The R20 Tattoo Removal Method
An Innovation in Treatment Protocols
The R20 laser tattoo removal method is an innovative approach to treating unwanted tattoos. Through a sequence of a series of treatments spaced 20 minutes apart, multiple laser treatments may be performed in one day. Research indicates that the R20 treatment protocol, if properly performed, can increase the speed of the tattoo removal process without unwanted side effects.
Both the standard laser tattoo removal method and the R20 method work by shattering tattoo ink in the dermal layer of the skin.
The standard protocol calls for single treatments to be spaced 6 to 8 weeks apart, allowing time for the natural immune system response that follows the laser procedure to take effect and flush away the shattered ink.
The R20 method typically calls for four laser treatments, spaced 20 minutes apart, to be applied in one day.
When using the R20 method, practitioners are advised to use fluence levels that are 50% to 75% lower than standard protocols to minimize the risk of over-treatment and to never use the 532 nm wavelength. After R20 method treatments are performed, patients should wait at least 8 weeks until their next treatment session to allow complete healing of the treated area.
The 20 minutes of waiting between treatments is an important part of the process. The wait time allows the laser “frosting,” “laser snow,” or “whitening” that occurs in response to a Q-switched laser treatment to subside, thus preventing the next pulses of energy from being blocked.
In many cases, especially on darker skin, the laser frosting will still be apparent. This may lead clinicians to want to wait longer in between treatments, including up to an hour or more for some patients. This delay between individual treatments can create a multi-hour process that may be tiresome and undesirable.
Practitioners should only perform the R20 method on patients that have already undergone a standard laser tattoo removal treatment and have healed as expected. Some patients may have hypopigmentation or hyperpigmentation in reaction to laser treatment, and the R20 tattoo removal method will amplify these side effects. Also, laser practitioners should not treat patients with skin types III-IV with the R20 method because they are the most prone to pigmentary changes.
The only published clinical study on the R20 method used a Q-switched Alexandrite laser, which is an uncommon type of tattoo removal laser. Q-switched Nd:YAG lasers, such as the Astanza Duality and Astanza Revolution, are much more popular amongst tattoo removal practitioners for their versatility, yet have not been scientifically studied with the R20 method.
The 755 nm wavelength of Alexandrite lasers has higher absorption rates by hemoglobin than the 1064 nm wavelength of Nd:YAG lasers, so the 1064 nm wavelength is safe to use with the R20 protocols. However, the 532 nm wavelength from Nd:YAG lasers has higher higher absorption rates by hemoglobin than the 755 nm wavelength, so there is a strong possibility of over-treatment if the 532 nm wavelength is used for the R20 method.
Also, one often-undiscussed element of laser tattoo removal is the optimal time period between patient visits. Most practices wait somewhere between 4 weeks and 8 weeks between treatments. The primary goal of waiting has traditionally been skin healing between sessions. The secondary goal has been to allow the body time to “flush away” the ink that has been shattered by the laser.
The R20 method described in the study showed 3 months of waiting between treatments. Typically, when any additional waiting time between treatments is implemented – regardless of treatment protocols – patients see improved results. Two patients with the exact same tattoo and the same immune system and same treatment would most likely see different responses if one looked at the tattoo after 8 weeks and if another looked after 12 months. The patient that waited a full year would almost certainly have more clearance.
More About the R20 Method
Astanza’s official perspective is that the R20 tattoo removal treatment method should be further explored and only used by cautious and well-trained laser practitioners. Astanza provides in-depth tattoo removal training for all laser customers and offers an open-to-the-public course, New Look Laser College, for those interested in entering the field of laser tattoo removal. Contact Astanza for more information.