SMP® FREQUENTLY ASKED QUESTIONS
QUESTIONS ABOUT THE SMP® PROCESS
SMP® is short for Scalp Micropigmentation. It is a technique in which pigment is deposited into the dermal layer of the skin on the scalp replicating the look of hair follicles. When viewed from close, the pigment dots appear like real hair follicles and the person has the appearance of a full head of hair that has been recently shaved.
Even from just one foot away, even close family members cannot tell where your real hair ends and where the SMP begins. Scalp hairs range from around 67 micrometers to 120 micrometers. (67 Um with Asian descent, 77 Um in Caucasian, and 120 Um from African descent).
Our SMP dots place in the dermis are between 90 to 150 micrometers in diameter. This may seem larger than real human hair, but when view from a few inches to a few feet away, the size is indistinguishable from real hair follicles.
Yes. If you’ve had previous hair transplants, it is most likely you have hair transplant scars. Scars can appear like a line across the donor area, or it could look like dots where the hair follicles were taken. SMP® can significantly hide these scars if you plan to wear your hair with the buzz cut look. By blending the scar with surrounding hair, it becomes much harder to spot, almost unnoticeable in most cases.
With proper care, including using high sunscreen when outside, your new SMP® look won’t require any touchup for eight to fifteen years or more. If you are outdoors most of the time or have a strong immune system, the treatment may require a touch up sooner. Because everyone is different, we cannot tell from the initial treatment when you may need a touch up in the future. Fortunately, our touch up fees are cost less than our regular treatment fee.
Most of our pigments use combination of metal oxides to replicate the gray scale needed for most of our clients. In some cases where clients have very fair or red hair, beta carotene additives are also used. We would love to disclose more information about our pigments, but we have spent many years perfecting the best SMP® treatment and do not wish to disclose any proprietary secrets to our competitors or imitators.
Fading is much more prevalent in situations where regular tattoo inks are used to try and replicate SMP®. Since we do not use the same tattoo inks, the chances are minimized. Without revealing too many of our trade secrets, we feel that the molecular structure of the SMP® pigments we use, along with their deposition in the upper layer of the dermis, provide the best chance for a long-lasting and stable treatment.
Is SMP® reversible?
Yes. SMP® pigmentation can be removed with an electro-optic Q switched laser, which is used to heat and break-up the SMP® pigmentation for easier absorption by phagocytes in the dermis. SMP® is fairly easy to remove in most cases because the pigment is not deposited as deeply as normal tattoo ink. The amount of our clients wishing for true SMP® reversal or total removal is less than one percent.
Pain varies from individual to individual. Some client has fallen asleep during the procedure. In other cases, clients experienced pain across the temples or above the ears during a treatment. Most of our clients rate their pain level on a scale of one to ten, as three to five during a treatment. Elma cream (a local anesthetic numbing medication) can be applied topically on your scalp one hour before treatment to help with any pain issues.
The cost depends upon the thinning or balding pattern, the area of the scalp to be covered and if any scars are present. The lower end of the price range is for clients with Norwood I or II level who just need simple alterations to their hairline or small areas of density added. The higher end of the price range is for Norwood VI and VII clients who have little real hair remaining. Scars are more difficult to predict, and the pricing vary depending upon a case by case basis. We will give you a cost analysis upon your free consultation visit at our clinic.
In most cases you can compare your hair loss to the Hamilton-Norwood scale for male patter baldness. This scale is rated from level I to increasing baldness at level VII. Typically, most male clients we treat will ask for enough SMP® scalp coverage to bring them back down to a Norwood I or II level of appearance.
Our founder, Ian Watson, the co-director of His Hair Clinic received SMP® in 2001. Therefore, he is the client with the world’s oldest SMP® treatment. Ian continues to proudly display his appearance as he manages clinics across the globe.
QUESTIONS ABOUT THE APPEARANCE OF SMP®
A normal client, depending upon balding or hair loss extent, will take 2-3 treatments to achieve their final appearance. The first treatment often places a very light application on the scalp to access fading and density levels. The normal reaction for many clients is to assume that the SMP® is too light and to be a bit nervous. However, this is a normal part of the treatment, as the 2nd and 3rd layers of pigmentation will give it the 3d natural looking scalp. The 2nd treatment adds most of the density to the scalp. The 3rd treatment are usually for completing the look, addressing darkness matching or to even the density across the scalp.
