"How many sessions will it take to get rid of it?" "If I want it gone quickly, can I just have it done stronger and more often?" These are the questions that come up most often in tattoo removal consultations. To give the conclusion first, the outcome of tattoo removal depends on "the right wavelength, the right interval and the right aftercare" rather than "stronger and more often". This article sets out, in turn, how the number of sessions is gauged, the questions of color and interval, and what can happen when treatment is delivered at high intensity.
Three-Line Summary
- Tattoo removal does not go faster just because sessions are stronger or more frequent. A wavelength suited to the color, a sufficient interval and aftercare decide the outcome, and if you have high-intensity sessions at short intervals to clear the tattoo quickly, a white scar can be left in place of the tattoo.
- The number of sessions needed is gauged with the six items of the Kirby-Desai scale (skin tone, location, color, amount of pigment, scarring and layering). This score, though, is not a promise of a session count but a measure of how difficult your tattoo is to remove.
- Unless you are in a hurry, sessions are spaced about 6–12 weeks apart. Add-on methods such as fractional laser pre-treatment are brought in depending on the type of tattoo and how treatment is progressing, and even when all of this is taken into account, a scar is sometimes left.
The Variables That Decide the Outcome of Tattoo Removal
From the standpoint of a board-certified dermatologist, tattoo removal is not just a matter of firing a particular laser device. It is a treatment in which the chemical properties of the pigment, the physiology of the skin and the time healing takes all have to be read. The outcome is decided by many factors together, including the choice of wavelength, the interval between sessions and aftercare. Grouped together, the things we consider when planning tattoo removal are as follows.
| Category | What we consider |
|---|---|
| Characteristics of the tattoo | Color and pigment ingredients; depth and amount of pigment (amount of ink); size and area; whether it is a cover-up or has been touched up; time since the tattoo was done; whether the surface is uneven or scarred |
| Characteristics of the skin | Skin tone (Fitzpatrick skin type); anatomical location; smoking status; history of allergy; age |
| What we weigh when planning treatment | Likelihood of scarring; likelihood of hyperpigmentation; choice of laser wavelength (type of laser); energy setting; interval between sessions; a test spot to check in advance for possible paradoxical darkening; the possibility of an allergic reaction and how to manage it; method of anesthesia; whether combined treatment with a fractional laser is needed |
Why So Many Things Are Considered
It is so that the tattoo can be removed safely, with as little scarring as possible. Even if it takes more sessions, and even if longer intervals between laser sessions stretch out the overall time, what matters most is removing the tattoo without leaving a scar. If you have high-intensity sessions at short intervals because you want it gone quickly, all that is left in the end may be a white scar.
Of course, even when all of these things are taken into account, there are cases where a scar is unavoidably left. No method lets us promise that scarring will not occur. This article looks at just a few of the basic items from the list above.
How Many Sessions Will It Take? — Gauging With the Kirby-Desai Scale
The biggest concern for people who want a tattoo removed is "How many sessions will it take?" A tool widely used to gauge this is the Kirby-Desai scale. The scores for six items are added up, and the total is read against a chart that matches scores to numbers of treatment sessions.
Reading the chart roughly, 5–7 points can be taken as about 5–10 sessions, 7–10 points as about 5–12 sessions, and 10–13 points as about 8–15 sessions. These are statistical values, though, so please treat them as no more than a rough guide.
The Six Items That Are Scored
| Item | What makes removal harder |
|---|---|
| Skin tone | The darker the skin tone, the harder treatment becomes. |
| Location | Tattoos on the face and neck are removed relatively easily, and removal gets harder in the order of the upper trunk, the lower trunk, the parts of the arms and legs nearer the trunk, then the parts nearer the hands and feet. |
| Color | Black alone is the easiest, and the more colors there are, the more sessions are needed. |
| Amount of pigment | It depends on whether the tattoo was done by an amateur, is just an outline, has shading, or is solidly filled in. The more pigment there is, the more sessions are needed. |
| Scarring | If there is scarring in the tattooed area, or scarring develops during treatment, treatment progresses more slowly. |
| Layering | The more layers of pigment there are, the harder it becomes. A cover-up, where one tattoo has been covered with another, also counts here. |
The Score Is a Measure of Difficulty, Not a Promise of a Session Count
With a low score, a tattoo can be removed relatively quickly. With a high score, by contrast, not only are multiple sessions needed, but removal itself can be difficult, so it calls for finely tuned treatment that takes each characteristic of the tattoo into account.
