• Scalp Micropigmentation (SMP)

     micro pigmentation

    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?

    How Scalp Micropigmentation Works

    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.

  • Thomas Chung Wai Nakatsui, MD

    Dr. Thomas Nakatsui
    Dr. Thomas Nakatsui
    Dr. Nakatsui performs large sessions of ultra refined follicular units using the lateral slit technique with extremely natural results.
  • Hair Growth Stimulators

    Hair Loss

    Reviving Thinning Hair

    These types of treatments work by stimulating hair growth. However, they can't stop hair loss completely as they don't address the root causes of hair loss. Products that act to stimulate hair growth include Rogaine, Tricomin, Folligen, Proxiphen (along with Prox-N and Nano Shampoo) and Retin-A.

    Tricomin

    Tricomin pack

    Tricomin, which is used by men and women, is a topical spray that has undergone a wide variety of scientific testing. The spray’s main ingredient is copper, which has been proven to be beneficial for hair.

    The FDA has conducted some clinical studies, with the subjects applying the treatment twice per day for 24 weeks. These results were shown to be very positive. However, the product’s parent company, ProCyte Corporation, chose to release Tricomin as a cosmetic. They wanted to avoid the FDA approval process, which tends to be very lengthy.

    Tricomin may be an effective option for those who want a treatment that’s undergone scientific testing, yet isn’t drug-based.

    The product can be used safely by men, women and children. It’s also non-irritating and has no known side effects. Tricomin can be used for any type of hair loss

    The product should be sprayed to damp or dry hair twice each day. But if you’re using another topical treatment, such as Rogaine, you should wait a few hours before applying Tricomin. This is because the scalp may turn a greenish color when mixed with other products. However, this discoloration isn’t permanent and washes out. And like other treatments, Tricomin needs to be used regularly to maintain its results.

    Besides the spray, Tricomin is available as a shampoo and conditioner. They should be used as an addition and not as a replacement, though.

    For more detailed information of Tricomin Follicle Therapy Spray, Shampoo and Conditioner, click here.

    Folligen

    Folligen

    The makers of Tricomin make this product, available as a cream, lotion and spray. It was originally designed as a skin repair cream in the Dermatology Department at the University of California at San Francisco.

    However, a 41-year-old woman with severe hair loss re-grew lost hair in two and one-half months with the cream. The company, Skin Biology, has since marketed this cream, which also contains copper-peptide as a hair loss treatment. The blue-colored copper-peptide complexes are meant to improve hair vitality and the health of the scalp and hair follicles.

    Folligen products are meant for both men and women. They feature a cream for hairline application, spray for overall use, and lotion for bald spots. While Folligen may work on its own, its best results may be seen when it’s used with products like Rogaine.

    Essentially, Folligen’s products soothe irritated scalps. They also relieve the itching and burning associated with Rogaine. However, the Folligen spray may cause itching or burning. Also, because the cream and lotion are bright green, it’s better to use them at night, while covering your pillow.

    And while you can wash Folligen off easily, it’s not advisable for people with very light blonde hair to use the product. They may develop a greenish tinge to their hair.

    Proxiphen, Proxiphen-N, NANO Shampoo

    Proxiphen is a prescription formula topical cream that has not yet received FDA approval. It combines the power of minoxidil and other chemicals. The cream should be applied everyday for the first 8 - 12 months, and after that, every other day. Proxiphen is dispensed only when a physician gives a diagnosis of hair loss.

    Proxiphen-N, the non-prescription Proxiphen is less expensive and is also not as strong. It’s advisable for patients to use minoxidil with Proxiphen-N.

    NANO (nicotinic acid N-Oxide) shampoos and conditioners are an excellent compliment to your existing minoxidil treatment. They contain NANO, which is a minoxidil-like hair growth stimulator. They also have agents that stimulate hair growth. These products are beneficial when used with Proxiphen and Proxiphen-N.

    In order to see some results, Proxiphen-N and the NANO products need to be diligently used for at least 8-10 months at the very least.

    A one-month supply at prescription strength is about $100. A 2-month supply of Proxiphen - N will cost $59.95. A 90-day supply of NANO Shampoo and Conditioner will cost $39.95 and $29.95, respectively.

    Retin-A

    Retin-A (also known by its scientific name, tretinoin gel 0.1%), is a topical treatment that’s primarily used as an acne medication. However, research has shown that Retin-A, either by itself or with Rogaine, may grow some hair in those with male pattern baldness or female pattern baldness.

    To use Retin-A, you should apply a thin layer with a gauze pad or cotton swab to the affected areas at bedtime. Remember to wash your hands immediately after using the product! You should also take care not to get any Retin-A near the eyes, mouth, or open cuts. The medication may irritate sensitive skin.

    It should also be mentioned that if Retin-A is used more often, the results will not improve. Rather, the side effects may increase. These effects include an immediate warming of the skin. Other skin problems may include peeling, itching, scaling, redness and maybe mild stinging. Luckily, once your skin adjusts to the medication, these effects should subside.

