A Cosmetic Tattooing Procedure to Conceal Hair Loss

Scalp Micropigmentation, the process of tattooing thinning or bald areas of the scalp to resemble shortly cropped hair, has been met with high amounts of enthusiasm from patients seeking alternative ways to mask and conceal their hair loss. This artistic and minimally invasive procedure, also referred to as SMP, provides men and women suffering from hair loss with an illusion of fullness or the appearance of thick, shortly cropped hair. SMP results (not the procedure) are often compared to topical concealers such as Toppik, DermMatch and Nanogen, because they also help conceal baldness and make thinning hair appear thicker and fuller.

Although scalp micropigmentation is increasing in popularity, it is still a new and evolving practice and its mystique may leave interested patients asking several important questions.

How does scalp micropigmentation work? What are the benefits, limitations and potential risks associated with the procedure? Who is a suitable candidate? What are the costs associated with SMP? What happens if consumers don't like the results? Is the ink associated with scalp micropigmentation permanent? Are all SMP practitioners equal or do some produce better, more natural looking results?

Scalp Micropigmentation is the artistic application of tattoo-like ink or pigmentation "dots" to bald or thinning areas of the scalp to recreate the appearance of shortly cropped hair (or "stubble") by a trained practitioner. SMP practitioners are typically experienced in the art but often aren't medical professionals or hair restoration physicians. Scalp micropigmentation is typically used for one of three purposes. These include:

• Creating the illusion of fullness or density to thinning hair by applying cropped, hair-like tattoos in between and around thinning hair.
• Creating the appearance of closely cropped or shaved hair on an otherwise bald scalp.
• Camouflaging a pre-existing hair transplant scar. Typically, this is a rare, but stretched, linear scars from follicular unit hair transplantation procedures via strip harvesting (FUT) can sometimes require revision.

Scalp micropigmentation ink is normally placed in the superficial dermis, a layer of skin between the epidermis (the outer layer of the skin) and subcutaneous tissues that consists of connective tissue and cushions the body from stress and strain. However, SMP practitioners often place ink at varying depths. Some practitioners are now beginning to use a “sweeping” technique when tattooing, in order to create a more three-dimensional appearance on the scalp.

Depending on the size of the balding/thinning area and the desired appearance, the procedure can take anywhere from 1-8 hours, and can now be completed with both permanent and temporary SMP ink.

According to Coalition hair transplant surgeon Dr. Robert Bernstein, the key to further achieving a natural result with SMP lies in holding the inking tool at an appropriate angle, controlling the depth at which the ink is placed, monitoring the amount of ink deposited at each site, and selecting appropriate ink tones.

To read more of Dr. Bernstein's input and discussion related to SMP at the 2012 annual ISHRS Scientific Meeting for hair restoration physicians, visit "Scalp Micropigmentation (Scalp Tattooing)at the 2012 ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting".

Permanent Versus Temporary Scalp Micropigmentation (Advantages and Disadvantages)

Defining and understanding the difference between permanent and temporary ink is important for any consumer considering the procedure.

Permanent scalp micropigmentation is performed with micropigmentation ink that is not designed to fade or change over time. The ink is placed slightly deeper in the scalp tissue, and the procedure can be performed with ink containing both colored and black pigment.

Advantages of permanent SMP include the ability to undergo a single SMP treatment without frequent “touch ups" and potentially lower long-term costs.

Disadvantages include the possibility that the ink will eventually fade to a green or blue hue (due mainly to the black pigment used in permanent SMP ink) and the inability to reverse the procedure without laser pigment removal (i.e. “laser tattoo removal”) if the work is unsatisfactory.

Temporary scalp micropigmentation is performed with ink that is specially designed to gradually fade and disappear within 6 to 24 months after the procedure. The ink is placed into a superficial layer of the scalp, which allegedly helps to define the pigmentation and decrease the probability of “blurring” ink. Temporary SMP is performed with ink containing no black pigment. Because black pigmentation can eventually fade into a blue or green tone, it would inevitably produce an unnatural looking result as it gradually fades and disappears, and should be avoided.

