Tattoo Removal Using R0

Immediate Repetitive Irradiation Method Using PFD

In laser tattoo removal procedures, it is common practice to use a nanosecond laser, such as a Q-switched Nd:YAG 1064nm, to finely break down pigments.

However, the conventional approach requires waiting 6-8 weeks for skin recovery after a single laser session before proceeding with the next treatment. For this reason, the total number of sessions often exceeds an average of 10, and tattoo removal can take a considerable amount of time.

A new approach that has emerged to overcome these procedural difficulties is the R0 method.

What is the R0 Method?

R0 is a tattoo removal method where the laser is applied sequentially up to four times to the same tattooed area during a single patient visit.

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

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

These bubbles scatter the laser light, significantly reducing the effectiveness of subsequent laser passes.

In previous methods, one had to wait tens of minutes for these bubbles to disappear on their own. However, even with such a wait, the bubbles often didn't completely vanish, and sometimes it was common to wait until the next session.

However, by applying PFD, frosting can be eliminated within seconds, allowing the laser application interval to be shortened to 1-2 minutes, making multiple repetitive applications possible.

Consequently, this means that a noticeable reduction in pigment can be expected within a much shorter treatment period compared to conventional methods.

Actual Research Cases

• Biesman Research Team, 2013
• It was reported that patients who underwent the R0 method were able to reduce the number of treatment sessions by approximately 30-50% compared to conventional methods.
• It was also confirmed that immediate repetitive irradiation is possible after laser application.
• Kauvar Research Team, 2020
• For patients who underwent the R0 method approximately 3 times, when considering a total of 10 laser applications (approximately 3 times with the R0 method),
• The results showed that it was possible to achieve more than 70-90% pigment removal.
• Furthermore, it was reported that the incidence of side effects such as post-inflammatory hyperpigmentation (PIH) was low.

However, in practice, why is it common to perform repetitive irradiation only about '3 times' instead of '4 times'?

Although the R0 method is theoretically capable of repetitive irradiation up to 4 times,

In actual clinical practice, it is usually stopped after about 2-3 repetitive irradiations.

There are several reasons for this.

1. Characteristics of Asian Skin

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

Especially for those with Fitzpatrick Skin Type III~IV,

Excessive repetitive laser irradiation can go beyond pigment destruction and cause excessive stimulation to the skin, which may actually darken the hyperpigmentation.

2. Balance Between Number of Irradiations and Procedure Safety

Up to 3 times, repetitive irradiation can be performed while observing the skin's reaction, but

If irradiation exceeds 4 times, the risk of damage to normal skin tissue, as well as pain, erythema, and minor burn reactions, can significantly increase.

3. Limitations of Laser Irradiation Efficiency

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

If repetitive irradiation is performed about 3 times in a single session, the efficiency of laser irradiation gradually begins to decrease thereafter,

At this point, even if the laser intensity is increased, the therapeutic effect gained is not significant, and there is a high possibility that only the risk of side effects will increase.

In conclusion, there is a difference between the technical possibility of 'up to 4 times' and 'the optimal number of irradiations that can be safely and effectively applied to a patient's skin.'

Therefore, our medical team prioritizes patient skin safety and treatment effectiveness, generally adhering to a principle of 3 repetitive irradiations.

So, why doesn't every medical institution utilize the R0 method?

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

• PFD drugs are expensive and difficult to obtain.
• The timing of drug application and repeated laser irradiation require the delicate judgment of experienced medical professionals.
• Compared to general tattoo removal procedures, the procedure itself takes 2 to 3 times longer.

For these reasons, it may be burdensome to apply in places that prioritize 'patient turnover'.

Nevertheless, we prioritize the completeness of the procedure and reducing the burden on our patients.

Therefore, it is difficult to overlook the advantages of this procedure.

[Clinic Name] is committed to performing treatments with only the appropriate amount of laser energy, avoiding unnecessary excessive irradiation.

We prioritize the safety of the patient's skin and always seek ways to enhance the effectiveness of tattoo removal.

We strive for swiftness in the procedure process, reduce unnecessary sessions, ensure stability, and endeavor to achieve highly satisfactory results.