R0 tattoo removal: key points

PFD and the removal of frosting allow repeated laser passes during one visit. The clinician checks that frosting has cleared and sets the intensity and number of passes according to the tattoo and skin response.

Genuine PFD is applied in a measured amount without dilution. After each pass, the disappearance of white bubbles is checked to determine the timing of the next application. Heat, redness and pain guide adjustments to intensity and pass count. A Mummy Mask provides soothing care immediately after treatment.

Expected benefits and suitable candidates

Potential benefits include fewer repeat visits, time savings, an improved skin tone and appearance, and less distress about an unwanted tattoo. Consultation is recommended for old or dense tattoos, people seeking a shorter treatment cycle, those burdened by many visits, or those planning removal before a wedding or employment milestone.

Before and after treatment

Temporary redness, warmth or mild swelling may occur. Avoid saunas, steam rooms and strenuous exercise for about one week. Moisturize and protect the area from the sun. Discuss sensitive skin or a history of excessive reactions before treatment.

Frequently asked questions

Warmth or stinging may occur. Numbing cream and adjustments to laser output help manage discomfort. Pain can be checked during treatment so output and speed can be adjusted; tell the clinician if you feel uncomfortable. Daily activities are generally possible, but redness or swelling varies by person, so avoid scheduling treatment close to an important event. Avoid saunas, alcohol and vigorous exercise for about one week.

Case photograph: the images show the same person and are unretouched. Results vary between individuals. Redness, bruising and swelling may occur. Treatment by an experienced clinician is recommended.

R0 Tattoo Removal Procedure

Multiple Laser Applications with PFD Medication

Most tattoo removal laser procedures utilize nanosecond lasers, such as Q-switched Nd:YAG (1064nm), to break down pigments within the skin.

However, with traditional methods, after one laser application, patients wait 6-8 weeks for skin recovery before proceeding with the next treatment. This can result in an average total of more than 10 treatment sessions and a lengthy overall duration.

To compensate for the shortcomings of conventional treatment methods, a new approach called the R0 method has been introduced.

Learn About the R0 Method

The R0 technique refers to a tattoo removal procedure where laser is applied consecutively up to 4 times on the same area during a single visit.

A key aspect here is the use of a special liquid medication called ‘PFD (Perfluorodecalin)’.

When a laser is applied to the skin, white bubbles, known as ‘frosting,’ appear on the surface of the treated area.

This layer of bubbles can scatter the laser light, potentially reducing the efficiency of subsequent laser applications.

In the past, it was necessary to wait for tens of minutes for these bubbles to disappear naturally, but even then, the bubbles did not completely vanish. Alternatively, waiting several weeks for the next session was the common practice.

However, applying PFD can resolve the frosting phenomenon within seconds. This makes it possible to shorten the time between laser applications to about 1-2 minutes, allowing for multiple consecutive treatments.

In conclusion, this method has the advantage of reducing the overall treatment period compared to conventional procedures while still offering effective pigment reduction.

Efficacy of the R0 Method Confirmed by Research

• Biesman et al., 2013
• Studies have reported that patients treated with the R0 method were able to reduce the number of treatment sessions by approximately 30-50% compared to traditional methods.
• Concurrently, it has also been confirmed that consecutive treatments are possible immediately after laser application.
• Kauvar et al., 2020
• When observing patients who had received the R0 method approximately three times, once the total number of laser applications reached about 10 (approximately 3 times with the R0 method),
• It was observed that over 70-90% pigment removal efficacy was achieved.
• Furthermore, the incidence of side effects such as post-inflammatory hyperpigmentation (PIH) was also reported to be low.

The R0 method is theoretically known to allow up to 4 repeated applications. However, in practice, it is often performed only about 3 times. What is the reason for this?

Theoretically, the R0 method is a procedure that allows for up to 4 repeated applications.

However, in actual practice, treatments are often concluded with 2-3 repeated applications.

There are several points to consider:

1. Characteristics of Asian Skin

Asian skin tends to have a high reactivity of melanocytes, and the likelihood of post-inflammatory hyperpigmentation (PIH) occurring is relatively higher.

Especially for those with Fitzpatrick skin types III~IV,

Excessively repeated laser applications can go beyond merely destroying pigment, potentially causing unnecessary irritation to the skin, which in turn carries the risk of deepening hyperpigmentation.

2. Consideration of Application Count and Safety

Up to 3 applications, repeated irradiation can be continued while carefully observing the skin's reaction.

However, if applications continue for 4 or more times, the likelihood of damage to normal skin tissue, along with pain, redness, or mild burn reactions, can significantly increase.

3. Limitations of Laser Application Efficiency

Even with the use of PFD, there are physical limitations to the amount of laser light that can reach the target pigment particles.

After about 3 repeated applications in a single session, the laser's penetration efficiency tends to gradually decrease thereafter.

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

Therefore, the ‘technical range allowing up to 4 applications’ and the ‘number of applications that can be safest and most effective for the patient’ must be considered separately.

For this reason, medical professionals will carefully review the patient's skin safety and treatment efficacy, primarily performing 3 repeated applications as a standard.

What are the reasons why the R0 method, with its numerous advantages, is not adopted by all medical institutions?

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

• The use of PFD drugs involves cost considerations, and there can be limitations in drug availability.
• The PFD procedure requires extensive experience and delicate judgment from medical staff to apply the drug at the precise time and plan multiple laser irradiations.
• Compared to other common tattoo removal methods, this procedure can take two to three times longer.

Due to these characteristics of the procedure, it may be difficult for medical institutions where quick patient response is crucial to easily choose it.

However, we place greater value on patient satisfaction with the treatment results and minimizing physical discomfort for our patients.

Therefore, we highly consider the effective aspects of the procedure offered by the PFD technique.

During tattoo removal procedures using PFD, unnecessary laser irradiation is avoided, and the treatment is precisely and repeatedly applied only to the necessary areas.

We prioritize our patients' skin safety and continuously seek methods to enhance satisfaction with tattoo removal.

This helps reduce the burden of multiple treatment sessions and allows you to achieve desired results in a relatively safe manner.