R0 Method for Tattoo Removal

Immediate Repetitive Treatment Technique Using PFD

Tattoo removal primarily involves breaking down pigments using nanosecond lasers, such as Q-switched Nd:YAG (1064nm). This has long been recognized as the standard treatment method.

However, the conventional method required a recovery period of approximately 6-8 weeks between treatments. The total number of sessions often exceeded an average of 10, meaning it took a significant amount of time to remove a tattoo.

To address these limitations, one of the newly developed methods is the R0 method.

What is the R0 method?

The R0 method is a tattoo removal technique where the same tattoo area is treated with a laser up to 4 times during a single visit.

The main characteristic of this treatment method is the use of a special liquid drug called 'PFD (Perfluorodecalin)'.

When a laser is applied to the skin, a white bubble phenomenon called 'frosting' appears on the skin's surface.

These bubbles scatter light, which can significantly hinder the effectiveness of subsequent laser treatments. 

Previously, it was common to wait several tens of minutes for these bubbles to disappear naturally, or to postpone the next treatment until a later session. However, even with waiting, the bubbles did not completely vanish.

However, using PFD can eliminate frosting in a matter of seconds. This allows for repeated treatments with short laser intervals of about 1-2 minutes.

As a result, it is possible to shorten the treatment period compared to conventional methods while expecting effective pigment reduction.

Actual Research Findings

• Biesman et al., 2013
• Analysis of patients treated with the R0 method showed that the number of treatment sessions could be reduced by 30-50% compared to conventional methods.
• It was also found that immediate repetitive treatment after laser application is possible.
• Kauvar et al., 2020
• In patients who underwent the R0 method approximately 3 times, when comparing the total number of laser treatments (approximately 3 sessions with R0 method vs. approximately 10 conventional sessions),
• The research results showed that 70-90% or more of pigment removal was possible.
• The incidence of side effects such as post-inflammatory hyperpigmentation (PIH) was also reported to be low.

Nevertheless, why are only '3' repetitive treatments performed, not '4'?

Theoretically, the R0 method allows for up to 4 repetitive treatments,

However, in actual clinical practice, treatments often stop at 2-3 repetitions.

The reasons are as follows:

1. Skin Characteristics of Asians

Asian skin tends to have high reactivity of melanin cells. This can lead to a relatively higher incidence of post-inflammatory hyperpigmentation (PIH).

Especially for Fitzpatrick skin types III-IV,

Excessive repetitive treatment can go beyond simply breaking down pigment and cause excessive irritation to the skin itself. This can increase the risk of worsening hyperpigmentation.

2. Balance between Number of Treatments and Safety

While it is possible to perform repetitive treatments up to 3 times while monitoring skin reactions,

If treatments exceed 4 repetitions, the risk of damage to normal tissue increases significantly, and the likelihood of pain, erythema, and minor burn reactions also sharply rises.

3. Limitations of Treatment Efficiency

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

After approximately 3 repetitive treatments in a single session, the efficiency of laser treatment may gradually decrease,

At this point, even if the treatment intensity is increased, the additional treatment effect may not be significant, and instead, only the risk of side effects may increase.

Therefore, there is a difference between the 'technical possibility of up to 4 times' and the 'appropriate number of treatments that can be safely and effectively applied to actual patients'.

We prioritize patient skin safety and effectiveness, and therefore, we generally adhere to 3 repetitive treatments.

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

This method does not provide advantages to all medical institutions.

• PFD drugs are costly and difficult to secure.
• The precise application timing and repeated irradiation plan for PFD drugs must be based on the medical team's extensive experience.
• This procedure may take 2 to 3 times longer than typical tattoo removal procedures.

Therefore, it may be a challenging method to implement in clinics that prioritize efficient patient turnover.

Nevertheless, we prioritize the completeness of the procedure and the reduction of our patients' burden above all else.

We also cannot overlook the advantages and efficiency of this treatment method.

Our medical team performs repeated treatments within the necessary scope without excessive irradiation,

To ensure effective results in tattoo removal while protecting our patients' skin safety, we always approach with caution.

This entire process is part of our continuous efforts to research and improve for more efficient, safer, and satisfactory results.