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Scalp Micropigmentation (SMP)
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.
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Books - Your in-depth guide to hair restoration
Finding excellent in-depth information about hair restoration, beyond infomercials and brochures, can be difficult. We recommend the below books for those interested in-depth and reliable hair restoration information.

MODERN HAIR RESTORATION

Hair Restoration has made great progress over the last several years with new techniques that have helped improve the quality and efficiency of hair transplants. Dr. Parsa Mohebi, one of the premier hair restoration surgeons, describes these groundbreaking methods, which include new, surgical techniques, hair loss medications, and non-invasive treatments in his book.

Hair loss can have a devastating effect on our self-image and can impact our personal and professional lives in innumerable ways. Dr. Mohebi assures those who are suffering with this condition that there are many medical and surgical treatments available today to help treat patients with different types of hair loss, including specific treatments for male and female patterned baldness. Dr. Mohebi gives his readers tips that can help them evaluate their current hair loss situation in order to find the best treatment available.

Modern Hair Restoration is a one of a kind A-Z guide for most types of hair loss sufferers. It is based on the latest advancements in treating male and female patterned baldness and the newest techniques of hair restoration. The medical breakthroughs described in this book have successfully treated thousands of patients and should continue to help the lives of many more hair loss sufferers for years to come.

Buy MODERN HAIR RESTORATION - A Complete Hair Loss Guide For Men And Women

The Hair Replacement Revolution

"The Hair Replacement Revolution" offers hair loss suffers atruly expert and comprehensive guide to all legitimate hair loss treatments.

This guidebook is written by two credible and respected physicians, Dr.Emmanuel Marrit and Dr. JamesHarris. It alsooffers suggestions for excellent hair restoration surgeons, which are NOTdetermined by financial contributions. This book can be purchased at Amazonfor $12.00 and is truly a "Must Read"!

Read exerpts from this great book.

Hair Restoration Surgery in Asians

Hair Restoration is in demand worldwide, but because Asian hair tends to be more sparse and coarse than Caucasian hair, transplantation procedures need to be adapted to Asian patients. This book, exclusively devoted to Asian hair, is a complete and comprehensive text written by a group of authors sharing their experience in their specialized fields of hair restoration. Included are many practical tips as well as chapters on regional transplantation such as eyebrows, eyelashes, sideburns, beards, and mustaches, in addition to the usual scalp hair restoration.

With its many illustrations, the book gives readers a complete knowledge of hair restoration surgery and provides a quick, easy-to-use reference on Asian hair and the differences in patients' demands. With an influx of new physicians in this challenging field of medicine, further education and training are imperative and must be available to provide a high standard of medical practice. This compilation meets that objective and ultimately makes the valuable contribution of restoring patients' self-confidence.

Buy Hair Restoration Surgery in Asians

To Bald or Not to Bald

Although it is usually an unwanted sign of ageing, hair loss may no longer be inevitable. Hopefully, by the time you finish this book you will understand the proven, effective treatment options that have become so popular. In subsequent chapters you will realize that hair loss is a problem that can be solved with new and exciting methods that will be explained in detail as we move along. We live in a new era of medical innovation and possibilities. Advances in medical research, technology and surgical techniques have restored patient's faith in the field of medical and surgical hair restoration. This books explains the entire process of hair restoration today.

Buy To Bald or Not to Baldon Amazon.

Hair Loss and Replacement For Dummies

What are the causes of hair loss? Can you prevent it? Can lost hair be restored? Hair Loss & Replacement For Dummies helps you understand why men and women lose their hair and offers thorough, objective reviews of a wide array of hair replacement options, including hair replacement surgery, prescription and over-the-counter medicinal treatments, hairpieces, natural remedies, and a variety of other options.

This authoritative, user-friendly guide explains the pros and cons of hairpieces, fibers, foundations, and hair thickening techniques. You’ll learn about pharmaceutical, laser, and topical treatments, and you’ll find out how to determine whether you’re good candidate for hair restoration surgery. You’ll even find help in assessing costs, controlling expectations, avoiding hair replacement scams, and determining which option truly is best for you. You’ll discover:
- What you need to know about hair and hair loss
- How to take better care of your hair
- Ways to prevent or reduce hair loss
- Creative techniques for concealing hair loss
- Shopping tips for hair-replacement systems
- How finesteride, minoxidil, and other medications might help
- Advice about low level laser treatments
- The low-down on hair restoration surgery
Complete with helpful myth-busting information about the causes of hair loss and the benefits of FDA-approved treatments, and helpful comparisons of the advantages of non-surgical and surgical hair replacement, Hair Loss & Replacement For Dummies is the resource to consult before you decide on any hair replacement treatment.