    Retin-A may also cause increased sensitivity to sunlight as well as wind and cold. For these reasons, you should avoid prolonged exposure to the sun and sunlamps. You should also use effective sunscreens, and wear protective clothing.

    In regards to pregnant mothers, research hasn’t shown any risk of birth defects, as of yet. Nevertheless, physicians recommend using Retin-A during pregnancy only if necessary. You should also consult your doctor before breast-feeding. One tube of Retin-A Cream can be purchased for about $28.00.

    Click to learn more about Superoxide Dismutase (SOD's)

  • Patrick Mwamba, MD

    Dr. Patrick Mwamba
    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.
  • H Rahal, MD

    Dr. H. Rahal
    Dr. H. Rahal
    Dr. H. Rahal and his staff perform large one pass sessions of ultra refined follicular unit hair transplantation with outstanding results.
  • Questionable Hair Loss Treatments

    Questionable Hair Loss Treatments

    Balding Has Been Cured

    Try telling that to 80 million men and women who are suffering from hair loss in the United States. They will laugh at you. Yet on a daily basis we are bombarded with ads for hair loss treatments like Avacor, Hair Genesis, Fabao and Procerin that use misleading advertising to sell their products. Thanks to their persuasive messages promising to regrow hair, consumers will spend nearly one billion dollars trying to find an effective hair loss remedy and fall victim to misleading advertising like this.

    Thinning hair is a source of distress for millions of men and women so it is not unusual for them to seek help from anything that sounds like it will work. Most questionable hair loss products use similar, misleading marketing techniques ranging from claims to testimonials and photos.

    Hair Loss Product Claims

    Many hair loss products claim to be able to restore hair through the use of drugs, herbal lotions or other exotic applications like lights, lasers or electrical fields. While many of these products have been around for years, there is little evidence that they can restore hair.

    How are they allowed to make such claims? These products often use small amounts of generic drugs found in Propecia and Rogaine (finasteride and minoxidil) which allows them to make the claim to stop hair loss or they imply hair growth with 'cosmetic' claims.

    Misleading Marketing

    Some hair loss products lead you to believe that they can stop hair loss by parsing their words. They can't come out and claim to regrow hair or stop hair loss, so they advertise vague claims like "thicker, fuller hair". This is a 'cosmetic' claim that any product can make. Be advised that cosmetic claims cannot restore hair or grow hair because they are not proven to do so.

    False Testimonials

    With the anonymous nature of Internet postings, people posing as users will mislead others with false testimonials. Often, positive reviews are produced by people compensated to post these messages. Since there is no real regulation of online postings, consumers are advised to take testimonials with skepticism.

    Phony Photos

    Most product advertising that claim that you can "Regrow Hair!" or make your hair 'thicker and fuller' and show a photo of a balding person with thin hair next to a photo of the same person with thicker hair covering the baldness. Photos don't lie, do they?

    Well, yes they do.

    You can prove it yourself. Take a photo of a head with thinning hair using a flash camera and then photograph the same head without the flash. The photo with the flash will look like a bald head and the photo without the flash will look like more hair.

    Lighting, length of hair and how the hair is arranged on the head determine whether a photo of a head looks bald or not. Most people go through the same routine as balding advances: they push hair from here to there and hair spray it into place in the hope that no one will notice that we are going bald. To the extreme, this becomes the 'comb-over' hair style.

    Review the photos of hair loss products you've seen. In most cases there will be just a few and they will all have misleading elements like lighting, hair style and length of hair in the 'before and after' photographs. If the products or services are really legitimate, there should be dozens of photos, if not hundreds or thousands.

    The FDA and the FCC

    Sadly, we think that the United States Food and Drug Administration and the Federal Communications Commission (agencies who regulate such issues) can stop these scams. Unfortunately, they can't. Since the FDA approved Minoxidil and Finasteride as effective in stopping hair loss, any inclusion of these products in any form enables marketing companies to make hair restoration claims.

    Even the studies done for Rogaine and Propecia are not that encouraging. When Rogaine was studied (active ingredient is minoxidil), 16% of the placebo group had measurable new hair growth. Four out of twenty-five people had real, measurable hair growth when they believed they were using something that worked. Both studies were limited in time and scope. To read the studies that were done achieve FDA approval, visit the FDA web site and scroll down to Propecia and Rogaine. (http://www.fda.gov/cder/foi/nda/index97.htm )

    Hair Loss and Hair Restoration

    If a person is genetically prone to hair loss and balding, FDA proven hair loss treatments may help slow the process if they are used early and often. If you are like many and have already lost more hair than you're happy with, there is only one option to restoring your own natural hair: hair transplants. Hair transplants have become an art in the restoration of natural hair which is genetically resistant to the causes of balding.

    Like any surgical solution, your success depends upon the quality of the doctor you choose. Doctors who are successful in restoring a natural looking head of hair are carefully reviewed by the Coalition of Hair Restoration Physicians for membership in this exclusive organization. They must allow access to past patients, confirm their training and provide photos and videos of their patients.

