R20 Method

Introducing the R20 method for laser tattoo removal

A protocol has been presented for laser tattoo removal that has the potential to revolutionise laser tattoo removal treatments. Published in the Journal of the American Academy of Dermatologyin Zoll (Kassida et al), the study showed that 61% of tattoos were removed in a single session.


Conventional laser tattoo removal involves a single pass with the laser over the tattoo ink. The skin immediately appears white and the tattoo appears to have been removed or reduced dramatically. This is a temporary effect called frosting or vacuolization and is usually exploded gas trapped beneath the skin surface. This frosting prevents further laser treatment from penetrating to the ink pigment.

What is most exciting is that the authors of the R20 method recognise that this frosting will disappear in 15-20 minutes, allowing for further laser treatment to be performed. In fact 3-4 treatments performed in a single session resulted in significantly more fading without increasing the risk of scarring without any added discomfort.

The R20 method for tattoo removal has the potential to revolutionise the tattoo removal industry because it addresses the top three reasons that people do not have their tattoos removed.

  1. It takes too long. The average tattoo can take up to 12-18 months to remove completely. The R20 method can reduce this time significantly. The study cited that professional tattoos showed a 70% improvement with the R20 method compared to a single pass method.
  2. Too many appointments. A series of treatments are often required and depending on the ink used, location on the body and other factors, anywhere between 5 and 15 treatments can be required. The R20 method involves fewer (and longer) office visits.
  3. It costs too much. The R20 method can be significantly less costly as well.

What did the R20 studies have to say about the new method?

From self-assessment questionnaire on R20.

  • 90% reported the R20 outcome was cosmetically appealing
  • 93% found R20 very tolerable
  • 96% found R20 cost effective
  • 87% considered R20 practical
  • 97% would recommend R20 to others

An abstract study for the R20 method can be viewed below.



Unwanted tattoos are treated with Q-switched lasers. Despite a series of treatments, efficiency is limited.


We compared a single Q-switched laser treatment pass with 4 treatment passes separated by 20 minute intervals.


18 tattoos on 12 adults were divided in half and randomized. One half received a single treatment pass (the ‘conventional’ method with a Q-switched Alexandrite laser (5.5)/cm2, 755nm, 100 nanosecond pulse duration, 3mm spot size), and the other half received 4 treatment passes with an interval of 20 minutes between passes (the ‘R20’ method). Tattoo lightening was compared 3 months later, by blinded evaluation of photographs. Biopsy specimens obtained before and immediately after treatment on both halves were also compared in blinded fashion.


Immediate whitening reaction occurred on the first treatment pass, with little or no whitening on subsequent passes. 3 months later, treatment with the R20 method was much more effective than conventional single-pass laser treatment (all tattoos favored the R20 method). Despite greater epidermal injury with the R20 method, neither method caused adverse events or scarring. Light microscopy showed greater dispersion of tattoo ink with the R20 method.


This prospective study involved a small number of subjects.


The R20 method is much more effective than conventional laser tattoo treatment, removing most tattoos in a single treatment session. New laser device technology is not required to practice this method.

For more information, please visit our FAQ section for the R20 method.

R20 tattoo method explained

So you have just read the case study about a new technique used for laser tattoo removal called the ‘R20 method’. Dr. Theodora Kassida in Greece came up with this new technique which involves: multiple passes over the tattoo during one session, instead of making just one laser pass over the same tattoo, during each visit; with the R20 method, multiple passes are made over the same tattoo with a 20 minute interval between each pass.

The main purpose is to clear out the ink and get rid of unwanted tattoos in much less time, i.e. shortening the time needed to get rid of a tattoo by a greater amount. Since there will be many questions and maybe some misunderstanding regarding this new method, please read the following FAQ’s to clear up any confusion.


Q: Is the R20 a new laser?

A: No. The R20 is a method used. It is simply just a new technique. It is not a new laser!

Q: Is the new R20 method safe?

A: So far, the final results have been encouraging. In the initial study by Dr. Kassida, the new technique was used on 18 tattoos of 12 patients. Most tattoos were black amateur tattoos, not professional. As with anything new, it takes a while before the short comings and problems are recognized.

Q: How many passes can be done over the tattoo?

A: In the original study by Dr. Kassida, there were 4 passes made over the tattoo. With 4 passes there was more damage to the epidermis (temporary swelling, bruising, redness, blistering etc.) this is a perfectly normal reaction for the skin to have but can be more severe than what you could expect using the conventional method. We monitor immediate skin reaction closely during and after each pass. How many passes in one session is based upon what kind of reaction we see. If we feel that just 3 passes are viable, due to a continued observation of your skin and we decide 3 passes is enough then please accept our professional opinion.

Q: I have colours in my tattoo. Can the R20 method still be used?

A: Colours in a tattoo can make the process a little more difficult, no matter which methods are used we always urge our clients to be aware that it can take longer for removal of coloured tattoos.

Q: Does it hurt more with each laser pass over the tattoo?

A: No. Most clients suggest that the sensation is the same or even less with each pass.

Q: What is the cost?

A: You will be charged the same price for each pass, the same price as you would for a single pass. This is due to the fact that for every single pass, the lasers costly internal and external consumable parts, like crystals, flash bulb lamps, precious gems such as garnets and lenses will have been greatly deteriorated, so extra passes unfortunately will need to be paid for.

Please feel free to book a free consultation to see if the R20 method is right for you.