How will my scalp look immediately after a treatment?
The area of the scalp that has been treated will have some redness for around 2-3 days after treatment. For darker skin clients the redness is not too noticeable. The pigmentation will appear darker for up to 7 days after treatment, again depending on your skin tone. Therefore, the pigmentation will appear to become lighter and softer as the tiny pigment filled scabs begin to flake away.
SMP® is applied to the scalp by means of a pigmentation machine that carries pigment into the dermis by a rapidly moving needle. When the epidermis and upper dermis is punctured, the skin begins its normal healing and clotting process. After the treatment, your scalp will be covered by hundreds of tiny pigment-filled scabs, which is seen in many after photos. These scabs are often 400 to 800 micrometers across and far larger than the eventual SMP® dot after the healing process.
These tiny scabs will flake away in the first 3-10 days and your body’s immune system also removes any excess pigment caught in the healing wounds during the first 3 weeks. As this happens, it appears to the observer that the SMP® dots are shrinking. When the healing process finishes, the final dots are often 90 to 170 Um in diameter and blend seamlessly into any natural hair.
If you show your scalp within the first 2- or 3-days post treatment, the scalp may still be a little red, and may be noticeable. After the initial redness goes away and you have shaved your scalp by day 4-10, you scalp would only be noticeable if you’ve made a major change from your previous hairline. The SMP® treatment allows you to design any hairline you like. If your friend or family have never seen you with a new hairline, they will notice. The vast majority of SMP® clients often choose a slightly receding look to account for the future ageing process and this allows the them to fit into their social scene often without being noticed.
Most of the fading will occur from day 3-10. This is when the darker pigment filled scabs will flake away from the epidermis. As excess pigment trapped in the epidermis also is eliminated, slower fading will continue in the first 3-4 weeks. By the 4th week post treatment, the pigments will ‘set’ and thereafter, fading will be almost nil.
Every client is different, and we cannot determine exactly when you may require a touch up. A best guess would be that for a normal healthy client who uses the recommended SPF 30 to 50 sunscreen when outside, and with a normal active lifestyle, a touch up could be needed about once every 8 to 15 years. Collagen microstructure of the dermis and the client’s immune response are the primary factors driving any pigment fading. Our touch-up rates are lower than the initial treatment rate.
During your initial consultation you will be asked where you would like your SMP® treatments to be applied, including any areas where hair loss may occur in the future. Once your treatments begin, SMP® will be applied in a pattern which will also include any future hair loss. This is a very common request.
Your hairline should look like the time you had hair, but you should also factor in the ageing process to allow some hairline to recede as you get older. Some clients prefer a natural broken hairline while others prefer a very defined and dark hairline. Even if a client prefers a defined hairline, we often ask them to try a more neutral, less defined look during the first one or two treatments. This allows them to adjust to their new look and have more time to reconsider if they still want the defined hairline.
Some clients want a drastically lowered frontal hairline. The standard rule here is 3 to 4 fingers above the eyebrows. If your hairline is lower than this, then it doesn’t look natural. Our experienced staff would recommend a more natural looking hairline that isn’t too low especially as you age.
How can I avoid the ‘grayed out’ look where it appears the treatment have over done pigmentation?
This has to do with dot density. After the 3rd treatment the dot density should be ideal. However some client seem to want more coverage, in doing so their scalp may end up looking artificially dark due to too many treatments.
Also, after so many years without hair, some clients try to go too dark which may end up looking unrealistic. That’s why the best approach is to only go as dark as needed for a seamless blending into existing hairlines.
QUESTIONS ABOUT THE TREATMENT
Once clients have decided to do the treatment, they often come to the first appointment with some anxiety and apprehension. Unsure about how the treatment will go, how their new hairline will look or how dark their scalp will become. Below are the most common questions about the treatment.
On the day of your treatment, we will fill out some paperwork, the general legalities and to make sure you understand how the treatment will progress.
Next, the practitioner will discuss in detail with you your new preferred hairline and all the areas where you wish to be treated. The practitioner will use a white wax pencil to draw in the hairline. Any changes to this line can be done prior to the treatment. The practitioner will also discuss the density of SMP® and overall shade you are seeking. This initial process takes approximately 1 hour and when you are fully satisfied with the placement of your new hairline, you will sign your name on the treatment documents agreeing to your new changes.
