Bernstein Medical Center for Hair Restoration

Scalp Micro-Pigmentation (SMP) Conceals Hair Loss and Camouflages Scalp Scars

According to an article published in the journal of Clinical Aesthetic, ((Rassman WR, Pak JP, Jino K, Estrin NF. Scalp Micro-Pigmentation, A Concealer for Hair and Scalp Deformities. Clinical Aesthetic, March 2015, 8(3): 35-42.)) scalp micropigmentation (SMP) is an effective cosmetic solution for millions of men and women who currently have significant scalp deformities for which there are few, if any, good medical treatment options.

Scalp Micro-Pigmentation is a Permanent Hair Loss and Scar Concealer

SMP is a permanent cosmetic tattoo of carefully selected pigments applied to the scalp in a stippling pattern to mimic closely cropped hair. This technique allows a physician skilled in SMP to effectively conceal a variety of alopecias and scars.

SMP can address the following situations:

Female hair loss not responsive to minoxidil or cannot be treated with a hair transplant
Hair loss due to chemotherapy
Deformities from autoimmune diseases, such as refractory alopecia areata or alopecia totalis
Scalp scars from scarring alopecias
Scars from neurosurgery or head trauma
A visible scar from a strip harvesting procedure or punctate scars from an FUE procedure
Visible open donor scars from older harvesting techniques – usually those from the 1950s through the early 1990s
A pluggy or corn-row look from older hair restoration procedures

Scalp micro-pigmentation can also create the appearance of fullness on an otherwise thinning or bald scalp with or without a shaved head.

The Scalp Micro-Pigmentation Process

The physician skilled in SMP has a variety of tools at hand, including pigments of different colors and viscosities. The pigments can be introduced into the skin using a number of different needle types and sizes.

The physician begins by taking a needle and inserting a tiny droplet of pigment through the top layer of the skin and into the upper dermis. Because the thickness of the top layer of the skin varies across the scalp, the doctor must judge the appropriate depth at each location by both “feel” and visual cues. For example, a portion of the outer skin layer that has more fat and hair follicles will have a different look and will produce a different feel when inserting a needle compared to a scarred or bald scalp.

To place the correct amount of pigment at the correct depth at a particular location on the scalp, the operator of the tattooing instrument must take into account the following variables:

The angle and depth of the needle
The time the needle is left in the scalp (in order to place the pigment into the upper dermis)
The resistance of the scalp, which varies locally across the scalp
The particular color and viscosity of the pigment
The size and shape of the particular needle

In order to produce the desired shading and create the desired illusion of texture and fullness, the doctor must vary the density of the stippling across the area of application. Because every patient is unique and every area of the scalp is different, the doctor must proceed carefully in order to achieve the desired aesthetic effect and to minimize the chances of the pigment bleeding into the area surrounding the point of application.

The complete SMP process usually takes two to four sessions.

Posted by Robert M. Bernstein M.D.

Scalp Micro-Pigmentation (SMP) is a Practical, Permanent Cosmetic Treatment for Hair Loss

Hair restoration physicians William R. Rassman, Jae P. Pak, and Jino Kim have outlined a practical, permanent cosmetic treatment for hair loss, called scalp micro-pigmentation (SMP) in a paper published in the journal Hair Transplant Forum International. ((Pak JP, Rassman WR, and Kim J. Scalp micro pigmentation (SMP): novel application in hair loss. Hair Transplant Forum International, Vol. 21, No. 6, Nov./Dec. 2011, p. 1, 186-87. ))

Scalp micro-pigmentation, first described in the medical literature in 2001, ((Traquina AC. Micro-Pigmentation as an adjuvant in cosmetic surgery of the scalp. Dermatologic Surgery, Vol. 27(2) 2001: 123-8)) is a cosmetic tattoo that creates the appearance of the short hairs of a closely shaved head on an otherwise bald or thinning scalp. SMP (also referred to as ‘cosmetic transdermal hair replication,’ ‘scalp pigmentation,’ ‘cosmetic hair follicle replication,’ or ‘micro hair technique’) is an option for patients who are not candidates for a hair transplant and who are willing to keep their hair cut short or shaved. It is can also serve as a “filler” for those with longer hair.