Advantages of temporary SMP include: the ability to redesign or discontinue the process (when the ink fades after 6-24 months) if the results are not satisfactory; the decreased rates of ink blurring, running, and definition loss with the superficial placement into the scalp; and the ability to use the three-dimension technique (which was designed by Beauty Medical in Milan, Italy, and is now utilized by several leading clinics recommended by this patient community).

Disadvantages of temporary SMP include ongoing maintenance and costs associated with undergoing subsequent SMP applications every 6 to 24 months, and the possibility of discoloration as the ink fades (though the temporary ink is purposely designed to fade evenly and without discoloration).

To learn more about the advantages and disadvantages of permanent and temporary SMP, visit "Temporary Scalp Micropigmentation: Advantages, Disadvantages, and Clinics Currently Offering the Procedure".

Scalp Micropigmentation Costs

The cost of SMP is variable and depends upon the type of procedure (temporary versus permanent), size of the procedure, and the practitioner/clinic performing the micropigmentation. While rates typically vary and change, permanent SMP can cost anywhere from $800 for a small procedure and $6000 for a large one. The cost of temporary SMP is approximately half the cost of permanent SMP and typically ranges from $500 to $2500 depending on the size of the procedure. Subsequent procedures, which are needed 6 to 24 months after the initial results fade are typically 50% of the original costs.

What Makes a Good SMP Candidate?

Although a wide variety of men and women are interested in scalp micropigmentation, the procedure is actually only ideally suited for a small, select number of hair loss consumers.
SMP is likely best suited for individuals interested in aiding the appearance of density in shortly cropped, diffusely thinned hair, and for patients trying to camouflage a hair transplant scar. It may also be suitable in creating a greater illusion of fullness in those who've already undergone surgical hair restoration.

SMP consumers should also consider a naturally asymmetrical hairline design and “fading” effect (from decreased pigmentation in the hairline to denser, increased pigmentation in the middle scalp) if hairline restoration is performed. This approach will likely create a more natural result in eligible candidates.

Creating Realistic Expectations

While scalp micropigmentation may be a useful adjunct therapy for a select group of consumers interested in concealing their hair loss, it should be approached with realistic expectations and performed by a trusted clinic. Individuals considering the procedure must remember that SMP is a two-dimensional process and cannot provide the texture and growth of real hair. Undergoing SMP without respecting its limitations may create unrealistic expectations and disappointing results.

Evolving Procedure or Just a Fad?

Is SMP just a fad or will it continue to evolve and cultivate additional interest from hair loss sufferers and hair restoration physicians?

While some hair loss experts are quickly embracing the procedure, others are more resistant, and liken scalp micropigmentation to less popular "niche" treatments like hair systems, laser caps, and topical concealers. Whether or not it will continue increasing in popularity and retain its momentum is not yet clear.

Hair restoration is a rapidly changing field and new and evolving therapies may eventually render scalp micropigmentation and other hair loss treatments obsolete.  Altogether, only time will tell whether SMP is a lasting adjunct therapy or a passing fad.

Clinics Currently Offering Scalp Micropigmentation

As of January 2013, the following hair restoration clinics recommended by this website are offering some form of Scalp Micropigmentation: Hasson and Wong (Drs. Victor Hasson and Jerry Wong), and Shapiro Medical Group (Drs. Ron and Paul Shapiro).

Dr. Feller, Dr. Lindsey, Hasson and Wong, and Shapiro Medical Group trained with Beauty Medical and offer the temporary SMP procedure; Dr. William Rassman performs his own variation of Scalp Micropigmentation with permanent ink.

Note that in many cases, a trained technician and not the physician will be performing scalp micropigmentation.