    While hair transplants are not possible for everyone, they are now more natural and affordable than ever before.

    View hundreds of real hair transplant photos done by the world's top hair loss specialists who are members of the Coalition of Hair Restoration Physicians.

  • Dr. Rafael De Freitas

    Dr. Rafael De Freitas
    Dr. Rafael De Freitas
    Dr. De Freitas is an expert in performing Follicular Unit Extraction (FUE). He's regarded as one of the world's best FUE surgeons. He performs dense-packed ultra-refined follicular unit grafting at an affordable price.
  • Avacor. Is it worth the price?

    Avacor

    One product you used to see quite often in advertising is Avacor. According to Response magazine, Avacor was the third best selling product on the Internet in April, 2002. Avacor was originally manufactured by Global Vision Products. After being taken over by new management, it is now being manufactured by Avacor Products LLC.

    Like most products that advertise 'Stop Hair Loss and Regrow Hair!', Avacor contains the only FDA approved topical drug minoxidil. Avacor, like other products with similar claims, mixes FDA approved drugs in their generic form with other ingredients in a multiple regimen of products like shampoo, lotion and vitamins.

    Avacor historically cost approximately $239 for a two to three month supply and over $1000 for a year’s worth.  New prices are much more reasonable which range from $180 for a 3 month supply to $400 for a year’s supply of the men’s and women’s formula. Note that the ingredients in Avacor can be bought over the counter at your local store at a fraction of the cost for which they are sold in Avacor. However, they do offer 24/7 customer service and a 90 day money back guarantee.

    Marketing Practices

    Avacor, like other products with similar claims, has taken a lot of slack over the years for their controversial marketing tactics. Avacor has a checkered past and has previously been the focus of lawsuits and investigative reporting by major media like ABC news. Recently however, new management has taken over and claims they are very serious about selling quality products at more reasonable prices, without the hype and controversial marketing strategies. In looking at their website, while Avacor still uses slick marketing language to promote their products, the vast majority of their claims are much more realistic.

    Avacor includes 3 distinct products that claim to provide “total hair care”. This includes a 'Scalp Detoxifying Shampoo', a 'Physicians Topical Formulation' and finally a 'Nutricap'. Avacor's Nutricap ingredients consist mainly of common herbs like saw palmetto, gingko biloba, keratin, resveratrol, and bilberry. While conjectured to inhibit the production of DHT, none of these ingredients are FDA approved or proven to stop hair loss. Avacor’s Physician’s Topical Formulation however, does contain 5% of the FDA approved hair regrowth agent minoxidil.

    Other than minoxidil, no other ingredient is proven to regrow hair. A number of studies have been done that suggest saw palmetto inhibits the production of DHT, like Propecia. But, unlike Propecia, it has never been proven to stop or reverse hair loss.

    Avacor Products

    Avacor admits on their website that the only product proven to regrow hair is the Avacor Physician’s formulation which includes the FDA approved ingredient minoxidil (5% for men and 2% for women). The other products claim to provide hair with the essential nutrients for healthy hair growth but are careful not to claim to prevent the progression of male or female pattern baldness (androgenic alopecia). Perhaps this is why the Avacor Physician’s formulation can now be purchased separately. Costs of the Physician’s Formulation are still, but only a little more expensive than Rogaine topical hair loss treatment, one of the first and most popular topical minoxidil products.

    The Avacor Study

    At this time, Avacor’s proof comes in the form of the FDA approved study showing that minoxidil can stop and reverse hair loss.  No other study is provided with their product.  Their website also is much more realistic as to what their product line can accomplish for hair loss suffering consumers.

    Confidence in Products and Services

    Before you consider spending hundreds of dollars for any product or service, do a review. Legitimate products will have legitimate studies and have been reviewed on many quality websites. Doctors with real talent and satisfied patients will be able to show you dozens of photos and allow you to talk with past patients. Proven physicians will make available their resumes along with their formal education and associations they belong to.

    It is always best to review a product or doctor for information on their background before you make a decision for something as important as hair loss and hair restoration.

    Conclusion

    At the very least, the Avacor Physician’s formulation will be as effective as the Rogaine liquid formula or generic minoxidil. However, to date, both Rogaine and generic minoxidil are more cost effective than Avacor.  The nutricap, shampoo, conditioner and other products may promote healthy hair and provide it with volume, but make no claims of stopping hair loss or regrowing hair.

  • Dr. Ron Shapiro

    Dr. Ron Shapiro
    Dr. Ron Shapiro
    A true pioneer, with a worldwide reputation for outstanding follicular unit hair transplantations among both colleagues and patients.
  • Dr. Özlem Biçer MD

    Dr. Ozlem Bicer
    Dr. Ozlem Bicer
    Dr. Biçer provides ultra-refined follicular unit extraction (FUE) at an exceptionally low-price. Dr. Biçer's practice combines quality with affordability with a patient-centered focus and attention to detail.