For those considering tattoo removal, the most common question is how many sessions are needed. Since the size, color, type of dye used, amount of pigment, and skin thickness of each tattoo vary, it is difficult to give a definitive answer.
However, there is a way to estimate in advance. If the pigment is deeply embedded, a treatment period of one to two years or more may be necessary, so it is better to start with an approximate range in mind.
Self-Diagnosis Index Divided into Six Items
Dr. William Kirby and Dr. Tejas Desai from the United States developed a self-diagnosis index to estimate the approximate number of tattoo removal sessions and reported it to the dermatology society. The research team identified six factors influencing the number of sessions and announced that the number of sessions could be estimated by summing the scores for each item.
- Skin color
- Tattoo location
- Tattoo color
- Ink volume
- Cover-up tattoo status
- Presence of scars
Skin Color Determines Laser Penetration
Skin color is scored from 1 to 6, from light to dark. This is called the Fitzpatrick skin type, and Koreans generally fall between 3 and 5 points. If your skin is light, give yourself 3 points; if it is dark, give yourself 5 points.
Darker skin interferes with laser penetration due to melanin cells. Conversely, the lighter the skin, the more laser is irradiated to the tattooed area, and the lower the possibility of scars or pigmentation that may occur during the removal process.
If you tan or your skin darkens during summer vacation while undergoing removal, removal may become more difficult.
If you are planning removal, we recommend avoiding tanning and starting with your natural skin condition.
The Higher on the Body, the Faster it Fades
When a laser is irradiated, the tattoo ink in the dermis is broken into fine particles, and these particles are discharged by immune cells through blood vessels or lymphatic vessels. The face and neck have well-developed lymphatic and blood vessels, so removal is relatively faster.
| Location | Score |
|---|---|
| Face, Neck | 1 point |
| Upper body above navel | 2 points |
| Torso below navel | 3 points |
| Arms, Calves | 4 points |
| Hands, Feet | 5 points |
Ink Volume, Cover-up, Scars, and Color
Ink volume is scored 1 point if done by an amateur tattoo artist with a small amount of ink, and 2 to 4 points if done by a professional tattoo artist. If there is little ink, it's 2 points; if there's a lot, it's 4 points. If a lot of ink was deeply inserted into a small area to make lettering or lines clear, the score should be relatively higher.
If a tattoo is covered with a cover-up tattoo, laser irradiation becomes much more difficult, so 2 points are added.
If there are no scars, it's 0 points; depending on the degree, it's scored from 1 to 5 points. If you see a change in texture in the tattooed area, that is a scar. If the needle went too many times during the procedure or if the person is prone to scarring, thick scars may remain, and these scars hinder deep laser penetration.
Excluding black, which absorbs all wavelengths, the more colors mixed, the more difficult removal becomes.
| Color Composition | Score |
|---|---|
| Black | 1 point |
| Black with a little red | 2 points |
| Mainly black and red with a little other color | 3 points |
| Various colors | 4 points |
Approximate Sessions Based on Total Score
When all item scores are added, Koreans are generally known to score between 7 and 15 points. Of course, it may be lower or higher depending on the case.
| Total Score | Estimated Sessions |
|---|---|
| 7 points | 5 to 9 sessions |
| 8 to 10 points | 6 to 14 sessions |
| 11 to 12 points | 8 to 17 sessions |
| 13 to 15 points | 10 to 20 sessions |
This index is based on about 100 patients who received the procedure, so its accuracy is limited, and it should be noted that it is a 2009 study. The number of sessions derived here is not an absolute value and should be used for reference only.
There are many unpredictable variables, such as individual skin conditions or ink volume that differs from what is visible, and a large part can only be known by actually performing the procedure. However, if the estimated number of sessions was around 10, but the actual procedure is progressing to 30 or more sessions, it may be necessary to review the current method.
What Has Changed Since the Index Was Developed
This prediction system is an index that indicates the number of sessions when removed with a Q-switched Nd:YAG laser, i.e., a nanosecond laser. This method is summarized in Nd:YAG Tattoo Removal.
Recently, picosecond lasers, which have a pulse width about 1000 times shorter than nanoseconds, are widely used. A shorter irradiation time breaks down pigment into finer particles, making it easier for immune cells to transport them.
For color tattoos, there are suitable wavelengths for each color, but a single picosecond laser usually has only about two wavelengths. PicoWay has four wavelengths, making it more suitable for removing color tattoos. If R-Zero Pico-Frectat Tattoo Removal with PFD special medication and Pinhole for Burn & Surgical Scar are added, it is possible to proceed in a way that reduces the estimated number of sessions.
If your score and actual progress do not seem to match, please leave a consultation via Chat Now. Results may vary individually.
Authored and Medically Reviewed by Dr. Kang Jin-moon, Chief Director (Dermatologist) Graduated from Yonsei University College of Medicine · Resident in Dermatology at Severance Hospital Former Professor at Bundang CHA Hospital · Member of the Korean Society for Medical Lasers View Medical Staff Introduction
First published 2023-11-08 · Last reviewed 2026-07-29
This article contains general medical information and does not substitute for individual diagnosis and treatment. Results and recovery progress may vary individually.