Expert Doctor

Scalp Micropigmentation SMP

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William Rassman, MD

Los Angeles, CA

Scalp Micropigmentation SMP

Scalp micropigmentation (SMP) is a cosmetic procedure which helps restore the appearance of hair on a shaved scalp by creating the illusion of a thicker head of hair. SMP is used by hair restoration doctors to produce natural looking hair by applying pigment to the epidermal level of the scalp to mimic the look of hair stubble. Depending on the extent of hair loss, SMP can replicate the natural appearance of real hair follicles. The hair follicles are created with the same nuances of natural hair regarding growth direction and various shades of pigment to create the most realistic appearance.

Am I a Good Candidate for Scalp Micropigmentation?


  • Adult patients of any age, skin type, hair color and stage of hair loss
  • Patients who are almost completely bald can use this technology to mimic the stubble seen on a closely shaved head
  • Patients with burns or birthmarks within the hairline can camouflage the flawed region
  • Scars on the head from a hair transplant, an accident, skin disease or neurosurgery can effectively be covered with micropigmentation

Patients who are NOT GOOD CANDIDATES include:

  • Those with certain skin diseases such as eczema, dermatitis and psoriasis on the scalp as they may be negatively affected by the needles and pigments used in this treatment
  • Any patient who has undergone a hair transplant and depleted their donor supply can benefit from SMP to fill-in the lacking areas between the longer hairs and create a denser appearance even if the hair length is kept short

How is Scalp Micropigmentation Performed?

Preparation - Preparing for scalp micropigmentation may mean shaving the head completely bald and this is especially true if there is a lot of treatment to be performed. Shaving the head a few weeks prior to the procedure can help the doctor discover old scars, birthmarks and blemishes that need to be addressed during the process. Patients who are not comfortable with a completely shaved head may opt for a shorter cut. Patients with an intact frontal hairline and reasonable coverage of the crown, while also having a diffused thinning pattern, may not need to relinquish their existing hair. Dry skin can make the procedure a little more difficult and can result in unsatisfactory results. Therefore, patients should alleviate any dry skin prior to the procedure by moisturizing their scalp at least a couple times a day.

First Session – SMP is a very detailed and time intensive procedure which usually requires three sessions. The first session takes between 4 to 8 hours depending upon the area that has to be covered. Prior to the procedure, patients are given local anesthesia, and perhaps sedation, to keep them comfortable. During the first session, the pigment is generally applied to the scalp one dot at a time. The doctor also uses a cartridge containing 3 single-use sterile needles which he uses to gently inject natural pigment into the 2nd dermal layer of skin. The spacing of the pigment can be determined by replicating the natural hair follicles on a patient who still has some hair. If the patient is already bald, a hairline can be established during the consultation using pre-hair loss photos and a wax pencil to contour the scalp.

Second Session – A second session may take approximately 3 to 8 hours with at least one week between treatments although 3-4 weeks between treatments is recommended to allow the skin time to exfoliate between sessions. During this session, the hairline is refined with micro-pigment dots and the color is perfected while adding density.

Third Session – The third session generally follows 3 to 5 weeks later and may only last 3 to 8 hours. Detail is added to the hair while the pigmentation is gone over again to prevent the pigment from fading. This process permits a gradual transition of rejuvenation and prevents the pigment from blotching.

What is the Cost of Scalp Micropigmentation?

The cost of SMP runs from $3500-$7500 depending on the amount of treatment performed and the area that is covered.

Recovery and Downtime

When it comes to RECOVERY, the procedure usually has no pain associated with it if local anesthetics are used. The body will immediately begin to “attack’ the pigments because pigments are foreign bodies. This attack can cause the pigments to change their appearance and that is why sessions 2 and 3 are required.  Patients can expect some redness in the treatment area which usually subsides after a couple of days. There is rarely any crusting and, in 3 days, patients will be their normal selves. 


Scalp micropigmentation can provide immediate results by granting the patient an instant visible hairline and/or fill depending upon the established goals. Since the procedure generally necessitates three sessions, results will improve over the course of the treatments. Each new layer refines the density, coverage and color to provide the best possible results. To maintain these results, patients are recommended to have touch-up procedures every 3 to 6 years. Scalp micropigmentation is a solution for thinning hair, and hair loss, which can last a lifetime. Patients should protect their heads from the sun since sunburn can cause damage to the scalp and impair the SMP results just like any tattoo. For the patient who is willing to shave their head with a buzz cut every 2 to 3 days, the appearance of a shaved and full head of hair is the expected norm.

Some people use SMP to make their thin hair appear thicker. Women are frequently such patients as there is no good option for most women with thinning hair.  The same process occurs as discussed above except that the hair is kept long. Performing SMP on longer hair is more difficult and more tedious but the results are worth the effort.

As time passes, the remaining natural hair may continue to deplete. A skilled hair restoration doctor who specializes in SMP can plan for this recession and counteract it by blending the pigment with the remaining hair so the noticeability of future hair loss is minimized.

Limitations and Risks of Scalp Micropigmentation

Common LIMITATIONS include:

  • Two dimensional - Scalp micropigmentation is limited by the fact that it is a two-dimensional treatment and only creates an illusion of real hair. Therefore, patients must be realistic with their expectations to avoid the risk of disappointment in regards to texture.
  • Removal - Scalp micropigmentation is a permanent procedure which can only be removed by laser treatments. The removal process is like that of removing a typical tattoo, but less invasive, since tattoos are much deeper in the dermis than SMP if performed properly. Although removal of scalp micropigmentation is painless, it usually necessitates 1 to 2 sessions.

A few RISKS of SMP are:

  • Pigment fading is considered a common risk and touchup procedures would be required to maintain the look. The risk of accelerated fading due to sun exposure can cause the patient to need touchup treatments sooner than expected. Constant retouching or inadequate technique by a technician can increase the risk of a blotchy or smudged look.
  • Reaction to pigment - Although the penetration depth of the ink is superficial, there is still the possibility of an allergic reaction, infection or the potential for skin cancer since some inks contain heavy metals. These risks are very rare when the procedure is performed in a clean medical facility. The risks for cancer are really not known. Patients should insist that the doctor use organic pigments that do not contain toxic metals.

The Look of Hair without the Need for a Transplant

Scalp micropigmentation can help some individuals obtain the look of a fuller head of hair without the risk and downtime of surgery. That makes SMP a valuable commodity for hair loss restoration. Patients interested in undergoing SMP should consult with a board-certified doctor who is experienced in performing the procedure. The surgeon should examine the scalp of the patient to determine if SMP is the best choice to help the person achieve the desired results.


Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview provided by William Rassman, MD in Los Angeles, CA.