So after working out your score, rather than thinking "It will be gone once I have had just the number of sessions that goes with my score", it is better to take it as a measure of how difficult your tattoo is to remove. If you take it purely as a session count, you may find yourself having high-intensity sessions at short intervals and wondering "Why isn't it coming off?" In consultation, too, we start by using this score to get a rough idea of the difficulty.
Why the Color of a Tattoo Matters
Depending on the color of the tattoo, the laser used may differ, the method may differ even with the same laser, and even within the same method the intensity often has to be varied. Colored tattoos also tend to carry a higher likelihood of scarring. The reason things have to be varied like this is that different pigment ingredients are used for different colors.
Color Groups and Pigment Ingredients
- Black shades — carbon black, iron oxide
- Red, orange and yellow shades — cadmium, azo compounds, quinacridone, iron oxide and others
- Blue, green and purple shades — copper phthalocyanine, phthalocyanine green, cobalt, manganese, quinacridone and others
- White shades — titanium
Broadly, removal gets harder going from the top of this list to the bottom. Yellow, skin-toned shades and white in particular may respond poorly to the laser itself, or may even turn darker after laser treatment. This is called paradoxical darkening, and a test spot is used to check for the possibility in advance. Why this happens with eyebrow tattoos is explained separately in our article on eyebrow tattoo discoloration.
Wavelength and Difficulty Vary With Color
Depending on the color, a different type of laser, that is, a different wavelength, may be used. For example, 532 nm is used for red and yellow, 1064 nm for black and blue, and yet another wavelength for green and purple. Even within the same laser, the way it is delivered may also be varied.
In published research, removal was found to be easiest in the order black, blue, red, green, then yellow and white. The order differs a little from source to source, but they agree that black is the easiest and the white end is the hardest.
A 4-Week Interval May Not Be the Right Answer
For a long time, 4 weeks was the generally accepted interval for laser tattoo removal. As of September 2025, when this article was first written, however, intervals of 6–8 weeks, and up to 8–12 weeks at the longer end, are sometimes recommended. In a study published in 2012, involving 352 people, the result was that leaving an interval of 9 weeks or more was more effective than a shorter interval of 8 weeks or less.
This means that, rather than treating often, it is better to leave enough of an interval to give the pigment broken up by the laser time to be absorbed. I prefer about two months, that is, an interval of 6–8 weeks. If you are not in a hurry, I recommend leaving about 6–12 weeks between sessions rather than keeping the interval short.
Differences by Smoking and Color
There is also research in which treatment was less effective in smokers than in non-smokers. In the same study's results by color, there was no great difference for black and red, but the results differed widely for the other colors. If you smoke, you should bear in mind in advance that treatment may take a little longer overall.
Why Stronger Is Not Better — Problems That Can Follow Laser Treatment
You may feel that stronger, more frequent treatment ought to remove a tattoo faster. We saw above that leaving an interval is better than treating often. So why is high-intensity treatment not a good idea? After laser tattoo removal, the following problems sometimes arise.
- The color spreads and remains
- The area loses its color and turns white
- Blisters form
- An allergic reaction occurs
- A scar is left
Treating in such a way that none of these problems ever arises is close to impossible. Even so, treatment has to keep these problems to a minimum.
Conditions That Make Problems More Likely
- High energy and too small a spot size — using high energy damages the basal layer of the epidermis and lets heat spread into the surrounding tissue, which raises the risk of scarring.
