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Hi, if you do scalp micropigmentation to correct a donor scar with non-permanent ink. Can you later do FUE into that scar afterwards if you don’t like the results of the micro pigmentation. How long do you have to wait before doing it ? Must all pigments be faded ? Are there any risks ?


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Since we have been performing Scalp Micropigmentation (SMP), there have been various clinics that started offering something like SMP, but with non-permanent ink. Non-permanent ink is just like makeup or just drawing something on your head with a pen, in my opinion, so you don’t have to worry about other procedures (it will erase off like a pen eventually).

On the other hand, SMP is permanent… but like all tattoos or cosmetic/medical pigments, it fades to a lighter color over the years. You may need a touch up, but it will NOT just erase. SMP is great to disguise an old hair transplant scar if you are going to shave your head or buzz it short with a zero guard.

There is no issue if you choose to have another hair transplant (strip or FUE) after the SMP, or even transplant into the scar if that is what you want. It just means that there will be more scars (linear scar from strip or hundreds of FUE scars) and you will need to pay and go through the entire SMP process over again if you want to hide the new scars. Very few patients have actually had another transplant into the scar, because our satisfaction rate is extremely high.

Tags: smp, pigment, hair transplant


Does SMP cause haïr shock loss ? As thousands of needles are inserted into the skin . Is this preventable ?


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We have not seen a single case of shock loss from Scalp Micropigmentation (SMP); however, because we do use anesthesia for the procedure, some loss is theoretically possible in a young man not on Propecia (finasteride 1mg).

Tags: smp, pigment, hairloss, hair loss, shock loss


We’re always updating our Scalp MicroPigmentation (SMP) site with new patient before and after photos, but I thought I’d take the opportunity to post a patient here so BaldingBlog readers can see an example of the visual impact that occurs.

This is a female patient with thinning hair. You can see the immediate results after just one SMP treatment. Further SMP will be done for increased darkness and density.

Before SMP on left / After SMP on right. Click the photos to enlarge:


Tags: hairloss, hair loss, female hair loss, smp, pigment, photos


Dear Dr. Rassman:

I am a 45 year old male with obvious hair plugs. I had two sessions done back in 1993. In considering all of my repair options, I would like to just be naturally bald. I wonder the hair transplanted can be removed. I am not interested in additional grafting. I like to be bald. Thank you.

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Shaving your head will probably bring out the pitting in the recipient area that often accompanies the old style of hair plugs. We have developed a process call Scalp MicroPigmentation (SMP), which works well when the hair is clipped very short to make you look like a normal fellow with a shaved head. The pitting I mentioned is often hidden by this process, but I would have to see you to tell you what can be done.

Here’s an example of a patient that had SMP done to hide his plug scars in the donor area. The photo was taken immediately after one session.



If you are not in California, send some good photos with multiple angles to the email address on the Contact page and I will try to give you an opinion over the phone.

Tags: repair, scarring, hair plugs, smp


Snippet from the article:

For readers that are not familiar with it, Scalp Micropigmentation (SMP) is a permanent cosmetic tattoo that mimics the very short hairs of a closely shaved scalp. I think that Scalp Micropigmentation (SMP) is a useful new adjunct to hair transplantation with interesting potential and I am pleased to see that doctors in our field, particularly Dr William Rassman and Dr. Jae Pak, are spearheading the development of expertise in the technique and promoting the technology to make it more widely available to patients.

One of the things that was apparent from their presentation at the ISHRS is that SMP is an “art” and that proper technique is extremely important in getting an aesthetically satisfactory result. This includes: the angle that the instrument is inserted, depth control, the amount of pigmented deposited, and color match – not to mention proper patient selection.

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Read the rest — Scalp Micropigmentation at the 2012 ISHRS Scientific Meeting – Dr. Robert Bernstein Provides His Input

I meant to post this last month, but better late than never…

Our friends at the Hair Transplant Network posted a good bit of feedback from Dr. Robert Bernstein relating to his thoughts on SMP and our presentation at the ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting, including the applications and the planning that should be considered for those that are interested in having the technique done.

Tags: scalp micropigmentation, smp, bernstein


Thanks for the amazing blog, doctor(s). I believe it literally saves people’s lives.

You’ve briefly mentioned previously that some people haven chosen to get FUT transplants, buzz their hair short, and get SMP, but I was wondering, why don’t more men who have gotten transplants but suffer from the “see through” look get SMP to help combat this issue? Does this SMP+HT combo idea work, aesthetically?

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Look at our SMP site and you will see that this technique is a great adjunct to a hair transplant, properly timed of course. We are doing more and more of these every day.

