Tattoo removal – how many treatment sessions do I need?

Case scenario:

Mrs. X, a 40 year old Chinese housewife had black eyebrows tattoo/embroidery done a year ago by an amateur eyebrow tattoo artist which she is very unsatisfied with the design. Now she would like to have her eyebrows tattoo removed so that she can get a new one. She  wanted to know how many treatment sessions she requires. Well, let’s start the calculation.

Skin type                              : 3                 = 3 points
Location                               : face            = 1 point
Amount of ink                      : amateur      = 1 points
Layering                               : no               = 0 point
Scarring & tissue change      : no               = 0 point
Color                                     : black         = 1 point
Total points                           : 6

Estimated number of treatments required by Mrs. X is 6. 

To determine the number of treatments needed for successful removal of tattoos, the Kirby-Desai Scale is used. It is a quantitative system that assigns numerical points to six different factors that, when summed together, reveal a score that determines the number of treatments a patient will need for successful tattoo removal. The six factors are as follows:

1. Patient Skin Type
2. Location of Tattoo
3. Amount of Ink
4. Layering/Cover-Up
5. Scarring/Tissue Change
6. Color(s) of Ink

Skin Type

Skin type or tone can be categorized using the Fitzpatrick Scale, a tool that classifies skin types from a 1 – 6 scale, with type 1 being the lightest skin tone and type 6 being the darkest. Patients with darker skin tones are more susceptible to certain risk of complications, including scarring and hypo or hyperpigmentation. Therefore, patients with darker skin tones need to be treated more conservatively and carefully with safer treatment protocols such as lower energy laser settings and longer waiting periods between treatment sessions, to minimize the risks of unwanted side effects. In general, people with darker skin tones require more visits for best tattoo removal results.


Location is rated on a scale of 1 to 5 depending on how vascularize that area is. Tattoos on the head, face and neck will fade faster, as these have the largest amount of regional lymph nodes and a larger vascular supply, so removing a tattoo from these areas takes less time. Meanwhile, tattoos on distal extremities such as on the feet and hands in particular will take longer to remove. In short, tattoos placed closer to the heart and major blood vessels and lymphatic system fade at a faster rate.

Ink Amount

This is rated on a scale of 1 to 4 depending on the tattoo ink density. Amateur tattoos or homemade tattoos typically contain less ink and is unevenly placed closer to the skin surface which usually require much lesser treatment session. Professional tattoos on the other hand use more ink and the ink is place deeper under the skin.


A layering/cover-up is defined as a tattoo on top of another one in order to conceal the previous piece or design. These often lead to a very heavily dense and saturated tattoo ink in that area. Therefore, more treatments will be needed to successfully remove the ink from the combination of cover-up tattoo and old tattoo.

Scar Tissue

Scar tissue is on a scale of 0 to 5. Scoring is based on the severity of scarring or tissues change, with 0 meaning there is no scarring present and 5 with significant scarring or tissue changes. Tattoos with scarring and tissue change are much more difficult to remove and usually require more treatment sessions.

Ink Color

Ink color is rated on a scale of 1 to 4. Darker colors respond the best to laser tattoo removal and the easiest color to remove, while the hardest are green, yellow, and light blue. Thus, the more colors you have on the tattoos, the more treatment sessions are required.

By using the Kirby-Desai scale, we are able to provide a more precise estimation(80% accuracy) of how many treatments are required for a successful tattoo removal. However the number produced by this scale should not serve as a conclusive answer. It's important to emphasize that this is only an estimate, each person is different and each tattoo removal is unique. Drop in for a consult with any of us at Anna Hoo Clinic regarding tattoo removal. We are more than happy to address whatever doubts and concerns you may have.

Dr. Ian Tan
Anna Hoo Clinic