- Colored tattoos — colored tattoos that respond poorly to treatment are said to scar more often than other tattoos. This is because the mix of colors calls for high energy, and treatment ends up being repeated.
- Deep, heavy pigment — the more pigment a tattoo holds, the higher the energy and the more sessions it needs, so the risk of scarring rises along with it.
- Darker skin tones — hyperpigmentation and loss of pigment are said to have appeared more often in darker skin.
So more care is needed with colored tattoos, tattoos that appear to hold a lot of pigment, and darker skin tones. In these cases, high-intensity treatment is avoided.
Normal Reactions, and Signs That the Intensity Needs Adjusting
After laser treatment, a range of local reactions appears in most cases. Blisters, swelling and scabs count among the normal reactions. But if a blister forms the moment the laser is fired, or purpura comes up too severely the moment it is fired, the intensity needs to be adjusted. Scarring is also more likely when infection sets in, so aftercare is important.
Ways to Improve the Effect Without Raising the Intensity
High energy raises the risk of scarring. So attempts have continued to improve the effect by other means, not by turning up the intensity.
R20 and R0
The first method to be used was R20, in which the laser is delivered 4 times at 20-minute intervals. After one pass, there is a 20-minute wait for the area that has turned white (frosting) to fade, and then the laser is delivered again. This method came out of research on lighter skin, however, and it is regarded as not a particularly safe method for Koreans. That is because the likelihood of inflammation, hyperpigmentation and scarring goes up.
R0 is a method that does away with this waiting time. After a laser pass, an agent is sprayed on to make the bubbles subside quickly, and several passes are delivered one after another without the 20-minute wait.
Fractional Laser Pre-Treatment
As of September 2025, the approach in wide use is to apply a fractional laser first. Pre-treatment with a CO2 or erbium fractional laser partly opens the epidermal barrier, and this improves energy delivery and helps the remaining pigment to be expelled.
Ordinarily, because of the gas bubbles and internal particles produced when the laser is fired, further laser passes delivered immediately afterward are less effective. The principle is that if tiny holes are made first, the two passes both work effectively regardless of this. There is also a variation that uses the fractional mode of a picosecond laser, without a CO2 or erbium fractional laser.
Carried out appropriately, it can improve the effect of treatment while reducing the likelihood of scarring, and there are also results in which the number of treatment sessions fell. It is not a method that is always needed, however; it is one that can be added depending on the type of tattoo and how treatment is progressing.
How I Divide the Cases
For tattoos that look likely to be removed within about 5–10 sessions, I treat with a picosecond laser alone. For some tattoos that look as though they will need more sessions, I have been trying the approach of using a fractional laser as well. The device used for tattoo removal at ABLE Dermatology is PicoPlus, a picosecond Nd:YAG laser.
New Tattoos and Old Tattoos
Which Comes Off More Easily?
Older tattoos are slightly easier. That is because natural fading, clearance by the immune system and chemical change in the pigment go on over time.
As a trend in the average number of treatment sessions, tattoos less than 1 year old take about 12–15 sessions, tattoos 5–10 years old about 8–12, and tattoos 10 years old or more about 6–10. These figures show a trend, so the actual number depends on the variables we looked at earlier.
Can a Recent Tattoo Be Removed Right Away?
Some people regret a tattoo not long after having it done and want it removed right away. For the reason given above, it is advisable to leave a little time first. For a new tattoo, the time to start removal is at least 8 weeks after it was done, and the recommended time is 8–16 weeks after; for colored tattoos containing several colors, waiting 3–6 months is recommended.
To Sum Up — Strategy, Not Intensity
In tattoo removal, stronger, more frequent treatment can actually do more harm than good. The key to tattoo removal is removing the tattoo safely and predictably, by bringing together a wavelength matched to the color, a sufficient interval, add-on methods where needed and thorough aftercare. That is why it is better to know something about tattoo removal before you have it done.
