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Scalp Micro Pigmentation

Frequently Asked Questions


There are many good candidates for hair micropigmentation. Men who want to shave their head and have their pattern of balding to appear looking like a full head of hair with a shaved scalp. Many autoimmune disease patients are ideal because they can’t have a hair transplant (e.g. Alopecia Areata, Alopecia Totalis).


There are patients who don’t want to have a transplant or aren’t good candidates like depleted donor areas, or hair transplant process that was never finished and for many reasons, can’t be finished.

SMP is very effective in treating scars from previous transplants and for treating the old type of ‘plugs’. Women with thinning hair are great candidates for this type of procedure as well for creating the illusion of more density.

Those suitable for SMP include:

  • Hair thinning or regional balding where the patient desires to appear to have a fuller head of hair, with or without a shaved scalp.
  • Scalp scars from scarring alopecias
  • People with autoimmune diseases such as refractory alopecia areata or alopecia totalis
  • Women who are balding or thinning who are not responsive to minoxidil or other medical treatments and do not qualify or wish to have hair transplantation
  • Neurosurgery scars and scars from head trauma, surgeries and/or hair restoration procedures.
  • Chemotherapy patients, who do not grow back significant amounts of their hair after treatment
  • Deformities in hair restoration patients resulting from unplanned processing hair loss in men, whose hair transplants can’t achieve the amount of ‘fullness’ they expect.
  • People with wide or obvious scars from donor strip harvesting techniques
  • People who have open donor scars from hair transplant surgery from harvesting techniques between the 1950’s and early 1990’s, from strip harvesting surgeries, or from FUE techniques that create punctate scars.
  • Patients who have old pluggy or corn-row look with or without donor site depletion and a see-through donor area.
  • People who dislike using topical concealers or wigs.


SMP acts as a concealer – the artistic effect is similar to the visual effect of a stippled painting of dots created between the pores of a balding scalp. Hair can be either shaved or long depending on the desired result. The density of the stippling does not necessarily match the number of pores that contain the hair in the average adult.


The average Caucasian has 50,000 pores (follicular units), Asians have an average of 40,000 pores and Africans have an average of 30,000 pores. The density of the dusting created in the SMP process can be designed to produce shading and create the illusion of texture and fullness.

Many of our patients will have between 2-4 sessions before the process is complete sometimes more if completing a full head. A slow and judicious approach is required for each session to avoid pigment or ink being placed too superficial or too deep causing ‘pigment bleeding’. This process can be quite stressful for the operator, both mentally and physically – it is critical for the hair tech to take frequent breaks during this process for best results.



SMP tattoos can last the lifetime of the patient however, many do fade over time requiring touch-ups. Most patients do not return for touch-ups but some do want to address the fading that occurs over time may return at 8, 20 or more years later.


Patients who had scalp micropigmentation are told to avoid being directly in the sun, and if they do, use a high SPF skin blocker or hat. It is always best to use a hat for extended sun exposure. If there is frequent sun exposure without being protected, the colour of the tattoo will fade and require more touch-up treatments every few years.



The informed patient often asks about the greying of their hair as they get older as SMP is a permanent process like any tattoo. The concern here is if they develop grey hair, the colour of the SMP process will be detectable. If they shave their scalp, this will not be a problem, but if they allow the hair to grow long, then dying the hair may have to be considered if the contrast becomes a problem as the patient ages.



Scalp Micropigmentation (SMP) is a relatively new modality for cosmetic dermatologists and hair transplant clinics which wish to expand their practices. It is for this reason that we accept opportunities presented by the SMP process, its strengths and challenges as well as a variety of medical and surgical scalp and hair complications that can result during its use.


SMP is a medical cosmetic tattoo, the elegance of the results reflects the technical and artistic skills of experienced technician. Gaining experience in this process – it will continue to bring great happiness to millions of people who have therefore had few options in treating their hair and scalp deformities.

Complications in this procedure can be avoided through the use of carefully selected ink colours and a good understanding of the variables confronting the technician by each new patient.

SMP in the hands of hair technician will eliminate most of the risks posed at hair dressing & beauty salons or home based businesses. As experience grows and further research provides better substantiation of safety and effectiveness of tattoo inks and the existing tattoo hand pieces, this process is likely to become a standardized offering for physicians and hair technicians in cosmetic practices.



The tools in the hair technician’s hand include inks and pigments varying in colours and a variety of formulas and thicknesses. Instruments include an advanced modified tattoo gun with the stroke modified for SMP work. The needles specifically for SMP.


Because every scalp is so different, every point of insertion is different from the prior and subsequent points, the hair technician is trained to make technical and artistic judgement as the process advances millimetre by millimetre. Scars retain pigment very differently than the skin of a atrophic or normal scalp.



After all, this is a tattoo. Because of the high variability associated with the elements in performing the SMP process, many doctors and tattoo artists tend to not offer this service. Patient deformities created by inexperienced operators will, for the most part, be permanent.


We tell our patients that this is a permanent process so they must be careful to select an experience person to perform this procedure. The only option for a poor result may be the use of a ND-YAG laser to remove the inks or pigments. This process is painful and may take many sessions to reverse the process and even then, it is not guaranteed.