This website does not currently recommend one SMP clinic over another. Those considering scalp micropigmentation as a tool to conceal hair loss and create an illusion of hair are encouraged to do their own diligence in researching each technique, practitioner and clinic.

To discuss scalp micropigmentation with hair loss sufferers and other interested parties and to view results showing before and after pictures, visit the Scalp Micropigmentation Forum.

It seems that lately, new hair loss treatments based on “revolutionary scientific research” hit the rumor mill on a monthly basis. Some of these treatments come to light via reputable scientific journals while others, like Recoverup, materialize one day with a flashy website, a lot of promises and very little verifiable data. Recoverup is a UK based company that claims to offer stem cell treatments for hair loss through clinics in Taipei, Taiwan and Penang, Malaysia. According to their website, this treatment is so quick and easy it can be performed in a single day with startling results visible in only one month. Does this sound too good to be true?

Recoverup’s baldness treatment process claims to rely upon Autologous Adipose Adult Stem Cells (AAA). Unlike controversial embryonic stem cell treatments, Autologous Adipose Stem Cells are derived from the patient’s own fat cells through a small liposuction procedure and are then grown into a culture to increase volume. These stem cells are then “differentiated” with “growth factors” and injected into the scalp in order to induce new hair growth. This multistage process from extraction to injection can be performed in two appointments scheduled in the same day.

The question is, does Recoverup’s baldness treatment really grow hair? They state that “Empirical data indicates patients would expect to see at least 40% of all treated areas showing one of four results; (1) darker hair (2) thicker hair (3) faster growing hair or (4) more hair per follicle. Overall the effect is of more volume, and density, in those areas which were treated.” However, the Recoverup website offers very little in the way of photo documentation. The few photos that are presented are of poor quality and covered in text making them very difficult to evaluate.

The estimated cost for the one day hair loss treatment is between $8,000 and $13,000 depending upon the area to be treated. However, if the area to be treated is sufficiently large enough to merit a second day of treatments then this fee increases. Recoverup states that the long-term effects of the treatment are unknown and are dependent upon such factors as the patient’s age and quality of the source stem cells. “However, as a general guide, in other areas of stem cell treatment, data indicates approximately 3-5 years of positive results from each treatment.”  Recoverup does offer a 30-day money back guarantee if a patient experiences no new hair growth but is also quick to point out that the results will vary. One can imagine quibbling over whether or not a single follicle that didn’t appear to exist prior to treatment would constitute success under their definition. In summary, assuming Recoverup’s AAA stem cell treatment does stimulate hair regrowth, a patient can expect to pay upwards of $13,000 plus travel expenses to Asia for a treatment that is, by their own estimates, about 40% effective and may last between 3 and 5 years. This hardly sounds like an attractive alternative or even supplement to today’s state of the art, ultra-refined follicular unit hair transplantation combined with the clinically proven medical treatments Propecia (finasteride) and Rogaine (minoxidil). It is recommended that patients approach all unproven, “revolutionary” medical treatments with cautious optimism. Androgenic alopecia is progressive and avoiding proven surgical and medical treatments in favor of experimental procedures may lead to further hair loss.

While hair restoration surgery is now a proven treatment for restoring hair where it has been lost, Hair loss medication such as Rogaine (minoxidil) and Propecia (finasteride), have made real contributions toward stopping and even reversing hair loss.

During the late 70’s and early 80’s it was discovered that minoxidil, used as a heart medication, had hair growing side effects. Minoxidil was tested for use as a topical scalp treatment for hair loss and proved to inhibit hair loss in many test subjects.

It has proven to be effective to some degree in slowing the hair loss process. For a minority of people it can even grow back lost hairs in the crown area (back of the head). However, Rogaine (minoxidil) does not slow or reverse the balding process in the frontal hairline area.

Rogaine is typically applied topically on the scalp twice a day, morning and evening. But once usage is discontinued the hair loss which had been inhibited will resume and the hair that was saved will be lost.