The session numbers and intervals given in this article are statistical trends, and they vary from person to person and from tattoo to tattoo. Please decide on a specific diagnosis and treatment plan after a thorough consultation with the medical team treating you.
From Consultation Through Treatment
A board-certified dermatologist examines you directly, identifies which layer the cause sits in, sets the device and the parameters, and then carries out the procedure as the same physician. This is not a structure in which a consultant sells the treatment.
The number of sessions, the intervals, the maintenance point and the cost are agreed together before the first session.
Frequently Asked Questions
- How many sessions does tattoo removal take?
- It is gauged by adding up the scores for the six items of the Kirby-Desai scale (skin tone, location, color, amount of pigment, scarring and layering). Roughly, 5–7 points can be read as about 5–10 sessions, 7–10 points as about 5–12 sessions, and 10–13 points as about 8–15 sessions. These are statistical values, though, so it is better to take the score as a measure of how difficult your tattoo is to remove than as a fixed number of sessions.
- Will it come off faster if the treatment is stronger?
- It would be hard to say so. High energy damages the basal layer of the epidermis and lets heat spread into the surrounding tissue, which raises the risk of scarring. If you have high-intensity sessions at short intervals to get rid of the tattoo quickly, all that is left in the end may be a white scar.
- How far apart should laser tattoo removal sessions be?
- A 4-week interval was the norm for a long time, but as of September 2025, intervals of 6–8 weeks, and up to 8–12 weeks at the longer end, are sometimes recommended. In a study published in 2012, involving 352 people, intervals of 9 weeks or more were more effective than shorter intervals of 8 weeks or less. If you are not in a hurry, we recommend an interval of about 6–12 weeks.
- Are colored tattoos harder to remove than black ones?
- On the whole, yes. The pigment ingredients differ by color, so black alone is the easiest, and the more colors there are, the more sessions are needed. In published research, removal was easiest in the order black, blue, red, green, then yellow and white. Yellow, skin-toned shades and white may respond poorly to the laser, or may even turn darker after laser treatment.
- Can a tattoo I have just had done be removed right away?
- We recommend leaving a little time before you start. For a new tattoo, the time to start removal is at least 8 weeks after it was done, and the recommended time is 8–16 weeks after. For colored tattoos containing several colors, we recommend waiting 3–6 months.
- Which comes off more easily, an old tattoo or a new one?
- Older tattoos are slightly easier. That is because natural fading, clearance by the immune system and chemical change in the pigment go on over time. As a trend, the average number of treatment sessions is about 12–15 for tattoos less than 1 year old, 8–12 for tattoos 5–10 years old and 6–10 for tattoos 10 years old or more, and the actual number differs from tattoo to tattoo.
- Can tattoo removal leave a scar?
- It can. After laser treatment, the color sometimes spreads and remains, or the area loses its color and turns white, and blisters, allergic reactions and scars sometimes occur as well. Even when treatment takes color, amount of pigment, skin tone and interval all into account, a scar is sometimes left, and more care is needed with colored tattoos, tattoos with a large amount of pigment, and darker skin tones.
- If blisters or scabs form after a session, has something gone wrong?
- Blisters, swelling and scabs count among the normal reactions that appear after laser treatment. But if a blister forms the moment the laser is fired, or purpura comes up severely, the intensity needs to be adjusted. Infection makes scarring more likely, so aftercare is important.
- Does smoking affect tattoo removal?
- There is research in which treatment was less effective in smokers than in non-smokers. If you smoke, it is worth bearing in mind in advance that treatment may take a little longer overall.
- Will it come off faster if a fractional laser is used as well?
- There is an approach in which a fractional laser is used first to make tiny holes, which improves energy delivery and helps the remaining pigment to be expelled, and there are also results in which the number of treatment sessions fell. It is not a method that is always needed, though; it is added depending on the type of tattoo and how treatment is progressing. Tattoos that look likely to be removed within about 5–10 sessions tend to be treated with a picosecond laser alone.