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


When it comes to hair transplants, some people don’t always finish what they start — perhaps due to money issues or just not wanting to go that route ever again because of disappointment in the results, failures of the surgery, or severe pain with the surgery. The pain and costs of more surgeries is a real turn-off for many of these people, but times have changed. Surgery is rarely painful, prices have come down, the results are not detectable as being any different from your natural hair, and alternatives are available… so exploring the sum of today’s options may be worthwhile.

Patients with an unfinished hair transplant hasn’t really been a problem in our practice, because we get personal with all of our patients and get to understand their goals, never promising them a rose garden, but setting up realistic expectations with regards to how many surgeries they will need to hit their targeted goals. In the old days (1980s) one rarely saw a finished hair transplant patient and few, if any, looked normal. I ran a large hair transplant practice in 1989-90 (before founding the New Hair Institute) and I was amazed that I never really saw a finished job while I worked there. Today, that is not the case as many completed hair transplants are undetectable.

If you are one of those individuals who did not finish their hair transplant work to meet their expectations and still look like an unfinished piece of poorly done art, I would suggest that you look at the Scalp Micropigmentation (SMP) process as a surgical alternative for thickening. This could possibly be a way of thickening up the appearance of your hair transplant without having another hair transplant. SMP works to camouflage even some of the old type of plugs when done properly.

For many people, SMP can contribute to completing the process, but a consultation with us is critical to defining your needs and the ability to achieve your objectives at a reasonable cost.

Tags: hair transplant, hairloss, hair loss, pigment


The pluggy hair transplants of the 1980s and 90s, and even the strip surgeries in the years following that, caused considerable scarring in some percentage of patients. Few of them complained unless their donor area was depleted from multiple surgeries so that long hair would not cover it. Even today, scars from follicular unit extraction (FUE) are causing problems for some patients who have had donor area depletion. I’ve seen a few men for consultations recently that have shown a see-through appearance at the back of their heads, asking us what they could do to help make this less noticeable, and prompting me to write this post.

The best solution for unmanageable scars was introduced by us in 2010 — Scalp MicroPigmentation (SMP) — and it can be effectively used to camouflage scars so that they can be made undetectable. Scars are more of a problem when patients have multiple surgeries, each surgery adding to the amount of scarring.

In the past, we have recommended scar revisions with variable success. Usually the scar would be reduced following the revision, but the biggest problem we found with this solution is in the patients who get poor scarring after strip surgery, get it because that is the way they heal. So when trying to repair it, we found limited value with occasional good results, but always leaving some level of detectable scar. There are people like me (three strip surgeries and no detectable scar) who heal very well, but there are some that aren’t as lucky. Treating these scars with SMP seems to always work regardless of the patients tendency to scar.

We’ve posted some outstanding results in the treatment of scars of all types and this is usually what happens to all patients, not the select few shown on this website.

Tags: scarring, hairloss, hair loss, hair transplant, smp, pigment, scar


Hi Dr. Rassman –

I had a question about your SMP. So if I currently have a thinning head of hair (had a HT two years ago, but need a second) and I wanted to get SMP as a form of permanent Dermatch or Toppik, would you have to shave my head to do it? Or can you do the procedure without shaving?

Would having SMP done make it more difficult/prevent me from having a second HT in the future?


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In some patients, we have been using Scalp MicroPigmentation (SMP) to thicken up the look of a thin transplant, thereby avoiding another transplant. This can be done without shaving the head, but it all depends on your current state of hair and your overall expectations. SMP wouldn’t prevent future surgery, though.

You should see a doctor with expertise in this area (like us) to find out if your proposed approach will work. This could be done with photo consultations with good, clear photos sent to us at the address on the Contact page.

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


Snippet from the study abstract:

Between October and December 2011, a persistent, raised, erythematous rash in the tattoo area developed in 19 persons (13 men and 6 women) within 3 weeks after they received a tattoo from a single artist who used premixed gray ink; the highest occurrence of tattooing and rash onset was in November (accounting for 15 and 12 patients, respectively). The average age of the patients was 35 years (range, 18 to 48). Skin-biopsy specimens, obtained from 17 patients, showed abnormalities in all 17, with M. chelonae isolated from 14 and confirmed by means of DNA sequencing. PFGE analysis showed indistinguishable patterns in 11 clinical isolates and one of three unopened bottles of premixed ink. Eighteen of the 19 patients were treated with appropriate antibiotics, and their condition improved.

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Read the full abstract — Outbreak of Mycobacterium chelonae infection associated with tattoo ink

This topic interested us because of Scalp Micropigmentation (SMP) and the use of pigments in our practice. What can you learn from this? A medical facility is critical for sterility and cleanliness, and the tattoo ink must be medical grade. We periodically culture our inks as a precaution for this problem.

Tags: tattoo, ink, sterile


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