During your first treatment, your practitioner will make suggestions for you. Because the practitioner has seen many outcomes, and aware of any pitfalls or early mistakes that may occur, he or she may be a little more forceful in making suggestions so that you experience an excellent result. During later treatments, when density, shade and fading levels can be assessed from the first treatment, the practitioner doesn’t need to be as forceful in their suggestions.
Yes. Your first treatment is purposely done more conservatively to prevent any possible mistakes. What that means is that the hairline will be placed a little bit higher than where a client may eventually want it, and the shading done a little bit lighter. On the 2nd treatment, the practitioner can go lower on the hairline and darker in the pigmentation.
The practitioner will indicate to you the best initial SMP® shade and then mix the proprietary pigments. A new needle will be inserted in the pigmentation machine and the treatment will begin. We normally will start from the hairline and move back to the crown. As your scalp is more sensitive in the front most clients which to complete the more sensitive sections first. The practitioner will ask if you require any breaks. Normally we can provide a break every 15-30 minutes. This gives you some time to stretch and relax.
We do the complete scalp in one setting. The time involved will depend on the size of the area to be treated. If the client is only touching up a hairline, the treatment could take 30 minutes or less. For a client with Norwood VII then the treatment time could take 3 to 4 hours.
We suggest wearing comfortable clothing, some bottled water or their favorite beverage (nonalcoholic). Clients should also bring any pain medication from a licensed physician if they are sensitive to low pain levels. A loose-fitting hat may be worn after treatment as the scalp may be a bit red and sensitive.
QUESTIONS ABOUT TREATMENT SCHEDULING
These questions will discuss the scheduling and how far apart each treatment should be. This is important to some clients who are travelling long distances to come to our clinic.
We recommend 5-7 days after your 1st treatment to commence the 2nd treatment. This allows the tiny scabs to fall off and some fading have occurred to access the next treatment density and shading levels. The third treatment should also be done 5-7 days after the 2nd treatment, but this can be extended to 2 to 4 weeks after the 2nd treatment, at the practitioner’s discretion. Any following treatments would be scheduled after 30 days to access overall fading and density levels.
Ideally the 2nd treatment is scheduled 7 days after the first, and with the 3rd treatment (if necessary) coming 30 days after the 2nd treatment.
Normally, 2 to 3 treatments are required. Some alopecia and hair transplant clients may require more. Each treatment takes between 30 minutes to 4 hours depending on the amount of area that needs to be treated. The whole scalp area is done with each treatment. We do not do just half a scalp during one treatment as the pigment or pressure of the needle may be slightly different from one treatment to the next.
QUESTIONS ABOUT PIGMENTS AND PIGMENTATION
Clients would like to know type of pigment used, what are the pigments, how long do they last, and how do they react to light? Below are the most common questions asked about pigments.
Whats the difference between an ink, dye, and pigment?
Dyes and pigments are both chromophores (part of a molecule responsible for its colour) which give colour to a substrate (an underlying substance or layer) they are added to. Dyes are chromophores that are usually soluble in water and often dilute down into a substrate (like paper or skin). Because they are water soluble, they can be diluted easily and also concentrated to a high level. They can provide deeper and richer colours than pigment compounds. The downside is that adding water to a dye, often results in smearing and further dilution.
Pigments are chromophores that are often insoluble in water and usually rest on top of a substrate. Although they cannot be concentrated like dyes, they are usually resistant to smears, staining and dilution. They are also more resistant to sheer force and stress. For these reasons they are preferred over dyes for SMP® scalp micropigmentation.
An ink is nothing more than a general term for any liquid, paste or powder which contains chromophores and is used to colour a substrate. An ink is made up of colourants (which are usually dyes or pigments), additives, binders and carriers, although, this can vary from one ink to another.
As it applies to a regular tattoo, an ink is usually composed of colourants (often pigments) and a carrier. This carrier can be water, denatured alcohol, ethyl, alcohol, glycerine, methanol or one of several other compounds. The carrier is used to keep the pigments free from bacteria, to act sometimes as a transport agent and to increase permeability of the skin.
