A few years ago, there was some noise about a faster way to accomplish tattoo removal in a report from a group in Italy. The basic idea is that we normally can only achieve one pass with the laser and then the immediate whitening effect that we call “frosting” occurs and prevents our performing multiple passes with the laser. The Italian group suggested that if you return the client to the waiting room and have them wait for 20 minutes, this frosting effect will resolve and the client can get another pass with the laser. This is repeated for as many as four passes. The claim is that the tattoo fades more readily with this approach. They call this the “R20 Tattoo Removal Method”.

I’m not willing to let an opportunity slip me by to improve outcomes for our clients and so I had dinner with an Italian laser engineer familiar with the process back in 2009 or 2010. I purchased several domain names related to the process in a hedge that there may be something to this approach. We performed our own study in which we attempted to validate the R20 Method in using our lasers at our clinic.

What we found is that there many be some slight improvement in lightening of certain tattoos with R20 method but that the complication rate soared. We had many more clients come back for their follow up visits 6-8 weeks later still healing from these R20 sessions and consequently had to have their next sessions deferred to allow for continued healing. I found this result to be unacceptable under the ancient medical law: “Primum non nocere” or “First, do no harm”. Unfortunately, many clinics across the country saw an opportunity to make more money by jumping on the R20 bandwagon and charging by the pass such that 4 passes of the laser would cost the client 4 times more money, even though they don’t get 4 times the result.

Bottom line, beware of clinics that offer to give you a better result with R20 method. We could adopt this approach at our clinics and bolster our bottom line but I think this is the wrong approach.