There are millions of men and women with cosmetic problems with their scalps and hair caused by dermatological and genetic conditions, such as intractable alopecia areata or female genetic balding. Millions of men have also developed iatrogenic deformities as a result of hair restoration procedures between the 1950s and 1990s, which were performed with crude techniques and scars from strip harvesting. As hair loss is often a progressive process, genetic and iatrogenic conditions become more prominent as time passes. Scalp micropigmentation (SMP) is a relatively new technique that uses a tattoo in a stippling pattern to replicate hair follicles close to the scalp.1,2 This new treatment can address the cosmetic problems resulting from the condition noted above.
SMP is becoming a more socially acceptable cosmetic solution for treating appropriate scalp and hair problems during an expansion in the tattoo industry, which has grown from 14 percent in 2008 to 21 percent in 20123.
We describe how the SMP process is used, demonstrate a variety of clinical applications, identify challenges involved in the technique, discuss the anatomy and histology of tattoo pigment interactions with human physiology, and explain some of the safety concerns. In this article, the authors show how SMP will greatly impact people who have been unable to hide deformities caused by a wide range of diseases and traumas.
A PERMANENT HAIR CONCEALER: SCALP MICROPIGMENTATION
The market for scalp concealers is multimillion dollar, and both men and women use them. This involves applying pastes or fibers frequently to the scalp so they approximate hair color and reduce the contrast between hair and scalp color. Tattoos have been used in the past to darken the scalp in Caucasians with alopecia4; however, this method has not been aesthetically pleasing and, therefore, has not been accepted by doctors or cosmetologists. We have refined our tattoo process for scalp applications using a combination of the technical components of a tattoo instrument and carefully selected pigments. When combined with the artistic and technical skills of a provider, many scalp and hair cosmetic conditions can be addressed.
There are many ways that SMP is used, significantly expanding the options for cosmetic treatment of various forms of alopecia. A person’s hair appears more plentiful when it is added to any effort to make their hair appear fuller. Scars appear more discrete when it is added to any effort to make their hair appear fuller. People also like to use tattoos to cover scars. Tattoo cover up is becoming more and more popular these days, mostly because it’s affordable.
In general, alopecia (e.g., alopecia areata, female genetic unpatterned alopecia) is associated with reduced hair density, but it varies in degree and distribution. The first step people take when they notice they are thinning or balding is to manipulate their hairstyles (e.g., comb-overs, bouffants). As hair loss progresses, these styling options change over time.
The hair color of many Caucasians suffering from chronic alopecia may be changed from dark to light (blonde or light brown) to reduce the contrast between a dark hair color and a lighter complexion. Diffuse or regional alopecias can be camouflaged by such changes. By using concealers that match the scalp color and using styling modifications, balding or thinning areas of the scalp can be effectively disguised. However, temporary concealers often interact with the environment, such as shedding on clothing or bedspreads or becoming runny when wet. The use of these topical concealers often requires a user to modify their activities and lifestyle.