Buy Hair Loss and Replacement For Dummies on Amazon
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Stemcelex – A Revolutionary Stem Cell Hair Loss Treatment?
Stemcelex is the newest product in a long line of hair restoration therapies claiming to “cure” hair loss via stem cell therapy. Given the recent onslaught of news regarding stem cell based hair loss treatments, injectable baldness cures, and research breakthroughs, it’s not surprising to see new therapies claiming to aggressively fight hair loss through these same mechanisms. However, is Stemcelex truly a stem cell based, regenerative hair loss cure, or is it another therapy simply riding the recent wave of interest in these types of non-invasive, revolutionary treatments?

At first glance, Stemcelex seems quite impressive. The product website is filled with scientific explanations, graphs, charts, and diagrams explaining the science behind stem cell based hair restoration. Stemcelex even states its affiliation with Dr. George Cotsarelis, a researcher at the University of Pennsylvania Medical Center who, along with a talented research team, recently discovered that the bald scalp does not suffer from a lack of stem cells, but rather a dysfunction in the pathway to properly activating stem cells to produce hair. The finding was significant and Dr. Cotsarelis’ involvement and the seemingly detailed science look promising, but what about Stemcelex itself? Does it utilize these scientific breakthroughs and offer an effective treatment for hair loss?

Unfortunately, despite the impressive name recognition and detailed explanations, Stemcelex doesn’t appear to live up to its lofty hair restoration claims. Despite claiming to “activate” the dormant stem cells described by Dr. Cotsarelis, Stemcelex does not offer any sort of feasible molecular/stem cell based therapy. The website cleverly explains the science behind stem cell inactivation and the promise of reversing the dysfunctional pathway, but instead of reinforcing Dr. Cotsarelis’ view that cures for reversing the inactivation pathway are not yet understood, Stemcelex claims to actually fix the stem cell inactivation through a series of unproven homeopathic and herbal treatments for hair loss.

So, what is actually inStemcelex? The treatment involves a three day cycle of different lotions and topical treatments for baldness applied twice a day.

Day1: On the first day of the hair restoration cycle, a topical lotion made from Jaborandi Pilocarpus is applied twice after washing and thoroughly drying one’s hair. According to Stemcelex, Jaborandi Pilocarpus is a parasympathetic activator (it excites the nerves that cause the body to “rest and digest” during periods of relaxation) that rids the scalp of excess oils and dandruff that impede healthy follicular hair growth. Furthermore, Stemcelex claims that Pilocarpus naturally darkens and thickens existing, native hairs. According to the experts, Pilocarpus has no reproducible pharmacological applications and any evidence that it actually thickens and darkens hair is anecdotal.

Day 2: The second day of the cycle involves Veratrum Lobelianum, a family of herbs commonly used in Chinese medicine. Stemcelex claims these herbs can penetrate the scalp and activate the necessary molecular signaling to “regenerate” the hair follicle stem cells. Furthermore, Veratrum allegedly down-regulates or prevents the production of Dihydrotestosterone (DHT), the hormone directly responsible for male pattern baldness. According to the research, members of the Veratrum family have been used in everything from a Native American poison to a drug researched in human blood pressure. Currently, they are used in cancer treatments. Although the science behind cancer therapies indicates that the drug could have some molecular benefit in signaling cell activation and inactivation, there has been no research or evidence suggesting that Veratrum is useful in fighting, reversing, or preventing the effects of male or female hair loss.

Day 3: During the third day of the Stemcelex cycle, a kelp based topical extract is applied twice daily to provide nutrients to the “new hair growth” and also ensure that the scalp remains clean and healthy. This step of the treatment doesn’t claim to be more than a simple dose of nutrients useful in good scalp hygiene.

