Hair Replacement systems, also known as hairpieces, hair replacements, hair systems or toupees, have improved over the past decade. Quality hair replacement systems are now refined in construction and light weight. For those with extensive baldness who require a full head of hair to be satisfied they offer a quick and nearly instant solution.

Hair systems are constructed of human hair or synthetic fiber. Recent advances have made the synthetic hair much more natural in appearance and texture.

A quality hair replacement system is specially constructed for an individual recipient. These systems are made of real hair, synthetic, or both. They're designed to attach to the head for an extended period ranging from 3-6 weeks, without ever being taken off. Visit Farrell Hair Systems for more information.

Hair systems can work for both men and women. In fact, more and more women are opting for hair systems over wigs, as they can be more comfortable and look more natural.

The process of getting a Hair Replacement System

Typically clients first visit a hair salon for an evaluation. The extent of their hair loss is measured. They are given information including prices, maintenance, and future schedules. Usually, it takes several days for the system to be prepared, based on the client’s preferences.

While a person can get virtually any type of look, you are generally guided towards an option that looks more undetectable and realistic. These studios employ their own hair stylists to achieve ideal looks. Clients can visit these stylists for monthly haircuts or touch-ups.

With these hair systems, a fine mesh foundation is placed on the scalp's balding area and precisely cut to these dimensions. Later, real or synthetic hairs will be inserted into a foundation to create the "Hair System" or hair piece.

The foundations of the past were actually designed to be thicker and more durable. Fortunately, today's foundations are much thinner to make them undetectable. However, this thinness comes at a price, literally. The thinner a system the more delicate it will be and thus it will require being replaced more often.

Once completed, the hair system is attached to the client scalp using clips, weaving, and/or adhesive. The hair system is then styled to match your existing hair.

Maintaining a Hair Replacement System

The stylist in the studios also remove the systems about once a month for maintenance, cleaning, and styling. During these adjustments a person can expect to have their hair system removed, their scalp thoroughly shampooed, and their hair cut. The hair system may also be touched up and or colored if needed.

It's crucial to carefully groom the hair system to maintain a natural appearance. With a quality system, a person can expect to continue doing all normal activities such as running, bicycling, and weightlifting.

However, hair systems typically require time, money, and effort to keep them looking their best. And some clients may feel some discomfort, as well as some insecurity that their hair system may be detected.

Various Methods of Attaching a Hair System

Hair replacement systems can be attached in a variety of ways. They can adhere to the skin, hair, or a combination of both.

When attached to existing hair this method can provide an extra sense of security for clients who enjoy active lifestyles. This type of attachment goes by names such as fusion, weaves, cabling, beading and bonding. Because this type of attachment depends on the rate of the hair's growth, the system must be reattached periodically.

Hair replacement systems can also be applied to bare skin. This can be performed in a variety of ways, such as waterproof and biologically safe glues as well as two-sided tape. However, while these glues and tapes are generally safe for the skin, it's possible to have an adverse reaction. For that reason you should tell the studio stylist of any discomfort.

It's also possible to have a hair system applied surgically. In this case, small skin grafts, known as "tunnel grafts", are taken from a donor site. These tunnel grafts are then formed into tiny loops and placed in the balding areas where the outer edges of the hair system will be attached. The edge of the hair system is then attached to these loops once they have grown into the scalp. Since the hair system is now attached to the scalp, rather than the existing hair that grows out over time, the hair system does not get progressively looser over time.

However, this method of attachment is not recommended due to possible complications such as skin infections.

Finding a Quality Hair Replacement System

If you're considering a hair attachment, you need to be aware of just how to locate the nearest studio, as well as what to look for in one.

Of course you can use the Yellow Pages or the Internet to locate a qualified studio. However, once you do locate one, it may be a good idea to check with the local Better Business Bureau for complaints against the company. It's usually only a problem if there have been multiple complaints against the company.

It's best to consider a hair attachment studio that specializes in non-surgical hair replacement systems. And once you do find an appropriate office, it's best to bring along a photograph showing your ideal look. Plus, try to meet with other clients who are wearing the hair system you may be considering.

It's also important to find out how a company handles potential client problems and complaints. Do they have money-back guarantees or trial periods? These are important questions to ask.

You may also want to check around with the American Hair Loss Council (AHLC), one of the leading groups governing hair loss. The AHLC can't endorse any individual firm. However, this organization supplies clients with a list of local AHLC specialists, known as the American Hair Loss Council Source Book. The specialist and studios on this list are all required to sign a statement that says they honor the group's code of ethics. This code is designed to protect consumers.

Follicular unit extraction is a minimally invasive procedure for performing follicular unit hair transplantation. However, unlike the predominant follicular unit transplant procedure, in which a strip of donor tissue is removed and dissected under magnification, the FUE procedure uses a small punch to extract each follicular unit one by one.

Both the strip excision and FUE procedures create 1, 2, 3, and 4 hair follicular unit grafts that are then transplanted into the balding area in the same manner. The primary difference between these two procedures is the technique used to harvest the follicular unit grafts.

Comparing the Strip Excision procedure to the Extraction (FUE) procedure

The common strip excision method of performing follicular unit hair transplantation involves surgically excising a thin horizontal strip of bald resistant skin from the donor area.

Strip Excision Procedure 

Donor strip being excised

Incision sutured together

Hair combed down after suturing

This donor area is then sutured together. These sutures (either stitches or staples) are then typically removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.

Patient’s donor area 2 months after surgery

Once this linear incision is fully healed the patient is left with a thin horizontal scar in the back of the head. This scar is typically hard to detect since the surrounding hair conceals it, even when the hair is cut short.

To view a video of an actual strip excision surgery.

How the FUE Procedure is performed

With the Follicular Unit Extraction or FUE procedure 1, 2, 3, and 4 hair follicular unit grafts are carefully extracted one at a time using a tiny punch of one millimeter or less. Often the surgeon requires the patient to buzz cut a portion of their donor area so that they are able to see the patient’s scalp.

The follicular units are extracted

The follicular units are extracted by placing the punch around a single follicular unit and cutting a small circle through the skin around that follicular unit. The follicular unit is then gently pulled up and away from the loose tissue underneath the skin.

The small hole left behind after the follicle is extracted then heals over the following week. Normally this small round incision contracts as it heals making the resulting round scar smaller than the size of the 1mm punch that made the incision. The FUE patient ultimately ends up with hundreds of small round white scars, which are normally not detectable once the patient’s hair grows out.View a video of an actual FUE surgery.

To Extract or to Excise, that is the question.

Advocates for the relatively new FUE procedure claim that this procedure produces less noticeable scarring and no tightness or numbness in the donor area since no donor tissue has been pulled together and sutured. Many patients and physicians find the claim that FUE produces less visible scarring to be debatable.

Some physicians and patients also have concerns about the relatively new FUE procedure, such as the lack of formal studies regarding the percentage of follicles that may or may not be transected during the sight unseen extraction process.

In addition, since the physician must personally extract all follicles, one by one, the FUE procedure is very physician dependent and thus very expensive. The FUE procedure also requires considerably more time in surgery to move a given amount of hair to the balding area.

The standard strip excision procedure has the advantage of utilizing a collaborative team to carefully create the grafts once the donor tissue is removed in a strip. This collaborative approach enables a well trained staff to do sessions of 2,000 to 3,000 all follicular unit grafts in a single day. This team approach enables a patient to get a much larger number of grafts/hairs in one sitting at a much lower cost per hair than with the FUE procedure.

However, some believe that despite being relatively costly the FUE procedure may be appropriate for patients who have very limited elasticity in their donor area or who only need a small number of grafts.

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.