The area lends itself to a variety of shapes, sizes, and designs and is one that can be easily shown off or hidden, depending on the needs of the tattooee.
Depending on the method for after-tattoo care, the spot may be harder to keep clean and dressed, if the tattooee has no one who can be trusted to do cleaning and swabbing.
When the koi in the tattoo is shown swimming upstream, it can be used to mean that the tattooee is still struggling with his problem, whereas a koi swimming downstream implies that the tattooee has already overcome his difficulty.