R-20 Method Explained

We sometimes hear the term “R-20 Method” in laser tattoo removal.  R-20 refers to the practice of “repeating” the laser tattoo removal procedure after 20 minutes.  The technique was developed by a physician who wanted to clear tattoos more rapidly.  However, the study pointed out that although it appeared to be initially helpful in some black inks, colors like green and blue were resistant.  Additionally, it has been shown that the more laser energy put into a given area increases the risk of tissue damage and thermal injury.

The R-20 process:  When a tattoo is treated with a laser, the area “frosts” or looks cloudy.  This frosting is caused by gasses forming under the skin.  Doctors who perform the R-20 method must wait 20 minutes for these gasses to reabsorb before doing the next pass with the laser because the gas layer effectively blocks or reflects the laser energy.  Some practitioners repeat the tattoo removal treatment every 20 minutes for a total of 4 passes.  Even some PicoSure clinics have utilized the R-20 method.  I have seen patients who received scarring resulting from both Q-switched and PicoSure R-20 procedures.

I personally do not use the R-20 method because I don’t believe it is necessary when the PicoSure settings are correct for a given tattoo and the delivery is meticulous and methodical.  In short, a single pass, performed correctly, can be just as effective as 4 quick passes.  In fact a thorough single pass may actually improve the outcome because it requires precision and technique while reducing the energy put into the tattoo and surrounding skin.  And let’s not forget, a single pass is less expensive than charging a patient 4 times the standard treatment amount.  It is also less damaging to the skin and takes less time.  The clinical trials which were used to get FDA clearance for the PicoSure did not use R-20 as a treatment standard.

In truth, technique is a huge part of the effectiveness of the PicoSure laser.  A laser is a tool just like any other.  We know that buying a cook book doesn’t make us a chef.  Handing a scalpel to an intern doesn’t make them a brain surgeon.  Tattoo removal with PicoSure requires strategy, experience and commitment on the part of the practitioner and the patient.


Please call Brendan @  512-327-5337

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