As applies to micropigmentation, a cosmetic ink is any substance which contains pigment and a carrier.
The best pigment for a SMP® is one that is inert, chemically unreactive under most biochemical changes, and heavily resistant to UV radiation. The molecular structure of the pigment determines the ability of the pigment both to resist common biochemical reactions in the skin and persevere under both immune system responses and UV radiation.
Both inks can use the same pigments to produce colour, however there are several differences. Metal and chemical content in SMP® pigments is extremely low, far lower than traditional tattoo inks. SMP® pigments are therefore highly unlikely to cause any issues with MRI or similar scans.
A significant difference is the depth at which the inks are injected into the skin. Tattoo pigments are usually injected into the middle dermis. SMP® cosmetic pigments are usually deposited into the very top of the dermis. This means they are closer to the epidermis and more easily degraded by UV radiation. Tattoo inks are less affected by UV radiation since they receive less light deeper down into the skin, but they are subject to more white blood cell agents. Unlike tattoo inks, SMP® pigments will not change colour over time.
Pigments are preferred because they do not dissolve in water, are resistant to forces, are not easily removed once injected into the collagen microstructure of the dermis, and they are much better at resisting UV radiation, which can be extremely damaging to a compound’s chemical bonds. Pigments are also relatively inert, do not respond to most biochemical reactions in the skin and can be made perfectly sterile for injection.
Unfortunately this is a proprietary business secret and an integral part of our SMP® technique. Many other competitors use regular tattoo ink which, unfortunately, appear truly black or a gray for the first several months, only to begin breaking down later to something more resembling a darker shade of blue or green.
There are two main reasons why our SMP® is superior to our competitors. One, they don’t degrade easily under UV radiation and two, when they do, they do not change colour. Our SMP® pigments are built upon research done previously by many different parties over the past 15 years to improve tattoo and cosmetic pigmentation ink. Because of this SMP® pigments are designed to be sterile, chemically inert, highly resistant to UV radiation and to decompose stably. This allows a client to wear SMP® in bright outdoor conditions for many years and when it fades, the client will not be the victim of a chemical reaction that leaves them with a blue Smurf head.
Due to differences in immune system response, exposure to UV radiation and skin condition, it is very difficult to predict the lifespan of the SMP® pigment. On average though, a healthy individual who uses sunscreen regularly when outside, we expect the SMP® treatments to last between 8 to 15 years. After this period a touchup may be required. Someone who doesn’t go out in the sun often can expect the SMP® treatment to last more than 20 years.
No. SMP® are very safe. But in specific individuals who have extreme allergies or sensitive immune systems, should be cautious. We do offer a patch test for $149. This is a quick trial application of a few dozen SMP® dots to an area behind the hairline to see if any response occurs.
QUESTIONS ABOUT BIOMECHANICS AND BIOPHYSICS
Working with a very small shaft comprised of 3 needles on the end of the pigmentation machine, stable chromophore pigment is injected into the 2nd dermal layer of the skin on the scalp. Pigments are delivered dot by dot over the scalp and the entire process scales with the Norwood level of the client.
The dot size is dependent upon the practitioners hand pressure and is in the range of 80 to 170 micrometers at the frontal hairline and 120 to 250 micrometers at the back apex of the scalp.
The needle is known as a standard 3 round needle and it is 3 steel needles soldered to a base in a circular pattern. This is the smallest standard size needle that is used in large quantities by pigmentation specialists.
The 3 round needle tip is sent downwards into the skin by an electromagnetically inductive circuit. The 3 round needle ends will bend together as backwards pressure is applied from the resistive skin and pigment will flow to this tip. The needle will break the epidermis and travel about 0.25 to 0.55 millimeters through the epidermis and into the top layer of the dermis.
As the needle reaches the upper dermis, tiny capillaries and blood vessels will be broken by the path of the needle and the wound would bleed a small amount. The path of the needle will leave a ‘V’ shaped micro-incision. This V shaped micro-wound will appear as a tiny incision about 400 micrometers wide at the top. Blood and clotting factors will swell up in the wound and some of the pigment will be pushed back up out of the wound.
