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Dr. Rassman,

For patients who have high contrast scalp and hair (ie. dark hair and fair skin). Wouldn’t a combination of SMP and surgery help minimize some of that contrast and maybe achieve a more fuller look?

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Yes! It would be advantageous to complement the scalp micro-pigmentation (SMP) with a hair transplant for a full and realistic (3-dimensional) look. No one treatment is perfect. Hair transplantation can never give you the complete fullness you once had, since it is just rearranging what you currently have. But hair transplants can give you a good hairline, adequate coverage, and even almost normal densities if the area covered is small.

SMP can give you the look of fullness but it will not be real hair, since it is like using concealers (think DermMatch or Toppik) but without the daily applications because it is permanent.

Tags: smp, scalp micro-pigmentation, pigment, hairloss, hair loss, hair transplant


Regarding your new SMP procedure I am very interested. I have been thinking about it for years and actually still have a good amount of hair and have had a hair transplant, which was not a great experience. I feel like the SMP can fill in the areas that are thinner than other, also covering up the linear scars? what is your opinion on that? Also, since I live in NY, what is the likelihood that your friend Dr. Bernstein will be offering this service? Thanks for all your help and keep up the good work!

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Scalp micro-pigmentation (SMP) has had great success in camouflaging scars on the scalp (see here).

At this time, we are the only physicians offering SMP in the United States. We have a travel reimbursement program for those who wish to fly out to Los Angeles for a day to have the treatment.

Dr. Bernstein is not presently offering this service.

Tags: scalp micropigmentation, smp, hair transplant, pigment


Hi Dr Rassman,
my question is the following : How often do you see people with Norwood “A”-pattern hair loss that reach Norwood 7 (or 6) AND how difficult is a 5a pattern to treat with transplants (can they get full coverage). Seeing that you now offer SMP. Because I’m a Norwood 5a patient who recently had a FUE hair transplant with Dr. Pak in your Los Angeles office it’s was about 1,200 grafts and I have to tell you it was the best decision that I’ve could’ve made!! I’m thinking of having another FUE procedure, so I was thinking of having the FUE & SMP done together to get more density.

I would really appreciated if you could let me know what you think about my question.

Thanks for everything you do and keeping us informed. Oh and 1 million thanks for a great job and keeping up the great work!!!

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I am pleased that you are pleased with Dr. Pak’s work!

NW5aThe Class 5A pattern does not evolve into a Class 6 or 7 pattern. The original chart by Dr. O’Tar Norwood showed that the patterns defined in the diagrams are the end stage, particularly the “A” series. I like to work on the “A” pattern patients, because there is usually enough hair to give them whatever they want (that is, unless their original density is very low).

Scalp micro-pigmentation (SMP) with follicular unit extraction (FUE) is a great combination treatment where you can achieve the dense look with SMP and a natural real hair line in the front with the FUE.

Tags: smp, fue, hairloss, hair loss, hair transplant, norwood


This is a typical patient with a series of scars, some from a hair transplant (the large smiley scar). This man elected to cut his hair very short and get pigmentation into the scar. Although an additional session would be a good idea to camouflage the scar better, he stopped at what you see below (on the right). Now if he grows his hair out, the scar should be close to invisible. The red ‘blotch’ you see on the back of his head has been with him most of his life.

The photo on the left is before SMP; The photo on the right is after SMP. Click to enlarge:


Tags: smp, scalp micropigmentation, scarring, hair transplant, hair loss, hairloss


Dr. Rassman

I see that you have recently begun offering micropigmentation. This is something that’s intrigued me for some time but, until you began offering it, there never seemed to be any reliable results posted anywhere. I’ve got a couple of questions off the record as I’m somewhat interested in pursuing this as a complement to my hair transplants.

