“Doctor, how many sessions will it take to remove my tattoo?”

An accurate estimate on the number of sessions required for tattoo removal is important to patients. Some patients need to work within a time frame to remove a tattoo, especially if they are having a wedding in a few month’s time. Other patients want to estimate costs and time incurred for each treatment. Whatever the case may be, having a degree of certainty with regard to the number of sessions and time required to remove a tattoo would let a patient make an informed decision on whether they would proceed with removal or not.

To understand the amount of time and effort needed for any tattoo removal, laser practitioners worldwide use the Kirby Desai Tattoo removal scale, a clinical predictive scale developed by American Dermatologists working in high-volume tattoo removal clinics. The scale considers patient and tattoo factors to estimate the number of sessions required for complete tattoo removal.

Factor 1: Skin type (1-6 points)

A patient’s Fitzpatrick skin type is graded from type 1 to 6 based on the amount of melanin in the skin. Darker skin types tend to carry more melanin, which reduces the amount of laser energy that reaches the pigment. This means more laser sessions. Additionally, darker skin types tend to have a higher risk of scarring and hypopigmentation. Thus, laser practitioners will usually use more conservative settings and extend the interval between sessions.

Factor 2: Location of tattoo (1-5 points)

After laser treatment, tattoo pigments are pulverized into smaller fragments which are then absorbed into the bloodstream cleared through the lymphatic system. Areas of the body with good blood supply and lymphatic drainage will get rid of the tattoo pigments more quickly.

Factor 3: Amount of tattoo ink (1-4 points)

Amateur tattoos tend to be more superficial and contain less ink when compared to professional tattoos which are deeper and contain more ink.

Factor 4: Layering of tattoos (0-2 points)

One way of concealing an unwanted tattoo is to place a larger and darker colored tattoo over it – a technique known as “layering”. This makes laser tattoo removal more difficult.

Factor 5: Scarring (0-5 points)

Skin implantation of tattoo ink causes trauma and foreign body reaction, which leads to scarring. Scar tissue impedes laser tattoo removal as it blocks both laser energy and the body’s scavenger cells from reaching the tattoo pigments.

Factor 6: Tattoo color (1-4 points)

Black tattoo ink is the easiest to remove, followed by red ink. Green, yellow, and blue inks are difficult to remove. White and pink inks are impossible to remove.

Estimating how number of sessions and time required for tattoo removal

The Kirby Desai scale gives a good estimate, with an 80% accuracy. If a patient scores 10 points on the scale (for an estimated 10 sessions), then the actual number of sessions required will range from 8 to 12 sessions. Each session should be 4-6 weeks apart. Here are some examples of how the Kirby Desai scale can be applied:

Skin type 2 (2point), upper chest (2 points), amateur tattoo (1 point), no scarring/layering (0 points), black ink only (1 point) = 5 sessions

Skin type 5 (5 points), upper chest (2 points), professional tattoo with moderate amount of ink (3 points), no scarring/layering (0 points), multicolored with black, blue, red, orange ink (4 points) = 14 sessions

Skin type 3 (3 points), upper chest (2 points), professional tattoo with significant amount of ink (4 points), no scarring/layering (0 points), multicolored with black, red, yellow ink (4 points) = 13 sessions

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