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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.
- Read more about Scalp Micropigmentation (SMP)
How our Physicians are Chosen and How to Research Surgeons
As patients, we know that the physician you choose is the most critical decision in restoring your hair is the physician you choose. Hair restoration physicians' skills, experience, and talent vary widely, as do the end results, vary widely.
You must research and choose your physician wisely. After all, who you choose will determine how natural and complete, your new hair will be for the rest of your life. The surgeons selected and approved by our community have been scouted and vetted by the forum's highly esteemed senior valued contributors of the Hair Restoration Network. Our valued contributors have all spent years researching hair transplantation, and they have all had hair transplants. To ensure there is no conflict of interest, none of our valued contributors receive any compensation. They are volunteers who have shared their experiences and contributed for years to our community. Each surgeon has been approved based on their ethics, surgical techniques, results, and reviews. To support the costs of operating and promoting our community, the approved physician contributes a monthly fee to sponsor our community.
Their recommendation is continued as long as they continue to show evidence of excellent patient results and satisfaction. If a patient expresses concerns, physicians are expected to resolve their concerns. We ask that patients first contact a physician with any concerns so that they can resolve them before publicly posting.
Note - The hair restoration physicians recommended on this site are not a definitive list of all excellent hair transplant doctors. Nor do we warrant or guarantee the results of any of the physicians presented on this site. As always, we encourage you to do your due diligence in evaluating these and all hair loss physicians.
We offer the following suggestions for researching a hair restoration physician:
- Does the physician take a holistic approach to hair restoration? Your physician should help you evaluate all your options, surgical and non-surgical.
- Have they invested time and resources in large micro follicular unit hair transplantation sessions? Outstanding work requires a staff dedicated to and trained to use high-powered magnification to produce more than 2,000 carefully trimmed grafts per surgical session.
- Choose a hair restoration clinic that is patient-focused rather than commercially focused. Some clinics emphasize revenue, speed, and volume rather than dedicating the time and individual care needed to produce optimal results. These commercial operations typically rely on heavy advertising rather than satisfied patient or doctor referrals.
- Is hair restoration the primary focus of their practice? Outstanding results require a physician and staff to perform hair restoration surgery regularly. Doing hair restoration as a sideline and other cosmetic procedures may hinder their ability to do large sessions of highly refined follicular unit transplantation.
- How many patients has this physician produced excellent results for? Like any skill, experience over time is critical to acquiring the skill and judgment required to produce excellent results.
- Can the physician provide detailed patient before and after photographs? Do they also have patients who are willing to speak with you and meet with you in person?
What do their hair transplant patients think?
Ultimately, the most critical measure of a hair transplant surgeon's work is their patient's level of satisfaction. Find out what patients think of their physician's work by visiting our discussion forum or viewing hair loss blogs created by patients. View our standards for recommending hair transplant surgeons.
Find an excellent hair restoration physician in your area.
Send a Virtual Consult
This online feature enables you to fill out a hair loss questionnaire and email it to any of the quality hair loss doctors recommended on this site. You can even attach your photos. They will then respond to your questions and concerns.
Click here, to send a Virtual Consult.
Suggest a physician for recommendation on this site.
We are always interested in learning about outstanding hair restoration physicians. Click below to suggest an outstanding physician for recommendation on this site.
Click here if you are with a hair restoration clinic.
Click here if you are a hair transplant patient.
- Read more about How our Physicians are Chosen and How to Research Surgeons
Nanogen Hair Loss Concealer Review
A Thicker Fuller Head of Hair in 30 Seconds?

A staggering 50% of men and 30% of women will experience some degree of thinning hair by the age of 50. Along with state of the art hair transplant surgery and credible drug treatments like Propecia (finasteride) and Rogaine (minoxidil), many balding men (and women) have added credible concealers like Nanogen to their daily treatment regimen.

As the term implies, concealers do not actually regrow hair but rather cosmetically enhance the appearance of balding areas of the scalp by reducing the contrast between scalp and hair color and/or adding fullness to thin, wispy hair follicles. Nanogen is no exception however, Nanogen is very popular and differs from other topical concealers in several areas.

How Nanogen Works

Nanogen is made of microscopic keratin fibers. Keratin is the same material that natural hair is composed of, giving the product a natural look and feel when applied to existing thinning hair. Unlike other fiber-based hair loss concealers, Nanogen’s “nanofibers” have a patent pending, “dipolar” electrostatic charge coating that causes them to cling to existing hairs in a fashion resembling needles on a Christmas tree rather than lying flat against the follicles. It’s this perpendicular binding that gives what some users have described as an immediate “lift” to the hair. By increasing the diameter of each individual follicle from root to tip, Nanogen is able to enhance the appearance of hair density resulting in the illusion of a full head of hair.

Applying Nanogen

Nanogen is available in ten different shades. These colors can even be combined to invisibly blend with your natural hair. The fibers are sprinkled onto the balding scalp from an applicator reminiscent of a large pepper shakerand then blended with the fingertips. Once the desired effect is achieved, there is an optional locking mist available to help the fibers stay in place through inclement weather conditions, intense exercise and perspiration.

Users should take care when applying Nanogen near the hairline. Over application can result in accumulation and an unnatural appearance.

Conclusion

Nanogen’s keratin-based nanofibers are an excellent choice for balding men and women wishing to improve the appearance of thinning hair. Unlike some creams, sprays or make-up type concealers, Nanogen fibers are odor-free, non-itchy, wash out easily and won’t stain your clothing or pillowcase. With practice, the application is clean, quick and simple.