After reviewing the active ingredients behind Stemcelex, there is no evidence to suggest that Stemcelex is an effective hair loss treatment at this point in time. The idea of activating the dormant stem cells is important to finding a molecular cure to hair loss, but despite understanding this importance, Stemcelex doesn’t offer any concrete stem cell reactivation agents. It’s possible that Veratrum may prove useful in cell signaling and reactivating dormant cells, but the current research and evidence simply don’t support its use at this time. Furthermore, Stemcelex charges a hefty $99.85 for a month supply of the treatment which may keep even the most curious and enthusiastic hair loss suffering men and women away.

Altogether, the idea of reversing dormant hair follicle stem cells is important, but therapies for effectively stopping and rewiring this pathway do not seem to exist at this point in time. Unfortunately, this seems to nullify the claims made by Stemcelex and prevent it from becoming a stem cell hair loss cure.
- Read more about Stemcelex – A Revolutionary Stem Cell Hair Loss Treatment?
Hair loss - Race, Age, and Gender Considerations
Hair loss is a universal condition, affecting all ages, races, genders and nationalities. It’s estimated that “androgenetic alopecia,” or male and female pattern baldness affects 35 million men and 21 million women in the United States alone. This section examines how race, age and gender affect hair loss.

Race and Hair Loss

In physiological terms, human beings are all composed of the same bones, muscles, and everything else down to the cellular level. But there are specific differences.

Hair, in all of its variations, is one area in which human beings display their differences. Hair follicles can widely vary in terms of color, length, shape, thickness, strength and various other factors.

There are many ethnic groups to consider. But we will focus on the special considerations of Asians, Blacks (of African descent) and Caucasians.

Asian Hair Loss Considerations

Asian people typically have very straight hair. Their scalps contain fewer hairs per square centimeter, they actually have a lower hair density than that of Caucasian hair follicles. But because the individual hair follicles of East Asians are thicker, this gives the look and impression of greater hair density.

For these reasons, hair restoration techniques for East Asians, much like other races, must be sensitive to a variety of anatomic and cultural differences. For instance, East Asian females often have an increased likelihood of developing “diffuse alopecia,” or hair that thins evenly over the entire head than Caucasian females.

Even though it’s not a definite requirement, it’s very helpful for Asian patients to seek out doctors with experience in Asian hair.

Another consideration for East Asians considering hair restoration surgery is the increased chance of developing keloid scars. A keloid is a thick, irregularly shaped and elevated scar with uncontrolled growth that results from excess fibrous skin tissue. East Asians typically have a greater likelihood of keloid development than Caucasians, but less than that of people of African descent. Therefore, before undergoing surgery, East Asians may want to consider being medically evaluated for keloids.

African Hair Loss Considerations

People of African descent usually possess naturally curly hair. This curly hair gives the visual impression of increased hair density for a given amount of hair, which is beneficial in hair restoration surgery.

The hair follicles beneath the skin of people of African decent also typically curve more than Caucasians. This can make harvesting the donor hairs, without severing or transecting the hair follicles beneath the scalp, more difficult. A hair restoration physician needs to be very aware of this difference and adjust to its requirements.

As in the case of East Asians, people of African descent possess some unique hair and skin characteristics. Some of these medical conditions are more common in black skin than in white skin. This may increase the risk for post-surgical complications.

Those of African descent have a higher chance of developing keloid scarring when injured. This in turn leads to a greater chance of noticeable donor scars. Keloids aren’t a widespread problem. But those with a history of them are carefully evaluated in regard to their existing scars. The evaluation usually involves a small "test procedure" to determine if there’s a normal healing rate.

Another issue is that of postoperative skin discoloration. With darker skin, there’s often a greater risk of both increased and decreased skin color after injury or surgery. These risks can be determined by the patient’s medical and family history.

Ingrown hairs are also a more common problem in darker skin. If a patient has a history of ingrown hairs or other minor skin infections, this may signal a higher risk for ingrown hairs post-hair restoration surgery. Again, this risk can be determined by a small test procedure.

Caucasian Hair Considerations

Caucasians (white people) may have a wide range of hair and skin types. However, if someone has dense and or coarse hair, as well as skin color similar to their hair color, they will generally achieve the best results for a given amount of restored hair.

