R20 laser tattoo removal is sometimes referred to as ‘Accelerated Tattoo Removal’. It essentially works the same as standard tattoo removal by shattering the ink in the dermal layer of the skin but has a very different procedure. While standard tattoo removal involves passing over the unwanted tattoo once per session and waiting 5-6 weeks between sessions; R20 removal procedures consist of multiple treatments in 1 day (usually 4) spaced around 20 minutes apart. The patient then has to wait 8 weeks before their next R20 session. The 20 minute wait between treatments is to allow ‘frosting’ that often appears with laser tattoo removal to subside(see pictures below) and ensure the laser pulses are not blocked on the next passing.

frosting
This image is before & after a standard tattoo removal session to illustrate ‘frosting’.

So, why should you avoid R20 removal?

First of all, there is only one published study on the R20 removal procedure which uses a Q-Switched Alexandrite Laser. This type of laser is uncommon and not as powerful as the Q-Switched ND-YAG lasers that are more widely used now. You can take a look at the abstract from the study here. The study itself has quite a few problems:

  • The sample size for the study was very small (12 participants)
  • As stated above, the laser used in the study is very uncommon.
  • The starting intensity of the laser was very aggressive for the first treatment.(5.5J/cm², 755nm, 100-nanosecond pulse duration, 3-mm spot size) . The starting intensity should be tailored to the skin type using the Fitzpatrick scale.
  • No darker skin tones were tested which are the most prone to pigmentary changes.
  • The method was only tested on black and blue inks.

The method has only been tested with one type of laser which is not as powerful as some of the more modern lasers which are more commonplace in practices. The more modern lasers have not been thoroughly tested with the method and so there is an even greater risk of extensive damage.

The R20 method can also cause greater epidermal injury to the treated area and this is stated in the study abstract (link above). There is also an increased risk of texture changes although it also states that none of the participants suffered scarring.

A standard tattoo removal procedure can take around 15 minutes whereas the R20 method can take anything from 80 minutes+ depending on the amount of time that is left between passes. This means that patients will have to take more time out and practices will have to book more time out to accommodate the method.

The method is also way too aggressive for sensitive skin types and would more than likely cause scarring or extensive skin injury. All patients should first be categorised using the Fitzpatrick scale so that the laser intensity is suited to their skin type.

The R20 procedure may fade tattoos quicker than standard methods, it is doing so at what cost? You may have to wait a little longer with standard removal but your skin will thank you for it.

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