  1. People often raise the question about how this will look as a person ages and their hair becomes gray or white. I’ve always thought that it may look odd as the dark dots are sure to stand out at that time. How do you propose patients will deal with this issue?
  2. Over a lifetime, if cared for properly, how often do you expect a patient will have to touch up the work and will this cause it to become less defined over time?
  3. Do you publish your fees?

Thanks for your time! Also, thanks for your Balding Blog. I’m a regular reader and you even published two of my questions in the past.

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Thank you for your insightful questions. I will answer them as best I can below:

  1. The pigmentation ‘dots’ are very small and for a person with hair that is not black (light brown for example) the pigment color can mimic the hair around the fringe, almost a dark gray which will not be a problem with age. We generally make the color match the hair color (shade). Remember that as the hair grows out from the scalp, it is exposed to sunlight (normally) and the hair in almost all people who do not have black hair will see some hair lightening, so we address that up-front as we select the initial color we use.
  2. Over time, the pigment may fade and might need a touch-up. Our base charge will cover someone for 3 months to deal with color absorption of the pigment. Everyone is different with regard to the amount of pigment that is absorbed after the initial treatment. For a second treatment and beyond, pigmentation absorption is much slower, but it might fade more after a few years. Touch-ups may be desired.
  3. Fees are individually determined at the time of the consultation, but they range from $2000 – $6000 depending upon the amount of work. This will include as many touch-up sessions as is needed to achieve the initial goals. It may take two or more sessions.

We will soon be trying a new pigment that is supposed to be reversible with one laser treatment, so even though we do not recommend that people consider this a reversible process, it possibly is. We plan to make it available after we determine how beneficial this pigment actually is.

Tags: scalp micro-pigmentation, pigment, tattoo, hairloss, hair loss, smp


I received a few emails asking for more views of the Scalp Micro-Pigmentation (SMP) patient we featured last week. One specific request was to see what the scalp looked like immediately following a session. Here we go…

Going from left to right (click the photos to enlarge):

  1. First photo is his transplanted hair (before SMP). Keep in mind that he was a Norwood 6, so most of what you see there is transplanted (6900+ grafts). He wanted it to look even thicker and opted for SMP for this.
  2. Next photo is 2 weeks following the first SMP session.
  3. Last photo is immediately following his second SMP session. Patients are instructed to not wash their scalp for 3 days following a procedure. The pigment appears darker at this point than it will be once washed.


I’ll update this post in the next day or two with a photo of the patient after he’s washed his scalp.

Tags: smp, scalp micro-pigmentation, hair loss, hairloss, hair transplant


This is a hair transplant patient who wanted his hair thicker, but had depleted his donor supply so that more transplants would not be productive. Many doctors would try still another procedure, but this was not my approach. Instead, I put pigment into the areas where he wanted more thickness. He loved the results of his transplants for his Norwood class 6 pattern and over the years he received a total of 6,905 grafts for that pattern, but as with many patients who have advanced hair loss, the supply did not eventually sustain the demand for hair.

With the addition of scalp micro-pigmentation (SMP) to augment the fullness, he felt that the results were exceptional. After his first SMP session he used a hat, but slowly and cautiously he showed off his shorn scalp to his friends without creating much fanfare. In a social setting, his friends saw the new look and all he got was compliments on how good he looked with his new hairstyle.

The first photo (left) is of the patient’s hairline after all of his transplant work (last procedure was almost 4 years ago); The next photo (middle) is immediately after shaving his head; The last photo (right) is 2 weeks after his first SMP session. Click the photos to enlarge:


He came in for his second touch-up SMP procedure, but this time we went a little denser with the pigment. The key in the plan I put together was that the SMP would be placed in behind the leading frontal hairline that we created with transplants so that he could let his hair grow out whenever he wished. As the interval between the first and second procedure was 2 weeks, he let his hair grow out over that time to sense what it would look like when he let it grow out long. He could not have been more pleased with the result! I’ll post some photos of the results in the coming weeks.