Learn more about aging and gender hair loss
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What are the Different Types of Alopecia?
Causes and Treatments

Alopecia is the medical name for hair loss to the scalp or body. While Androgenetic Alopecia (genetic hair loss) is the most common, there are many other forms of alopecia related hair loss worth discussing. Each medically named alopecia comes with distinct symptoms, a unique cause and exclusive treatments. Below, we've compiled a list of and description for the most common types of alopecia related hair loss along with the available treatment options for each.

While the information on this website can be used as a guide, men and women who believe they are experiencing hair loss should always be properly diagnosed by a qualified hair restoration physician to determine its cause. To learn more about each distinctive alopecia hair loss condition, click the links below.

Traction Alopecia
Alopecia Areata
Diffuse Patterned Alopecia
Diffuse Unpatterned Alopecia (DUPA)

Cicatricial alopecia (Scarring Alopecia)

Alopecia Universalis and Alopecia Totalis
- Read more about What are the Different Types of Alopecia?
Hair Restoration Evolution
Hair transplant procedures have evolved a long, long way since they began in the early 1950's. The "corn row" or "doll's" hair look that was associated with hair transplantation has evolved into today's "follicular unit" procedure that, when done right, is undetectable even by a hair stylist.

The Concept of the Hair Transplant is Born

During the past several decades superstition, old wives tales, and guess work has gradually been replaced by science.

The early 1800's is renowned in hair restoration circles as the age of the con men. There were hundreds of hair restoration treatments released and many lasted well into the late 1900's. These "cures" were marketed by "doctors", whose only skills were those of fast-talking and nerves of steel (as well as bravery, considering they were conning hardened cowboys and outlaws!).

The salesmen hawked their products from the safety of their side shows and "Wild West" spectaculars. They used endless tricks to get people to buy their products, such as rubbing grease into people's hair, to make it look thicker.

In 1939, a Japanese dermatologist, Dr. Okuda, published a revolutionary method in a Japanese medical journal that would lay the ground work for modern hair transplantation.

This method involved using hair transplant grafts to correct lost hair from various areas, including the scalp, eyebrow, and moustache areas. However, this study didn't make an impact in the Western Hemisphere due to the interruption of World War II.

Hair Restoration Comes of Age

In the late 50's one physician in particular, Dr. Norman Orentriech, began to experiment with the idea of relocating or transplanting the hair on the back and sides of the head to the balding areas.

Dr. Orentriech's experiments showed that when bald resistant hairs from the back and sides of the head were relocated they maintained their bald resistant genetic characteristic regardless of where they were transplanted.

This principle, known as "Donor Dominance", established that hair could be transplanted from the bald resistant donor areas to the balding areas and continue to grow for a life time. This laid the foundation for modern hair transplantation.

The Scientific Era of Hair Restoration

During the 60's and 70's hair transplants grew in popularity. However, the standard of care used larger grafts that were removed by round punches and often contained many hairs.

This now outdated hair transplant technique could achieve good results with a full look if a patient completed all planned sessions. However, a patient was typically limited in the manner they could style their hair.

Patients who stopped short of completing all planned sessions were left with hair transplants that looked obvious and unnatural. Such uncompleted hair transplant results are some times referred to as "Barbie doll hair" or "corn rows".

Many who have had these older techniques now refine or complete their bad hair transplants with today's very refined techniques to achieve a natural look that they can style in any manner.

Continue reading Hair Restoration Evolution - Hair Loss Solution
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Patrick Mwamba, MD

Dr. Patrick Mwamba

Dr. Patrick Mwamba is one of the early developers of the follicular unit extraction (FUE) method and is the most experienced body hair transplant surgeon in Brussels, Belgium.
Dr. Taleb Barghouthi

Dr. Taleb Barghouthi

Dr. Barghouthi performs Ultra Refined Follicular Unit Extraction (FUE) and Follicular Unit Strip Surgery (FUSS) with excellent results. He and his staff can perform extensive mega sessions with dense natural results.
Damkerng Pathomvanich, MD

Dr. Damkerng Pathomvanich

Dr. Damkerng Pathomvanich and his experienced staff regularly perform large densely packed megasessions with outstanding results.
Dr. Rukshan Senanayake

Dr. Ruk

Dr. Ruk has years of experience with FUE. He tailors each procedure to individual needs, hair type, and desired outcomes. Dr. Ruk has raving reviews and high-quality before-and-after photos that showcase his exceptional results.