The skin is comprised of three layers, the epidermis on top, the dermis in the middle and the sub-dermis below. The epidermis sheds itself every 45 to 50 days and, therefore, placing any pigment there would be futile and it would slough off. The middle dermal layer contains many micro-collagen fibers that is comprised of strands with spaces (lumen) between them. These open spaces are the areas where the pigment is deposited.
Once the client’s immune system responds to the site of the wound and cleans up the loosely held pigment, the more tightly packed pigment molecules in smaller lumen will not be touched by roving macrophages, or the rate of removal becomes so low to not be measurable.
Yes. Although some bleeding is normal, there are some clients that may bleed more than average. If clients bleed above the average rate, pigment will be trapped in the blood and move upward with the clotting factors and some pigment will be pushed out of the wound. This is the exact opposite from the goal of retaining as much pigment as possible in the dermis. Additional treatments may be required for clients that bleed above normal levels to achieve the appropriate SMP® darkness shades on the scalp. Although bleeding is dependent on genetic and blood pressure, some clients have found that eating certain legumes or spinach for 10 days before treatment, can lower bleeding rates significantly.
A small scab is formed at the incision site within 30 minutes and this is hardened by additional fibrin over the next several hours. This scab will then remain as fibroblasts fill in weakened areas under the scab within 48 hours and endothelial cells migrate to the site in a complex cascade. As this process completes, the scab falls away, usually within three to seven days.
Right after the treatment, the scalp will be covered in hundreds of small pigment filled scabs, which are seen in many of our after photos. These scabs are often 400 to 800 micrometers across and far larger than the eventual SMP® dot. The dot may appear to shrink but it is the scab falling off that makes the dot smaller. When the process is complete, the final dots are around 80 to 170 micrometers in diameter and blend seamlessly into any natural hair.
At an average size of 80 to 170 micrometers, the pigmentation dots need to be large enough not to be removed by roving macrophages and large enough to show through the epidermis as distinct dark dots that mimic actual shaved hair follicles.
Be weary of competitors who promise proprietary needle sizes that can lay down dots smaller than 80 micrometers. This may indeed be true, but by the time the immune response has finished, the dot may be reduced in size to 30 to 40 micrometers, which is then very difficult for anyone to see. This is the exact reason why we aim to place dots that are ideally 150 micrometers in diameter and are then reduced by the immune and would healing responses to about 110 micrometers. In comparison, the average human hair diameter is between 66 to 120 micrometers.
The 3 most important are 1. Long-term immune responses and 2. Individual dermal collagen micro-structure and 3. Ultraviolet radiation exposure (sunlight).
- Long -term immune responses
The immune response manifests itself at the micro-level through macrophages and phagocytic cells whose job is to remove foreign debris, particulate and antigens. SMP® pigment molecules are seen by these defender cells as foreign material and removed from larger lumen within the dermis. In some clients, this immune response is very strong, the result is that there is a large apparent fading. In other clients, this response is much less, and a larger percentage of the SMP® pigment is retained in the collagen micro-structure of the dermis. Long-term immune response is entirely dependent upon the unique biochemistry endowed to everyone. Some people heal from a wound in 2 to 3 days while others take weeks or longer to heal from a minor scab.
- Individual dermal collagen micro-structure
Individual dermal collagen micro-structure is also a major factor in SMP® pigment retention and fade resistance. Some clients simply have ‘loose’ skin. That means their internal lumen spaces are larger, the collagen micro-structure is not as tight and any pigment deposited will diffuse out and be more easily removed by the immune system.
- Ultraviolet radiation exposure
Although 1 and 2 are different for everyone, we can control the amount of UV radiation that hits your scalp each day. SMP® is a pigment molecule (chromophore) which if subjected to long-term UV radiation exposure will eventually breakdown. That’s what in the aftercare it is very important to wear a good quality sunscreen to protect your scalp from UV radiation whenever you go outdoors. A client who is mostly indoors can expect to not require any touchup for about 20 years whereas client who is always outdoors and don’t wear any sunscreen could require a touchup as little as 2 to 3 years. On an average client, a touch up may be required by 8 to 15 years.
The nature and alignment of the chemical bonds in a pigment’s three-dimensional structure determine its ability to undergo chemical reactions or degrade under UV radiation. The perfect pigment for a hair simulation application is one that is inert, chemically unreactive under most biochemical changes and heavily resistant to UV radiation.
