Tattoo Removal Sessions: Self-Diagnosis to Predict and Effectively Reduce Them

Hello, I am Dr. Sang-jo Lee, a board-certified dermatologist. One of the most common questions people ask when they visit Yonsei Star Dermatology Sinchon for tattoo removal is, 'How many sessions will it take to remove my tattoo?' Tattoo removal can require a long treatment period of 1 to 2 years or more if the pigment is deeply embedded, so many people are curious about the number of sessions.

Dr. Kirby and Dr. Desai, renowned in the field of tattoo removal, reported to the dermatology society a self-diagnosis index that can predict the approximate number of tattoo removal treatment sessions. Today, we will delve into what factors determine the number of tattoo removal sessions based on this index, and what methods can shorten the number of sessions.

Kirby and Desai's research team identified six factors influencing the number of tattoo removal sessions: skin color, tattoo location, amount of tattoo pigment, presence of cover-up tattoos, presence of scars, and tattoo color. They stated that by scoring each item and summing the total, one can estimate the approximate number of tattoo removal sessions. Let's examine how each factor affects the number of tattoo removal sessions.

1. Skin Color

Skin color is scored from 1 point for light skin to a maximum of 6 points for dark skin. This is referred to as the Fitzpatrick Skin Type; typically, Caucasians are 1 point, African Americans are 6 points, and Asians are usually between 3 and 5 points. If you consider your skin to be light, you would give it 3 points; if your skin is a bit darker, you would give it 5 points.

Darker skin colors affect the number of tattoo removal sessions because melanin particles interfere with laser penetration. The lighter the skin, the less melanin interference, allowing more laser energy to be delivered to the tattooed area, which can lead to better results. The possibility of scars or pigmentation that can occur during laser tattoo removal also becomes very low. In other words, the darker the skin color, the less effective laser penetration may be, potentially reducing the effectiveness of tattoo removal. Therefore, it is important to be careful not to tan or darken your skin color by going on vacation during the tattoo removal period, as this could make tattoo removal more challenging.

2. Tattoo Location

Tattoos located on the face or upper body tend to fade faster. The reason for this can be found in the principle of tattoo removal. When the practitioner irradiates the tattooed area with a laser, the tattoo ink in the dermis is broken down into tiny fragments, and these fragments are then expelled by the body's immune cells through the lymphatic vessels. Since the face and neck have well-developed lymphatic vessels and blood vessels, tattoo removal is easier in these areas.

• Face, Neck: 1 point
• Upper body above navel: 2 points
• Lower body below navel: 3 points
• Upper arms/legs: 4 points
• Lower arms/legs: 5 points

3. Amount of Tattoo Pigment (Ink Volume)

The amount of ink directly affects the number of tattoo removal sessions. If an amateur tattoo artist performed the tattoo using a small amount of ink, it's 1 point. For tattoos done by a professional tattoo artist, it's 2 to 4 points. If the ink amount is small, give 2 points; if it's large, give 4 points. Especially for cases where a large amount of ink was deeply injected into a small area to make lettering or lines clear, the score may be relatively higher. Please keep in mind that this study was conducted in 2009, so there may be some differences compared to recent tattoos.

4. Presence of Cover-up Tattoos

Many people, when they dislike or regret a tattoo, cover it up with a cover-up tattoo. However, this makes tattoo removal much more difficult. Therefore, if you have layered a tattoo with a cover-up tattoo, add 2 points.

5. Presence of Scars

If there are scars in the tattooed area, tattoo removal becomes very difficult. Kirby and Desai's research team assigned 0 points for cases without scars and 1 to a maximum of 5 points depending on the degree of scarring. If there are scars in the tattooed area, you may notice changes in skin texture, which indicates a scar. Scars can occur if the needle went too deep during tattooing, or if an individual is prone to scarring, leaving a thick scar in that area. These scars interfere with laser penetration, increasing the score.

6. Tattoo Color

For tattoo removal, each color requires an appropriate laser wavelength. Therefore, excluding black, which absorbs any wavelength, tattoos with various mixed colors are more challenging to remove.

• Black: 1 point
• Black tattoo with a little red: 2 points
• Mainly black and red with other colors: 3 points
• Multi-colored tattoo: 4 points

By summing the scores from the six categories explained above, you can estimate the approximate number of tattoo removal sessions. For Koreans, scores between 7 and 15 points are most common. Of course, depending on the case, scores can be below 7 or above 15 points. You can refer to the following for the number of tattoo removal sessions based on the score:

• 7 points: Approximately 5-9 sessions
• 8-10 points: Approximately 6-14 sessions
• 11-12 points: Approximately 8-17 sessions
• 13-15 points: Approximately 10-20 sessions

The tattoo removal session prediction system above is an index that indicates the number of sessions when tattoos are removed using a Q-switched Nd:YAG laser, which is a nanosecond laser. Recently, picosecond lasers (Pico Laser), which have a pulse width about 1,000 times shorter than nanosecond lasers, are widely used for tattoo removal, achieving better results. Here are some tips to shorten the number of tattoo removal sessions.

1. Utilizing Picosecond Laser (Pico Laser)

When the laser's irradiation speed is shorter, it breaks down tattoo pigment into finer particles, making it easier for immune cells to absorb and transport them, thus allowing for faster and more effective tattoo removal. Therefore, using a picosecond laser for tattoo removal can shorten the number of sessions.

2. Choosing a Picosecond Laser with Various Wavelengths

To remove color tattoos more quickly, it is recommended to use a device like PicoWay Laser, which has various wavelengths among picosecond lasers. As explained earlier, for color tattoos (excluding black), there are appropriate laser wavelengths for each color. Typically, a single picosecond laser has about two wavelengths, so removing color tattoos can take a long time. However, PicoWay Laser has four wavelengths, making it more suitable for removing color tattoos.

3. Combining Specialized Medications and Techniques

Furthermore, if methods like the R-Zero Technique are added, which overcome the limitation of conventional tattoo removal (only one session at a time) by using specialized medications such as Perfluorodecalin (PFD) to allow up to four repeated treatments, the number of treatment sessions can be reduced more effectively than the predicted number introduced today.

So far, we have learned about a self-diagnosis method that can predict the approximate number of tattoo removal sessions. As explained earlier, this index is based on the results from 100 patients who underwent tattoo removal, so there may be individual differences in the actual number of tattoo removal sessions. Please remember that this is merely a reference and should not be blindly trusted. For a more accurate diagnosis and effective treatment plan, it is important to consult directly with a board-certified dermatologist.