See what Real Patients are Saying about DermMatch on our Hair Loss Forum

For an in-depth comparison of Nanogen and similar fiber-based hair loss concealer Toppik, see the discussion topic, Product Review: Nanogen. To see what other members and Nanogen users are saying, you are encouraged to use the "search" feature of our hair restoration discussion forum.
- Read more about Nanogen Hair Loss Concealer Review
Dr. Ratchathorn Panchaprateep

Dr. Panchaprateep

Dr. Ratchathorn in Thailand performs high-density FUE, and she is involved in every step of the procedure. She provides patients with top-notch quality at an affordable rate.
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.
Jerry E. Cooley, MD

Dr. Jerry Cooley

Dr. Jerry Cooley and his staff were early adapters of using microscopes to do excellent all follicular unit hair transplantation.
Hair Loss from Cavemen to Hair Cloning
Hair has always been an important symbol of status throughout history. Whether it signified social, financial, gender, or professional status, hair has come to be considered a sign of success. And this idea appears to go all the way back to the cavemen.

A few years ago, the frozen body of a man on the Austrian-Italian border was discovered by scientists. Upon examining the clothing and weapons found on the specimen, they were astounded to find that the body was from the Neolithic Age, making him more than 5,000 years old. They had previously thought that the body was only a few years old, based on his trimmed beard and short hairstyle. So even during prehistoric times hair care was in practice.

Even 4,000 years ago, the ancient Egyptians were searching for a hair loss cure. One “cure” used around 1500 B.C. in Egypt called for reciting a magic spell to the sun god and then swallowing a mixture of onions, iron, red lead, honey and alabaster.

Around 1100 B.C. in ancient Egypt it was popular to rub the fats of various animals onto the scalp, including those of the lions, hippopotamuses, crocodiles, ibex, serpents and geese.

Another recipe for growing hair prepared for the King of Upper and Lower Egypt included toes of a dog, refuse of dates, and a hoof of an ass. Of course, these “cures” failed to re-grow hair.

But with baldness regarded as shameful in ancient Egypt, men and women were willing to put such things on their head in the hope they would work. During these times it was believed that baldness stood for the public announcement of a man’s loss of virility.

The Gospel on hair loss

Yes, hair loss is even mentioned in the Bible. According to this Old Testament passage God does not condone ridiculing the bald.

Kings 2: 23 “From there Elisha went to Bethel. As he was walking along the road, some youths came out of the town and jeered at him. "Go on up, you baldhead!" they said "go on up, you baldhead!" He turned round, looked at them and called down a curse on them in the name of the Lord. Then two bears came out of the woods and mauled forty-two of the youths. And he went on to Mount Carmel and from there returned to Samaria.”

As a hair loss sufferer you can take solace in knowing that today you have treatments for hair loss only dreamed of by the Kings of ancient Egypt and the emperors of Rome.

Hair loss and attempts to stop or reverse it have been around for centuries.

How mankind has treated hair loss over time.
- Read more about Hair Loss from Cavemen to Hair Cloning
Dr. Manish Mittal

Dr. Mani Mittal

Dr. Mani Mittal provides customized hair restoration plans for each patient. He's involved in every step of the procedure and consistently provides high-quality results with high growth rates. His ability to recreate hairlines with artistry and finesse makes him an optimal choice.
Trichotillomania and Treating Hair Loss
Men and women who have the impulse to pull their own hair out may be suffering from trichotillomania. Trichotillomania is an impulse control disorder characterized by the repeated urge to and behavior of pulling out one's own hair. Impulse control disorders resemble substance addictions because the patient feels out of control of his or her own behaviors. Men and women with trichotillomania live relatively normal lives but typically show signs of hair loss, thinning, and bald spots all over the scalp and body from pulling it out.

Treating trichotillomaniagoes far beyond trying to stimulate hair regrowth.Even if Rogaineor laser therapy for hair losswere to regrow hair, there is a strong possibility that trichotillomania patients will continue to pull their hair out. Patients with trichotillomania therefore, should be treated at the source of the disorder in conjunction with using proven hair loss treatments.

In addition to medication, Habit Reversal Training (HRT) by a trained counselor has proven to be successful in treating trichotillomania. With Habit Reversal Training, the individual is taught to recognize and redirect their impulse to other more constructive activities. Often times, trichotillomaniapatients are asked to keep a journal of their hair pulling episodes. This can help the counselor and patient to identify and develop strategies to avoid situations that might trigger hair pulling episodes. Journals often include the location of the incident, number of hairs pulled, date, time, and their feelings and thoughts during the episode.

Treating a trichotillomania patient's baldness may be done simultaneously or after proper treatment of the disorder. Rogaine (minoxidil)can be a helpful aid to HRT by stimulating the follicles underneath the scalp, potentially facilitating or expediting hair growth.Treating a patient’s hair loss while they continue to pull their hair out is not constructive. Since this type of balding is not genetic due to the production of DHT, Propecia (finasteride)won't likely help.

Patients who've suffered from trichotillomania for awhile may damage or even remove the hair roots by excessive pulling, making non-surgical hair regrowth next to impossible. Surgicalhair restorationmay be an option for trichotillomania patients whose hair roots are too damaged to produce new hair on their own. Hairrestoration surgeryshould be reserved only for patients who've been successfully treated and no longer suffers from trichotillomania.

Catching and treating trichotillomania early will most likely reduce damage done to the hair follicles and eliminate the need for hair loss treatment, since undamaged hair will return on its own.
- Read more about Trichotillomania and Treating Hair Loss
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
- Read more about Hair Restoration Evolution