Rogaine originally required a prescription, but in 1995, it became available in 2% strength Rogaine over-the-counter. Today, men and women can buy 5% strength lotion over-the-counter as Rogaine or as generic minoxidil.

To date Rogaine (minoxidil) and Propecia (finasteride)are the only hair loss medications with FDA approval. Propecia’s active ingredient, finasteride, was originally used to treat enlarged prostate glands. It was discovered that, like minoxidil, it had the “side effect” of stopping male pattern baldness and for some even regrowing hair.

Propecia is taken as a pill once daily and acts to inhibit the body’s ability to create dyhydrotestosterone or “DHT”. DHT acts as the active ingredient or catalyst in the balding process.

Rogaine and Propecia

The 90’s brought great advances in hair restoration, both surgical and non surgical. Now most people can realistically halt and reverse their hair loss with truly natural results.

In 1988 minoxidil, Rogaine, became the first hair loss medication to be approved by the FDA for the treatment of hair loss.

In 1998 the FDA approved Propecia for the treatment of hair loss. Propecia (finasteride) should NOT be taken by woman or children for any reason.

Learn about all your hair loss treatment options.
 

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Nioxin is an excellent product including both a shampoo and conditioner formulated specifically for men and women with thinning hair."> While neither the shampoo nor conditioner hasn't been proven to have any effects on DHT (the hormone responsible for male pattern baldness); Nioxin's ability to strengthen follicles and energize cellular activity can improve the overall health of your scalp and hair. Nioxin therefore may have the ability to delay the effects of hair loss. For best results, use both the shampoo (refered to as Nioxxin Shampoo Scalp Cleanser) and conditioner (referred to as Nioxin Scalp Therapy) in conjunction with one another.

Nioxin Scalp Cleanser's cooling properties refreshes and cools the scalp promoting maximum cleanliness and freshness. Because of this, Nioxin shampoo, especially when combined with the conditioner also significantly reduces scalp itchiness and tenderness after hair transplant surgeryin both the recipient and donor areas.

Nioxin Scalp Therapy is an excellent volumizing scalp and hair conditioner that moisturizes and improves your hairs' natural resilience, while promoting a healthy scalp environment for optimal hair growth. Nioxin Conditioner is the perfect conclusion to the Nioxin Shampoo Scalp Cleanser.

Nioxin Scalp Therapy's minty fresh cooling sensation literally refreshes and cools the scalp promoting maximum cleanliness and freshness. Because of this, Nioxin also significantly reduces scalp itchiness and tenderness after hair transplant surgery in both the recipient and donor areas.

We strongly recommend using Nizoral shampooevery 2 or 3 days in conjunction with Nioxin. Its active ingredient ketoconazoleat 2% concentration has proven to be a moderate DHT inhibitor and has growth properties approximately as effective as Rogaine2%.

Developing Realistic Expectations:

Men and women sometimes suffer from hair loss for different reasons. Thus, diagnosing its cause is necessary to facilitate and promote proper treatment.

The Nioxin product line is an excellent scalp and hair cleansing shampoo and conditioning therapy but is not proven to stop hair loss. Thus, we strongly recommend using Nioxin in conjunction with the "Big 3" (Propecia, Rogaine, and Nizoral.

To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a

Ingredients (Full List)

