Long ago, a full head of hair was valued as a means of protection, heat retention, and camouflage.

Today we value hair for other reasons. Whether we admit it or not, good hair still is associated with power, virility and youth.

Such associations date back to ancient times. Remember the story of Samson and Delilah? When Delilah cut Samson’s long hair he lost his power.

 "And Delilah made him sleep on her knees; and she called for a man, and she caused him to shave off the seven locks of Samson’s head. . . and his strength went from him."(Judges 16:19)

As “enlightened” as we are today, stereotypes associated with hair loss persist. The bald or balding are sometimes passed over and teased at work, in the media, and in the social scene. The media idolizes the young and the attractive and often lampoons the bald or balding.Of course, it’s not fair. But at least losing your hair is not health threatening. However, it can result in various psychological and emotional issues. These include insecurity, isolation, panic, a sense of loss, and even depression. But let’s first look at the role of hair (and the lack of it) in our society.How is Hair Loss seen by Society? So why does something as superficial as hair seem so important to so many men and women? Studies have shown that hair is a symbol of social, professional, cultural, and/or religious affiliations. Good hair implies power, virility, strength and youth.

Studies reveal how baldness is perceived.In a study done in 1971, a picture of one person was distributed to 60 people. But each picture had been altered by a commercial artist to reflect a non bald, balding, or bald condition. The results revealed some negative stereotypes.

When the person was shown with a balding head of hair he was rated as weak, dull, and inactive. This same person with a bald head of hair was rated as unkind, bad, and ugly. Yet this same person with a full head of hair was rated as handsome, virile, strong, active, and sharp.

Today, more than 30 years later, it is hard to know if things have really changed. But maybe some of these tired negative stereotypes about being bald are starting to change, at least in the media.

Today, bald NYPD Blue's -Dennis Franz, a multiple Emmy Award-winner, is considered a sex symbol.

As is Tony Soprano of the popular HBO TV show the Sopranos.

And, of course, let’s not forget Telly Savalas of the 70’s TV show Kojak who was once voted by People magazine as the “sexiest man alive.”

Studies about Baldness and Self Esteem

Those who are bald or balding are generally thought of as older, weaker, and more ineffectual, both in the work world and on the social scene.

According to a 1995 article in the “British Journal of Psychology,” balding men have been found to have lower levels of self-esteem than their peers, are less sociable, suffer more from depression,and are less likely to succeed in life.

Hair loss, especially when first occurring, can lead to rash decisions. So it is important to slow down and look at the many viable options that are available for dealing successfully with hair loss.

Our Hair Treatments section offers in-depth information on many viable treatments.

1992, researchers from the Old Dominion University in Norfolk, Virginia surveyed 145 balding men and found that 84% were preoccupied with baldness.

Their responses showed that they were filled with self-consciousness and helplessness. They were also envious of men with full heads of hair.

Additional research indicated that single men and woman who had begun losing hair in their early twenties were more likely to suffer from extremely low self-esteem.

Hair loss often creates emotional distress.

Loosing your hair can be disturbing, especially if you're a young man or woman. This unwanted loss forces those afflicted to face new issues, such as the perceived loss of youth and sexual attractiveness.

It's common for young people who are balding to have feelings of isolation. They may feel uncomfortable among their peers and in public. Young people with hair loss often lose their confidence and may also become less productive at work.

For older people hair loss is often just one more sign that they're reaching middle or old age. It may prompt them to question the direction of their lives or fear that their lives are closer to the end than the beginning. This can result in a sense of loss, insecurity, or even depression.

And as bad as men have it, hair loss can be even worse for women. Balding women must deal not only with the thought of aging, but also that they may not be considered attractive.

Coming to terms with hair loss.

Yes, hair loss can be disturbing. But there are many effective options available to you, ranging from hair loss drugs that often halt thinning to restoring the hair you’ve lost with surgical hair restoration.

However, prior to choosing a hair loss treatment, it is wise to deal with the psychological effects of hair loss.

Hair loss at any age, while not painful or dangerous, can cause emotional damage and distress.

Finding support and advice to cope with hair loss.

You can find support and share ideas and advice privately with other hair loss sufferers by reading and posting on our popular hair loss discussion forum.

By sharing with others you will realize that others share your same concerns and feelings about going bald. You will also learn about what hair loss treatments actually work or not from those who have already tried them.

Find a "Hair Loss Mentor" for - one on one - support and guidance.

In addition to our discussion forum, you can also view Hair Loss Weblogs created by actual hair restoration patients. These blogs contain photos journals documenting the person's hair restoration. Often you can correspond with these blog authors by email.

If you have a hair loss question please post it on our Hair Loss Q & A Blog. This blog can also be searched for dozens of answers on many hair restoration topics.

