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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.

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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:

  1. A man in his mid-30s, who was diagnosed with scarring alopecia in his teens, used SMP to camouflage his scarring.
  2. 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.
  3. 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.
  4. 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.
  5. A 22-year-old man filled in scars from a previous FUE hair transplant using scalp micro-pigmentation.
  6. 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.

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According to an article published in the journal of Facial Plastic Surgery Clinics, ((Rassman W, Pak J, Kim J. Scalp micro-pigmentation: a useful treatment for hair loss. Facial Plast Surg Clin North Am. 2013;21(3):497–503.)) scalp micro-pigmentation (SMP) has been found to be a useful cosmetic treatment for hair loss and scalp scars.

SMP is a scalp tattooing technique that uses fine dots – like a stippled painting – to mimic the appearance of extremely short hairs on an otherwise bald scalp.

SMP can create the appearance of a fuller head of hair on a scalp that is losing hair by softening the contrast between the hair that remains and the color of the scalp. It can also effectively camouflage a scalp scar, like the donor scar from a strip hair transplant procedure, the scar from a scalp reduction or scars from trauma to the scalp.

Finally, SMP can help augment the results from either a Follicular Unit Hair Transplant (FUT) or a Robotic FUE Transplant (R-FUE), especially for patients who do not have enough donor hair to give the appearance of full coverage.

More Art than Science

While one might think the placement of the dots need only follow, in a straightforward fashion, the natural distribution and density of hair that occurs on a normal scalp, the application of SMP is in fact more art than science.

The effective application of SMP requires a strategy and technique custom tailored to each patient that takes into account the particular aesthetic needs of the patient and the particular characteristics of their hair and scalp.

To correctly design and execute such a tailored approach, a physician needs to have considerable expertise regarding where to place the dots, the proper needle size, the best angle of application, the depth and duration of penetration, and the best type of dye to use for a particular person’s scalp.

In addition to SMP being an art form, the article stresses that in the case of concealing pattern hair loss, a physician also needs to have a thorough medical understanding of the progressive nature of the genetic balding process.

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