NicH0le007

Anytime

Hi Yaz, I think the most consistently good permanent SMP work that I have seen done is by former techs from HIS, Vinci, and NHI. I refer to Matt Iulo at Scalp Micro in NYC most often (he is formally from HIS as well). I think if you want a great honest opinion of someone I'm sure he knows --ask him. MY advice, find out if he is still using the same pigment as he was at HIS or is he learning a new pigment? Same equipment or new? How long has he been on his own and does he have examples of his work he can show you. And, lets say in worse case scenario you dislike your SMP -- How is he going to take care of you? Does he refund? Will he redo? Does he have access to a laser? HIS pigment does laser out pretty well in a few sessions but that's not the case for all permanent SMP. I have a pt I am correcting from another large organization (not represented on here) that has taken 11 laser sessions to remove his pigment. I started in this industry doing permanent SMP -- I believe in the right hands it is safe. Those hands are honest and transparent and they tell you everything. No sales gimmicks. Also, look at his hairlines. Does he have the ability to do soft natural hairlines? I know most guys think when they get SMP done that they are going to stay with that look but the reality is many itch for hair down the road. Don't get yourself locked into a situation that will be hard to get out of. Don't lower your hairline beyond your existing hair or go too low. If you are older than 30 get an age appropriate hairline, etc. Think about future planning. Best of luck, I hope this was helpful

I can look for some photos for you! Feel free to email me at Nicole@shapiromedical . com anytime, I'm happy to help you find someone. But, I will say this -- the only 3d SMP I recommend is scalp (1d) + hair follicle replication (2d) + real hair (3d). The companies that promote that they can do hair strokes with pigment make me very nervous. I have never seen a hair stroke hold its integrity throughout the healing process in the scalp. They turn into big blobs.

Dr. Pak best permanent SMP Dr. Umar best tricopigmentation or temp SMP

Also, a few threads down nocureforbaldness is doing a monthly update of his results from a beauty medical company out of UK. Maybe PM him for his experience.

Debbie is an internationally known permanent cosmetic make-up artist and she is now currently teaching tricopigmentation for Milena. I have seen her work in person and taken many classes with her. I would like to have her explain motivation and thought for that hairline. If I were doing a hairline on pt whom was not doing a transplant to strengthen those corners - yes, personally I would have stayed within the existing hairline because I never like to lock anyone into 1 look. FYI - Milena does work out of a clinic in UK once a month, I believe.

The Jargon: Phagocytosis – think of it as the cell eating or swallowing an item ie: a particle of pigment Phagocytic- cells that are capable of phagocytosis; some cells can become phagocytic during an inflammatory response (ie:keratinocytes), whereas others are phagocytic all the time (ie: immune cells). Extracellular-outside the cell. Intracellular-inside the cell. Dendritic Cell- an immune cell type that continually samples its environment for changes, and will migrate to lymph nodes to trigger an immune response if necessary. Mast Cell – an immune cell that plays a crucial role in allergic reactions and is present in connective tissues. Extracellular matrix – a generic name for the scaffold of proteins both structural and “glue”types) that cells attach to and are supported by. Major components include basement membrane (one type of collagen network), elastic fibers, structural glycoproteins (eg: fibronectin), proteoglycans (“glue”) and collagen. Fibrocyte – a cell type that makes up most of the cells in connective tissue. They secrete collegen as well as other proteins that make up the extracellular matrix when activated. Thaey are normally phagocytic, but become so when inflammation occurs. Fibroblast – a fibrocyte that is actively secreting proteins (an active fibrocyte). Granulation tissue – tissue that fills in gaps formed from debris or necrotic tissue removal. It consists of newly formed small blood vessels embedded in a loose structure of fibroblasts and immune cells. As the tissue matures, immune cells decrease in number, fibroblasts form collagen networks and blood flow resumes to the area. Hope this all is helpful. Nicole