Empowering yourself with information and sharing your feelings and concerns will also make you feel much more in control of your hair loss. Then, if and when you finally do choose a hair loss treatment option, you will feel much more confident in your decision.

Many who once were preoccupied by their hair loss find a solution and move on in life, sometimes with a "new lease on life". While others choose to remain bald and simply accept it.

The choice is yours to make. This site is dedicated to helping you successfully resolve your hair loss issue on the inside as well as on the outside.

The disturbing truth about hair loss

In 1999, the psychological impact of hair loss, as well as its leading treatments, was the subject of the American Academy of Dermatology's summer scientific meeting in New York. At this meeting it was revealed that there were direct links between androgenetic alopecia (male and female pattern baldness) and personality disorders in those afflicted.

In one study of 116 subjects with hair loss it was determined that 76.3% of the participants had at least one actual personality disorder. This was an extremely high rate of disorder compared to the much lower rate of 10% of the general public suffering from personality disorders.

Another study showed that twice as many women than men with hair loss rated themselves as “very” or “extremely” upset about their hair loss.

In the 80's hair restoration surgery as a hair loss solution evolved dramatically, as the large punch grafts were gradually replaced with a more refined combination of mini and micrografts. This "combination mini micrografting" hair transplantation procedure no longer used the punch to extract the bald resistant grafts. Rather a strip of bald resistant hair was surgically removed from the back of the head and then trimmed into mini and micrografts.

Typically the minigrafts (4-8 hairs) were used to create fullness and density, while the one, two, and three hair micrografts were used to create a refined and feathered hairline in front. This combination procedure also normally used more grafts, several hundred grafts per session, rather than the approximately 50 to 200 large grafts of the original punch graft procedure.

Follicular Unit Hair Transplantation (FUT) the "Gold Standard"

The 90's saw the gradual introduction of a very refined surgical procedure hair loss solution now known as "follicular unit hair transplantation" or "FUT". This exacting and labor intensive procedure transplants hairs in their naturally occurring one, two, three, and four hair "follicular unit groupings" in which they grow naturally.

To create such natural follicular unit grafts, which mimic the way hair grows naturally, typically requires the use of high powered magnification. Such magnification enables the surgical technicians to properly visualize the follicular units in the donor tissue. They are then able to isolate them and cut them into 1, 2, 3, and some times 4 hair follicular unit grafts.

The Age of Natural Hair Transplant

Critical to the ultimate success of the follicular unit hair transplant procedure was the introduction of the binocular microscope by Dr. Bobby Limmer of San Antonio Texas in the late 1980's. Dr. Limmer found that by using the microscope he and his staff were able to successfully isolate and trim the naturally occurring follicular units into individual grafts.

For his part in pioneering the use the microscope in graft dissection and the follicular unit procedure Dr. Bobby Limmer was awarded the "Platinum Follicle Award" by the International Society of Hair Restoration Surgery in 1996. Many physicians now fondly refer to him as the "Godfather of Follicular Unit Hair Transplantation".

Dr Bobby Limmer

Dr Bernstein

While Dr. Limmer pioneered the use of the microscope in trimming follicular unit grafts, it was Dr. Robert M. Bernstein, in collaboration with Dr. Bill Rassman, who pioneered and advanced the concept of large sessions of all follicular unit grafting. These large follicular unit sessions enabled patients to achieve both naturalness and density.

Dr. Bernstein, who coined the name "follicular unit hair transplantation", tirelessly advocated for its adoption in ground breaking articles and lectures that are today recognized as benchmarks in the advancement of this procedure. Click to read these ground breaking hair restoration articles and papers.

In recognition of his many contributions in both conceptualizing, pioneering and advocating "follicular unit hair transplantation", Dr. Bob Bernstein was awarded the "Platinum Follicle Award" by the International Society of Hair Restoration Surgery.

Over time the merits of this refined but difficult to perform procedure became accepted and the follicular unit hair transplant procedure has become acknowledged by most hair restoration physicians to be the "Gold Standard" for surgical hair restoration. Click here to see video of a Follicular Unit Hair Transplant procedure.

Some feel that hair restoration surgery has evolved to its highest degree now that it relocates hair exactly as it grows naturally. However, even the "Gold Standard" in hair transplantation has continued to evolve by becoming even more "ultra refined".

Today some leading hair restoration surgeons, including all members of the Coalition of Independent Hair Restoration Physicians, perform an ultra refined follicular unit hair transplant procedure using very tiny incisions that enable them to safely "dense pack" tiny grafts when appropriate. This ultra refined follicular unit procedure is a hair loss solution that enables patients to achieve cosmetic density in a given area after only one surgical session.

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.