sixel-tmux works literally anywhere you can use tmux: as long you can display unicodes on your terminal, the sixels will be "captured" by sixel-tmux and converted into something you can see. Sixels are in-band, so ssh isn't a problem.
In a way, using sixel-tmux is like "giving magical goggles" to your terminal, to let it render sixels so you can see something (even if it isn't perfect), in the hope you'll be tempted to use a better terminal that will show you sixels in all their glory, with a pixel perfect quality.
Sixels enable all kind of cool things, like gnuplot right in your terminal (cf https://github.com/csdvrx/sixel-gnuplot ): sometimes I even watch youtube on my terminal lol
sixel-tmux was made as a first step towards turning derasterize into a more general library: my plan was to add it to nnn but I got bored along the way and moved to other stuff. I might still do that I I love nnn as a filemanager.
BTW, even if there have been quite a few interesting work by @hpa and others in the last 2 years, I think derasterize still has textmode supremacy. derasterize is a collab with @jart after I started adding features to her previous solutions which was based on half blocks like this solution; she's also made further work based on this like https://justine.lol/printimage.html and https://justine.lol/printvideo.html
On Linux, virtual terminals are currently limited to 512 glyphs and 16 colors. You can't do much graphics with that, unless you bypass the terminal layer and write directly to the framebuffer, like w3mimg does.
VT's but not XTerms. Also, framebuffer based VT's allow 256 colors with ease.
On the font issue, yes, sadly you are right. It's retarded to just have 512 glyphs on a framebuffer, not a true tty. The framebuffer or KMS should support TTF fonts by default. A Unifont TTF would be godsend here.
I should have been clearer: as long as you have a font which has entries for the glyphs used by derasterize and sixel-tmux - check the source and you'll see you don't need a lot of them.
https://github.com/saitoha/libsixel