Tattoo Removal Using the R0 Technique

Fast Repetitive Laser Pulses Using PFD

Laser tattoo removal, which involves breaking down pigments with a Q-switched Nd:YAG (1064nm) nanosecond laser, has become the standard.

However, the traditional method required a recovery period of 6 to 8 weeks after each laser treatment before the next session could proceed. As a result, the total number of treatment sessions often exceeded 10 on average, and the overall duration required for treatment tended to be lengthy.

To address the limitations of this traditional method, the R0 technique was introduced as an alternative.

Understanding the R0 Technique

R0 is a tattoo removal technique that involves repeatedly applying laser pulses up to 4 times on the same area during a single visit.

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

When the laser is applied, white bubbles known as ‘frosting’ appear on the skin's surface.

These bubbles scatter the laser light, which can reduce the effectiveness of subsequent laser passes.

In the past, one had to wait for tens of minutes for these bubbles to naturally dissipate, but they often didn't disappear completely. Alternatively, it was common to wait until the next scheduled treatment session.

However, by applying PFD, the frosting can be removed within seconds, and the interval between laser passes can be shortened to 1-2 minutes, allowing for repetitive treatments.

This means that significant pigment reduction can be expected with a much shorter treatment period compared to traditional methods.

Real-World Cases from Research

• Biesman et al., 2013
• For patients who underwent the R0 technique, it was reported that the number of treatment sessions could be reduced by approximately 30-50% compared to traditional methods.
• Furthermore, it was confirmed that repetitive treatments are possible immediately after laser application.
• Kauvar et al., 2020
• Analysis of patients who received the R0 technique approximately 3 times showed pigment reduction effects equivalent to about 10 total laser passes (around 3 R0 sessions).
• As a result, over 70-90% pigment reduction was achievable,
• and the incidence of side effects like PIH (Post-Inflammatory Hyperpigmentation) was also low.

While the theoretical maximum number of repetitive R0 passes is 4, why is it typically recommended only up to 3 times in practice?

The R0 technique was theoretically designed to allow repetitive laser passes up to a maximum of 4 times.

However, in actual clinical practice, most procedures involve only 2 to 3 repetitive passes.

This is due to several considerations.

1. Asian Skin Sensitivity

Asian skin tends to have a higher reactivity of melanin cells, making it more prone to post-inflammatory hyperpigmentation (PIH).

Especially for individuals with Fitzpatrick skin types III to IV,

excessively repetitive laser passes, beyond breaking down pigment, can over-stimulate the skin, potentially worsening hyperpigmentation.

2. Balance Between Treatment Sessions and Skin Safety

Up to about 3 passes, the laser can be repeatedly applied while monitoring the skin's reaction.

However, if treatment exceeds 4 passes, the risk of damage to normal skin tissue increases significantly, and the likelihood of pain, erythema, and minor burn reactions rapidly rises.

3. Limitations of Treatment Effectiveness

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

After about 3 repetitive passes in a single session, the treatment effectiveness from subsequent laser passes gradually diminishes.

At this point, even if the laser intensity is unnecessarily increased, additional therapeutic effects are minimal, and it often only increases the risk of side effects.

In conclusion, the ‘technical possibility of up to 4 passes’ and the ‘appropriate number of treatment passes that are safe for the patient's skin and can yield optimal results’ are different.

Our medical team prioritizes your skin's safety and satisfactory results, establishing 3 repetitive passes as our guiding principle.

Why don't all medical institutions adopt the R0 technique?

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

• PFD drugs require cost consideration, and stable supply can be difficult.
• The appropriate timing for PFD drug application and the plan for repeated laser irradiation require the medical team's extensive experience and precise judgment.
• Compared to typical tattoo removal methods, PFD procedures may require 2 to 3 times more time.

Therefore, medical institutions that prioritize patient turnover may find it difficult to readily adopt this procedure.

However, we consider the subtlety of the procedure results, along with reducing the patient's procedural burden, as important values.

Therefore, we believe that the effects and potential benefits offered by PFD procedures cannot be overlooked.

At our medical institution, we avoid excessive laser irradiation and meticulously perform repeated irradiation with precise quantities only on the necessary areas.

This is an ongoing process of researching ways to maximize the effectiveness of tattoo removal procedures while protecting the patient's skin.

Our medical institution aims to enhance the efficiency of the procedure process and reduce the burden of the required number of sessions. Furthermore, we prioritize the patient's skin safety and strive to achieve precise and highly satisfying results.