-Inflammatory Hyperpigmentation) was reported to be low.

So why are repetitive passes typically done '3 times' rather than 'up to 4 times'?

Theoretically, the R0 method can allow for up to 4 repetitive laser passes, but

in actual clinical practice, treatment often stops after 2-3 repetitive passes.

The reasons can be explained as follows:

1. Characteristics of Asian Skin

Asian skin has highly reactive melanin cells, making it more prone to post-inflammatory hyperpigmentation (PIH).

Especially for individuals corresponding to Fitzpatrick Skin Type III~IV,

excessive repetitive passes can go beyond pigment removal and stimulate the skin, increasing the risk of worsening hyperpigmentation.

2. Consideration of Number of Passes and Safety

While it is possible to perform repetitive passes up to 3 times while carefully observing the skin's reaction,

if more than 4 passes are applied, the likelihood of side effects such as risk of damage to normal skin tissue, pain, redness, and minor burn reactions significantly increases.

3. Limitations in Pass Efficiency

Even with PFD, there is a limit to the amount of pigment particles that a laser can break down.

If approximately 3 repetitive passes are performed in a single session, the efficiency of passes decreases thereafter,

and often, increasing the laser intensity yields minimal additional therapeutic effect, while only increasing the risk of side effects.

Thus, the technical potential of ‘up to 4 passes’ and the ‘actual number of passes that are safe and yield optimal results for the patient’ are different.

Medical professionals prioritize patient skin safety and expected outcomes, applying the principle of 3 repetitive passes.

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

This treatment method does not always bring only advantages from the hospital's perspective.

• PFD medications can be challenging to obtain consistently, in addition to being costly.
• This procedure requires the careful judgment of experienced medical professionals when determining the timing of medication application and planning repeated treatments.
• Compared to conventional tattoo removal methods, the time required for this procedure may be two to three times longer.

For this reason, it may not be the preferred approach for clinics that prioritize efficiency.

However, our medical team values the completeness of the procedure and minimizing our patients' burden.

We believe that the clinical effectiveness of this method cannot be overlooked.

We perform treatments by delicately repeating only as much as needed, avoiding unnecessary excessive treatment,

We always take a meticulous approach to ensure the most satisfying tattoo removal results, all while prioritizing the safety of our patients' skin.

We strive to shorten treatment times, reduce the number of required sessions, ensure safety, and achieve a high level of satisfaction.