Nioxin Shampoo Scalp Cleanser: AQUA/EAU/WATER, TEA-LAURYL SULFATE, SODIUM LAURETH SULFATE, COCAMIDOPROPYL BETAINE, HYDROXYPROPYLTRIMONIUM HONEY, COCAMIDE MEA, PEG-150 DISTEARATE, PANTHENOL, GLYCOPROTEINS, POLY-SORBATE-60, POLYSORBATE-80, CYSTINE BIS-PG-PROPYL SILANETRIOL, HYDROLYZED KERATIN, ACETAMIDE MEA, PROPYLENE GLYCOL, ETHOXYDIGLYCOL, DIMETHYL ISOSORBIDE, COENZYME A, PANTOTHENIC ACID, PYRIDOXINE, CYANOCOBALAMIN, BIOTIN, FOLIC ACID, NIACIN, THIAMINE HCl, UBIQUINONE, ACHILLEA MILLEFOLIUM, ANTHEMIS NOBILIS, CAMELLIA SINENSIS, CITRUS GRANDIS, EQUISETUM ARVENSE, HUMULUS LUPULUS, MELISSA OFFICINALIS, MENTHA PIPERITA, PRUNUS AFRICANA, ROSMARINUS OFFICINALIS, SALVIA OFFICINALIS, SERENOA SERRULATA, SYMPHYTUM OFFICINALE, TARAXACUM OFFICINALE, THYMUS VULGARIS, URTICA DIOICA, SACCHAROMYCES LYSATE EXTRACT, PHOSPHOLIPIDS, SACCHAROMYCES/COPPER FERMENT, SACCHAROMYCES/IRON FERMENT, SACCHAROMYCES/MAGNESIUM FERMENT, SACCHAROMYCES/SILICON FERMENT, SACCHAROMYCES/ZINC FERMENT, PEG-23M, MELANIN, CITRIC ACID, SODIUM CHLORIDE, TETRASODIUM EDTA, DISODIUM EDTA-COPPER, SUPEROXIDE DISMUTASE, CI 42090/BLUE 1, PHENOXYETHANOL, METHYLPARABEN, PROPYLPARABEN, METHYLISOTHIAZOLINONE.
Nioxin Scalp Therapy: AQUA/EAU/WATER, CETRIMONIUM CHLORIDE, CETYL ALCOHOL, DICETYLDIMONIUM CHLORIDE, AMODI-METHICONE, TRIDECETH-12, LAURAMINE OXIDE, GLYCOPROTEINS, DIMETHICONE, SODIUM PCA, CYSTINE BIS-PG-PROPYL SILANETRIOL, PANTHENOL, POLYQUATERNIUM-11, ACHILLEA MILLEFOLIUM, ANTHEMIS NOBILIS, ARCTIUM MAJUS, CALEN-DULA OFFICINALIS, CAMELLIA SINENSIS, EQUISETUM ARVENSE, FRANGULA ALNUS, GERANIUM MACULATUM, HUMULUSLUPULUS, JUGLANS REGIA, LARREA DIVARICATA, MELISSA OFFICINALIS, MENTHA PIPERITA, PRUNUS AFRICANA, QUASSIA AMARA, ROSMARINUS OFFICINALIS, SALVIA OFFICINALIS, SERENOA SERRULATA, SYMPHYTUM OFFICINALE, TARAXACUM OFFICINALE, THYMUS VULGARIS, URTICA DIOICA, YUCCA FILAMENTOSA, PHOSPHOLIPIDS, DIMETHYL ISOSORBIDE, CETEARYL ALCOHOL, ETHOXYDIGLYCOL, CETEARETH-20, PROPYLENE GLYCOL, SACCHAROMYCES LYSATE EXTRACT, COENZYME A, PANTOTHENIC ACID, PYRIDOXINE, CYANOCOBALAMIN, BIOTIN, FOLIC ACID, NIACIN, THIAMINE HCl, UBIQUINONE, SACCHAROMYCES/COPPER FERMENT, SACCHAROMYCES/IRON FERMENT, SACCHAROMYCES/MAGNESIUM FERMENT, SACCHARO-MYCES/SILICON FERMENT, SACCHAROMYCES/ZINC FERMENT, MELANIN, TRIETHANOLAMINE, SUPEROXIDE DISMUTASE, CI 42090/BLUE 1, PHENOXYETHANOL, METHYLPARABEN, PROPYLPARABEN, METHYLISOTHIAZOLINONE.