While SMP® pigments are not perfect and do in fact degrade over time (SMP® will fade as the decades past), but it does not change colour like tattoo ink.
QUESTIONS ABOUT THE PATCH TEST
A small percentage of clients who are interested in SMP® are unsure if it is the correct solution for them and would like to try a few SMP® dots on a tiny portion of their scalp. Other clients have extreme allergies or reactions to any foreign material which touches the skin. For both groups, we offer the patch test.
A patch test involves the application of a very small amount of pigment using the SMP® technique. About 10-15 dots are made in the area of about 1” in diameter in a discrete area of the scalp agreed with the client in advanced. The colour of pigmentation is very light to make it virtually unnoticeable should a client decide not to proceed with the full SMP®.
No, the patch test is optional. It is for clients who are worried about their pain sensitivity or suffer from skin allergies. We cannot be held liable for clients who fail to disclose their medical history or allergic reactions before SMP® treatment begins.
No. The cost is $149. However, if you decide to do the full treatment, we will deduct the patch test towards the cost of the full treatment.
It is very rare that you will have an adverse reaction to the patch test. However, you should watch out for any itching, redness, rash or swelling. If you do notice these, monitor how long they take to disappear.
QUESTIONS ABOUT PAIN MANAGEMENT
Most clients come to our clinic unaware of what to expect during a treatment and unsure of how painful the treatment sessions will be. Below is some questions about pain.
Note: We are not authorized to prescribe or recommend any drug for the management of any discomfort. We do recommend that you consult your doctor prior to using any pain relief products.
On a pain scale from 1 to 10, with one representing a minor scratch to 10 representing something like a kidney stone or a major burn, most clients rate a SMP® treatment overall as a 3 to 5. Some clients have fallen asleep during the treatment, in most cases, the treatments are mild. There is more sensitivity in the areas right above the ears and skin over the temple nerves. The least sensitive areas to treat are the apex of the scalp and the back crown.
You have a few options. You may take an over the counter medication such as Tylenol or ask your doctor to prescribe you something stronger. If a client feels a prescription pain reliever is called for, two common options would be a synthetic opioid or EMLA cream.
EMLA cream is a numbing cream that can be placed on skin to provide pain relief. It is often used to numb an area before placing an IV, drawing blood, or giving injections. When do you use EMLA and how long does it last? EMLA should be applied at least 1 hour before a needle stick and longer before painful procedures.
If you plan to use EMLA cream, it should be applied with a wrap over the ointment so that oxygen cannot reach the medication or the scalp. If you simply apply EMLA to the skin, without a wrap over it, you will receive little to no pain relief. For EMLA to work, you need to apply it for one to two hours before the needle touches your scalp, and it can dull pain for about 50 minutes in most patients. After 50 minutes to two hours, your skin will return to its normal pain sensitivity.
QUESTIONS ABOUT AFTERCARE
As soon as one treatment is finished, clients obviously want to get back to their regular life. Below are common questions about aftercare guidelines
Take it easy. In the first 3 days, there should be no sweating, no water on the head, no shampoo, no washing of the scalp, no running, no cardio exercises, no weightlifting or other gym activities. Simple walking around the house and doing daily office tasks is fine.
By day four with a foil shaver. If you decide to shave at this date, please use an electric foil shaver like the Remington R91 and be careful not to run it over the top of any scabs that have not flaked off.
By day ten. This is to prevent the razor blade removing still healing scabs and pull up and out any minute amounts of pigment with them.
By day four and after
By day four and after
By day 10 and after
By day four and after
Milk of Magnesia. This antacid agent reduces shine, but is indeed the single best lotion for creating a matte appearance. Two other products many of our SMP® client recommend are L’Oreal Pure and Matte Lotion for Men and Headblade Headlub Matte Lotion and Peter Thomas Roth Max Anti-Shine Mattifying Gel. Most are available online.
Dermatologists recommend using a sunscreen with an SPF of at least 30, which blocks 97 percent of the sun’s UVB rays. Higher-number SPFs block slightly more of the sun’s UVB rays, but no sunscreen can block 100 percent of the sun’s UVB rays. It is very important you put on sunscreen every time you go outdoors, even on cloudy days. If you don’t wear sunscreen, then we recommend you wear a cap to protect your scalp from harmful UV radiation.
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