Since my post from last week, I have come under fire on some forums and even on this site for changing my stance on scalp pigmentation (from being somewhat negative in past posts to my current enthusiasm). Really, the change in my view reflected a better command on the art, something that I hadn’t previously seen when I made my earlier comments about the tattoos that I saw in my office over the years. I realize now that I should’ve been more open-minded to possible advancements.

Nothing is perfect in this world. This patient would have rather gone the transplant route or have taken a magic pill that would get him his hair back, but it was not a reasonable option for him… so as a second best option, SMP more than met his goals. Now I must note that due to his nearly 7000 grafts that were transplanted, he does have a linear scar in the back of the head. We’re still working with him to cover it with SMP and will post resulting photos soon.

Update Mar 8, 2011: More photos here!

Tags: smp, scalp micro-pigmentation, hair loss, hairloss, hair transplant


New Hair Institute is pleased to introduce a new service we’re offering —

Scalp Micro-Pigmentation (SMP)

Like any tattoo process, the technique involves placing a special pigment into the skin of the scalp to mimic ‘hair follicles’ almost to the size of a closely cropped head of hair. Think 5 o’clock shadow or stubble. We have been using Scalp Micro-Pigmentation (SMP) for two purposes:

  1. As an alternative style for making a balding person look full headed with the placement of pigment into the scalp (example below)
  2. To camouflage the scars from a strip procedure or anywhere on the scalp. Almost any size scar can be treated with SMP (example will be posted in the coming weeks).

So what does it look like?

NW7This patient came in for a hair transplant consultation. He likes his hair cut close, so follicular unit extraction (FUE) would have been a reasonable way to get there without a detectable linear scar that traditional strip surgery would inevitably produce. The problem for him is that he needed somewhere between 4000-6000 grafts to cover the balding area. We routinely offer up to 1500 FUE grafts per session and recommend the strip technique for larger sessions. That means that he could have been looking at 2-5 FUE surgeries to obtain the final look he wanted and as he continued to bald, he might run out of donor hair before completing the final look he wanted. This patient was heading towards a Norwood class 7 pattern, and eventually he might need 6000-8000 grafts to follow the hair loss he would experience over time when/if his Propecia would stop producing the benefits he is now getting from the drug. As hair transplantation is a supply/demand process, would he have enough hair to complete the entire transplant process to a fully evolved Class 7 pattern? I doubt that he would.

The pictures below tell the rest of the story. He came in with his balding pattern and left the same day with a completely different look, certainly not a balding look.





I want to emphasize that this patient will have to maintain this short-clipped look unless he elects to have a hair transplant. The upside of this technique beyond what you see is the low maintenance he will have, just trimming his head about every other day. If he is against medication use (like Propecia) this style allows that choice, but as balding progresses as it inevitably will, touch-ups of the SMP technique will be needed. The downside of this is that the pigment is considered permanent, so the style must be acceptable for him and it is a lifetime decision.

This patient elected to do the process under local anesthesia to subdue whatever pain might be there during the procedure, but like any cosmetic tattoo procedure, it can be done without anesthesia. He may require one or two touch-ups to the look that he now has, as the pigment tends to fade a bit after the first session, but he does not have to look at repetitive surgeries into his future.

He’s been thrilled with the initial results. His overall comments to me reflected upon the freedom that his new look gives him and how much he loved rubbing his bald head. No more styling gels and repetitive worries about going bald have made him a happy man. He also knows that when hair cloning or hair multiplication become available (fingers crossed), he can just add the value these breakthroughs will give him, and maybe get him the hair that he wanted at some appropriate time in the future.

Over the next few months, we’ll show more of the work we have been doing with Scalp Micro-Pigmentation (SMP). Contact my office at 800-NEW-HAIR (or 310-553-9113) for pricing and availability.

Update: I answered a bunch of questions posed by our readers in the comments below.

Tags: scalp micro-pigmentation, smp, hairloss, hair loss, new hair institute


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