In fact, it is almost impossible to determine the exact number of laser treatments a patient will need. Why is this? Every patient is different and so is their tattoo. The rate at which a tattoo fades is dependent on a variety of factors that are specific to each patient.
Drs. Will Kirby and Alpesh Desai, specialists in tattoo removal, created a predictive scale to help quantify the number of treatments needed for a patient to achieve optimal results. Named the Kirby-Desai scale, this practical tool can help estimate the total number of treatment sessions needed for an individual patient.
Patient Skin Type: 1 to 6
Laser tattoo removal can be successful across all patient skin types. However, patients with darker skin tones and more melanin are more susceptible to experiencing pigmentation changes likes a lightening or darkening of the skin. For this reason, laser practitioners revert to safer treatment protocols such as lower energy laser settings and longer waiting periods between treatment sessions to minimize the risks of unwanted side effects. According to the Kirby-Desai scale, lighter skin types need fewer sessions.
|Skin Type||Features||Tanning Ability|
|Type I||Caucasian; blonde or red hair, freckles, fair skin, blue eyes||Always burns, never tans|
|Type II||Caucasian; blonde/red hair, freckles, fair skin, blue/green eyes||Usually burns, then tans|
|Type III||Darker Caucasian, light Asian||May burn, tans well|
|Type IV||Mediterranean, Asian, Hispanic||Rarely burns, tans well|
|Type V||Middle Eastern, Latin, light-skinned African, Indian||Very rarely burns, tans well|
|Type VI||Dark-skinned African||Never burns, tans well|
Location of Tattoo: 1 to 5
Once a laser shatters the ink trapped in the dermal layer, the ink pigments are flushed out by the body’s immune system, specifically the blood and lymphatic system. Thus, tattoos placed closer to the heart and major blood vessels fade at a faster rate. According to the Kirby-Desai scale, tattoos on the head, neck, and upper body need fewer treatments than outer regions of the body such as the feet and hands.
Color(s) of Ink: 1 to 4
Each color used in a tattoo requires a specific wavelength of light to be removed. Some tattoo colors are considered easier to remove than others. Black is known to be the easiest color to treat as it absorbs all wavelengths. Second to black is red, when compared to other colors.
Green, yellow, and blue are considered some of the most difficult to treat, thus receiving a higher point on the Kirby-Desai scale.
Amount of Ink: 1 to 4
There are two types of tattoo applications – amateur and professional. Amateur tattoos tend to contain less ink and have unevenly applied ink. Conversely, professional tattoos typically use more ink and place the ink deeper into the skin. In their study, Drs. Kirby and Desai found that most amateur tattoos were smaller in size in comparison to professional tattoos. They categorized the amount of ink into 4 categories: amateur, minimal, moderate, and significant, with amateur needing the fewest number of treatments.
Scarring/Tissue Change: 0 to 5
Tattoo application can sometimes lead to scarring and tissue change, depending on how aggressive the tattoo artist applied the tattoo. Tattoos that have existing scarring and tissue change are much more difficult to remove and usually require more treatment sessions. The study found that patients with darker skin types are more prone to scarring. Scoring is based on the severity of scarring or tissues change.
Layering/Cover-Ups: 0 to 2
Many patients try to remove a tattoo by covering or layering a new design over the previous unwanted tattoo. The new tattoo is usually larger in size and often uses twice the amount of ink in order to effectively conceal the preexisting tattoo. Laser tattoo removal on a cover-up tattoo will first remove the new tattoo and reveal the original tattoo. Therefore, more treatments will be needed to successfully remove the ink from the combination of cover-up tattoo and old tattoo.
The keyword being estimate, as the Kirby-Desai scale is only 80% precise.
Although there is no definitive answer as to how many treatments a patient will need for complete removal. The Kirby-Desai scale allows a more accurate prediction of the number of treatments needed, however the number produced by this scale should not serve as a conclusive answer.