3 Treatments in One Visit! [R0 Tattoo Removal]

Tattoo Removal Using R0 Method

Immediate Repetitive Treatment with PFD

Generally, tattoo removal primarily uses nanosecond lasers, such as Q-switched Nd:YAG 1064nm, to break down pigment particles.

However, traditional treatment methods typically require a 6-8 week interval for recovery after each laser session. The total number of sessions can exceed an average of 10, making it quite time-consuming.

To address the drawbacks of these traditional methods, the R0 method has been proposed as an alternative.

Understanding the R0 Method

R0 refers to a tattoo removal technique where a laser is applied repeatedly up to four times on the same area in a single visit.

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

When the laser is applied, white bubbles, commonly referred to as ‘Frosting’, appear on the skin surface.

These bubbles can scatter the laser light, reducing the efficiency of subsequent passes.

In the past, one had to wait for tens of minutes for these bubbles to naturally dissipate. However, they often didn't disappear completely, leading to the inconvenience of waiting until the next treatment session.

Applying PFD can eliminate frosting in just a few seconds, allowing the laser application interval to be shortened to about 1-2 minutes, enabling multiple repetitive treatments.

This method shortens the treatment period compared to previous methods, while also offering positive effects on pigment reduction.

Case Studies

• Biesman et al., 2013
• Patients treated with the R0 method reportedly experienced a 30-50% reduction in the number of treatment sessions compared to traditional methods.
• It was also confirmed that repetitive treatment immediately after laser application is possible.
• Kauvar et al., 2020
• For patients who underwent the R0 method approximately 3 times, the total number of laser applications corresponded to about 10 sessions (approximately 3 sessions with the R0 method),
• and over 70-90% pigment clearance was reported.
• The incidence of side effects, such as post-inflammatory hyperpigmentation (PIH), was also observed to be low.

So, why is repetitive treatment primarily limited to 3 passes, not the maximum of 4?

Theoretically, the R0 method allows for repetitive laser application up to 4 times.

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

There are several considerations behind this:

1. Characteristics of Asian Skin

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

Especially for Fitzpatrick skin types III~IV,

excessive repetitive treatment can go beyond destroying pigment particles and instead strongly irritate the skin itself, increasing the risk of worsening hyperpigmentation.

2. Number of Passes and Safety Considerations

While repetitive treatments can be performed up to 3 passes with careful observation of the skin's reaction,

exceeding 4 passes can increase the likelihood of side effects such as damage to normal tissue, pain, erythema, and subtle burn reactions.

3. Limitations of Laser Application Efficiency

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

When repetitive treatments are performed approximately 3 times in a single session, the laser's application efficiency gradually decreases thereafter.

At this point, increasing the application intensity yields minimal additional therapeutic effects and tends to only increase the risk of side effects.

In conclusion, there is a difference between the technical applicability of 'up to 4 passes' and the actual optimal number of passes that can be safely applied to a patient's skin.

At our clinic, considering both patient skin safety and treatment efficacy, we generally proceed with treatments based on approximately 3 repetitive passes.

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

This treatment method does not offer benefits to all medical institutions.

• PFD drugs come with a financial burden and are difficult to secure stably.
• The timing of PFD drug application and the plan for repeated laser irradiation require careful diagnosis by medical staff with extensive experience.
• Compared to general tattoo removal procedures, this procedure can take 2 to 3 times longer.

For this reason, it is also a difficult procedure to utilize in places that need to treat many patients in a short amount of time.

However, at our clinic, we place greater importance on the completeness of the procedure and reducing our patients' burden.

Therefore, we cannot overlook the efficiency this method offers.

Kkeut Korean Medicine Clinic avoids excessive irradiation during tattoo removal, and repeatedly irradiates with the laser only as much as necessary, depending on the skin condition.

We always exercise caution so that sufficient tattoo removal effects can be expected within a safe range that does not damage the patient's skin.

We strive for more efficient tattoo removal, while minimizing skin burden, and achieving satisfactory results.