When exploring tattoo removal options, one of the most common questions is "How many laser tattoo removal treatments do I need?" At Dr. TATTOFF one of the reasons we're known as the laser tattoo removal experts is due to our ability to accurately estimate how many treatments it will take to remove a tattoo before you begin your treatments. While certainly part of our accuracy comes from the experience of having performed tens of thousands of treatments, a larger part of that accuracy is due to our use of the Kirby-Desai tattoo removal scale. Developed by Dr. TATTOFF's very own Dr. Will Kirby, the Kirby-Desai tattoo removal scale was first published earlier this year and has quickly become recognized as the gold-standard for determining how many laser tattoo removal treatments it will take to remove a tattoo. The American Osteopathic College of Dermatology recently published an article about the Kirby-Desai tattoo removal scale in its magazine, DermLine.

From the article:

Scale Quantifies Laser Tattoo Removal Sessions Required

A recently published numerical scale can help dermatologists assess how many laser treatments it will take to remove a tattoo. The Kirby-Desai Scale was developed by Will Kirby, D.O., FAOCD; Alpesh Desai, D.O., FAOCD; Tejas Desai, D.O., FAOCD; and first-year resident Francisca Kartono, D.O. In their study published in the March issue of the Journal of Clinical and Aesthetic Dermatology, the scale was determined to be a practical tool to assess the number of laser tattoo-removal sessions required.

More Tattoos, More Removals

Tattoos have become increasingly popular in the Western world. Current estimates suggest that more than 20 million people—or between 3% and 5% of the population—have at least one tattoo.1,2 Also on the rise are tattoo removal requests, as patients often regret getting this form of body art. Up to 50 percent of adults 40 years of age and older seek to remove their tattoos.3 Lasers have been used to remove tattoos since the late 1970s. In recent years, they have become the treatment of choice due to their high efficacy and low incidence of deleterious side effects. However, due to the varying types of tattoos, it has been difficult to quantify the number of laser treatments required with certainty. Currently, patients receive a poorly defined assessment of the number of treatments. As a result, they often engage in the process without full awareness of the potential success and cost.

The Scale

Consequently, the authors developed the Kirby-Desai scale to be used during pre-consultation. The scale was made with the assumption that the dermatologist is using a quality-switched Nd:YAG (neodymium-doped yttrium aluminum garnet) or Alexandrite laser incorporating selective photothermolysis with six to eight weeks between treatments. To test the scale, the authors performed a retrospective chart review on 100 clinic patients who presented for laser tattoo removal between July 2004 and August 2008. Using an algorithm, they assigned a numerical score to each tattoo across six different categories (e.g., skin type, location, color, amount of ink, scarring, and layering). The cumulative score was proposed to correlate with the number of treatment sessions required for satisfactory tattoo removal. Several factors within the aforementioned categories can affect the number of treatments required. For example, colors other than black can be twice the size of the black pigment, thus requiring more treatments. Amateur tattoos are typically placed unevenly in the superficial dermis and tend to contain less ink than those done by professional artists. As a result, amateur tattoos tend to respond quicker to laser treatment. When patients layer an undesirable tattoo with another, the second one tends to be larger and darker, thus requiring more treatments to remove. The average number of treatments required to satisfactorily remove a tattoo was 10, with a range of three to 20, the study revealed. The number of treatments correlated well with the average Kirby-Desai scale of 9.87 with a standard deviation of ±2.45. Using the scale will enable dermatologists to better estimate the number of laser treatments required for tattoo removal, the study concluded, while decreasing the uncertainty of the process for patients.

References: 1 Armstrong M. Career-oriented women with tattoos. Image J Nurs Sch. 991;23:215–220. 2 Anderson R. Tattooing should be regulated. N Engl J Med.1992;326:207. 3 Kilmer S, Fitzpatrick R, Goldman M. Tattoo lasers. http://www.emedicine.com/derm/topic56 3.htm. (Accessed March 2009.)