The paper discussed case studies of six hair loss patients of varying age and hair loss condition who used SMP to camouflage scalp scars or areas of hair loss:

A man in his mid-30s, who was diagnosed with scarring alopecia in his teens, used SMP to camouflage his scarring.
A 30-year-old male, who had worn a hat continually since being diagnosed with alopecia totalis in his teens, used SMP to frame his face and re-build his self-esteem.
A 55-year-old man, who had large-graft (“hair plug”) hair transplants and several scalp reductions, used SMP to fill in plug scars and re-define his hairline.
A 32-year-old man used SMP to cover donor area scars from previous FUT procedures, fill in his thinning crown, and create a smooth hairline.
A 22-year-old man filled in scars from a previous FUE hair transplant using scalp micro-pigmentation.
A 45-year-old man, who had always shaved his head and refused hair transplantation, used SMP to create a hairline with an overall look of a clean-shaven head.

SMP can be applied to patients with alopecia areata, alopecia totalis, or pattern baldness. SMP can also help hide the scar tissue from several types of scarring alopecia. Finally, it can help to camouflage the scar tissue caused by large-graft “plug” transplants, scalp reduction procedures, or poorly performed or failed hair transplant procedures.

The authors note that adoption of SMP by physicians and potential patients has been slow because of the highly variable outcomes due to a lack of standardized SMP techniques and materials. However, the authors say a standardized SMP technique is being formalized that should support consistent high quality outcomes.

Posted by Robert M. Bernstein M.D.

New Arthritis Drug Reverses Baldness from Alopecia Areata

Could a recently FDA-approved drug for rheumatoid arthritis also be a cure for a common type of hair loss called alopecia areata? The drug is called Xeljanz, and that’s what Dr. Brett King, assistant professor of dermatology at Yale, is hoping.

Dr. King’s patient, Kyle Rhodes, was diagnosed with alopecia totalis, the extensive variation of the auto-immune condition called alopecia areata that involves one’s entire scalp and body hair. By age 18, this condition had caused Kyle to lose all the hair on his head and body. He was also diagnosed with plaque psoriasis, a condition characterized by scaly red patches of skin.

While Dr. King was reviewing the research literature on tofacitinib citrate (Xeljanz), he discovered that the drug had been used to treat psoriasis in people and alopecia (hair loss) in mice, so he decided to try Xeljanz on Kyle’s condition.

The results were exactly what Dr. King hoped: after two months on the drug, Kyle’s psoriasis improved, and his hair started to return to his scalp and face. After five months, his scalp hair, eyebrows, eyelashes and facial hair were clearly visible. By eight months, his facial and scalp hair had fully returned.

Dr. King believes Xeljanz could be a major breakthrough in treating a disease that up till now has had few good treatment options.

This isn’t the first time a successful drug treatment for hair loss has been discovered serendipitously: oral minoxidil (later developed into the topical medication Rogaine) was first used as a treatment for high blood pressure, but it is now used as an FDA-approved topical treatment for androgenetic alopecia by both men and women.

Xeljanz, however, currently taken in pill form, isn’t an FDA-approved treatment for alopecia areata; further, it has some potentially serious side effects that could limit its use if it does become approved.

In order to reduce the possibility of those side effects, Dr. King is in the process of creating a topical form of Xeljanz a patient can use at the site of hair loss rather than take an oral medication. By applying a cream form of Xeljanz directly on the scalp, this would limit the drug from entering the blood stream in significant quantities and thus causing systemic side effects.

As a first step to getting FDA-approval, Dr. King has submitted a proposal to begin clinical trials that will use a cream form of Xeljanz.

Posted by Robert M. Bernstein M.D.

Can a Hair Transplant Repair the Bald Areas Caused by Alopecia Areata?

Q: Can a hair transplant into bald areas caused by alopecia areata ever be successful? — R.K., Providence, R.I.

A: Alopecia areata is an autoimmune disease in which the body attacks its own hair follicles. It generally appears as round patches of smooth bald areas scattered in the scalp or beard. Less commonly, it can involve the entire scalp (alopecia totalis) or all facial and body hair (alopecia universalis). Unless the condition is well localized and totally stable, hair transplantation is not likely to be effective because the transplanted hair would be subject to the same problem.

We prefer that one have no new lesions for a minimum of two years before considering surgical hair restoration, although this does not ensure that the procedure will be successful.

You may find more information on this relatively common condition at the National Alopecia Areata Foundation (NAAF). For more information, visit: www.naaf.org.