Hey guys, sorry this is a late response. 1. Beauty Medical Pigment is made of : Isopropyl alcohol, water, glycerin, titanium oxide, yellow color iron oxide, black iron oxide, and red iron oxide. 2. In the UK for trico I would go see Debbie Clifford. She is an outstanding tech who has been in the industry for many years. 3. The Question: Will TricoPigmentation Fade? The Answer: YES. Why? Two reasons. The first = because the pigment is injected so superficially into the upper layers of the dermis much of it is exfoliated during the cell renewal process. The second = TricoPigmentation pigment is designed to fade completely over the course of 6-18 months because the particles it is made of are small enough for your cell defense system to “eat” and eliminate. Before we go any further into this discussion it is important to make the distinctions between the different types of fading you will experience: 1. The portion of pigment that washes away at your first hair wash reflects the pigment that was left only on the surface of the scalp that was superficially sitting in your pores, hair follicles, etc. 2. Short term fading (fading between sessions): After each session every patient is generally sent home, and asked to return to the clinic about six weeks later for their next session. The reason for this is for two fold– to give the scalp a chance to heal, and to enable the pigments to settle down and fade. Once the pigment is in the scalp, the amount of pigment that remains over the first 28-45 days generally reflects the depth of the pigment placement. Let’s discuss the science. To understand short term fading we will discuss: anatomy of the skin, the cell renewal process, and placement of the pigment. Let’s start from the beginning: Remembering that the SMP process begins by inserting a micro drop of pigment through the skin and into the upper dermis (second layer of skin) by perforating the skin with a needle. To get to the upper dermis it must first perforate the epidermis, which is the most outer layer of the skin. First, let’s discuss the purpose and function of the Anatomy of the skin because it plays a very important role in short term fading and the cell renewal process. The epidermis: is the outer layer of your skin and includes the part of your skin you see every day – the surface. However, the epidermis is comprised of more than just the skin's surface. It consists of a number of levels, each with their own distinct role 1. stratum corneum – surface, 2. stratum lucidum, 3. stratum granulosum, 4. stratum spinosum, 5. stratum basale-deepest layer Cells in the deepest level of your epidermis are extremely active and divide constantly to make more and more new cells. Once generated in the stratum basale, these new cells are pushed upward through the other levels of the epidermis and toward the surface of your skin. Along the way, they die and eventually become filled with keratin, a very strong protein. These dead, keratin-filled cells make up the outer parts of the epidermis and provide your body with the tough, protective overcoat it needs to survive. The dead cells on the outer parts of your skin are constantly shed and replaced by new ones. As a result, every 20-30 days, your body has an entirely new surface of skin. The upper dermis (papillary layer): the second layer of skin, a connective tissue made up of collagen and networks of elastic fibers which give skin its resiliency, is the layer in which smp pigment is deposited. The majority cell type in the dermis is fibrocyte (or fibroblast) other cells that are important in relation to pigment placement are resident immune cells – dendritic cells, macrophages, and mast cells. The lower dermis (reticular layer): is made up of dense connective tissue and contains blood vessels, hair follicles, sweat glands, lyphatics, nerves, and sebaceous glands. If pigment in injected any lower than the upper dermis into the reticular or further into the hypodermis you will see migration and discoloration. Hypodermis: a loose connective tissue containing mostly adipose (fat) tissue. Epidermal-Dermal Junction (Basement Membrane): the area of tissue that joins the epidermal and the dermal layers of the skin. Second, Lets Discuss the placement of pigment and the cell renewal process. The SMP process causes damage to the epidermis, epidermal-dermal junction (basement membrane), and the topmost layer of the dermis. The pigment itself is initially dispersed as fine granules in the upper dermis, but collects into more concentrated areas at 7-13 days. The largest layer of the epidermis is the stratum spinosum, and this area will fill with pigment in the track created by the needle. The deepest layer of the epidermis is the stratum basale, a row of cells that resign on the basement membrane separating the epidermis from the dermis. Significant amounts of pigment may be found in the basel cell layer immediately after the process is done. Pigment particles are found within the cytoplasm of keratinocytes and phagocytic cells, including fibroblasts, macrophages, and mast cells. Also important to note and understand is that at one month, the epidermal-dermal junction (basement membrane) is reforming, and collections of pigment particles that are present within the basale are starting to disappear, as these cells migrate upward toward the surface. Eventually, all of the pigment found in the epidermis will be pushed upward with the exfoliation of the stratum corneum and the only pigment that will remain at this point will be the pigment that was placed into the upper dermis. Because those once damaged epidermal cells were shed and replaced by new, pigment free cells the color may look less deep as when all the cells were carrying the pigment in the initial wound. 3. Long Term Fading: The fading that takes place 3 months-2 year s after the treatment is complete: This is the period after the pigments are fully settled creating the appearance they will ultimately maintain over the long term should you maintain your SMP. Let’s Discuss the Science: A. First, At 3 months the basement membrane of the epidermis (epidermal-dermal junction) is fully reformed, preventing any further loss of ink through the dermis into epidermis via the basel layer. B. Second, pigment stays in place for years by tricking the body’s immune response. Think of the needle and pigment as a military operation. The immune system leaps to defend the body against a wound and pigment invasion, thinking a bad infection is about to occur. The body is functioning properly by responding this way. Phagocytes are like pac-men. When pigment is deposited in the dermis , the body mounts an immune response with macrophages, phagocytes and mast cells. Macrophages and phagocytes are the rough equivalent of microbiological pac-men, and literally eat and envelop the tattoo ink in an effort to contain the invasion of foreign material. As the damaged epidermis and dermis heal, granulation tissue and specifically dermal fibroblasts interlock the ink-containing phagocytes in a collagen network just beneath the dermis/epidermis junction. That’s how permanent pigment stays put for years. Permanent cosmetic pigments have 20+ microns of various shapes and traditional tattoo Ink 30+ also variously shaped. These particles are too big to be carried off my macrophages. Tricopigmentation (temporary SMP) are different from the pigments or inks used in both permanent makeup and traditional tattooing. The difference in the pigments are mainly seen by difference in particle sizes. Tricopigmentation pigment particles are 15 microns and are all perfectly round in shape. These particles are small enough that they can be eaten and dispelled by the macrophages making it’s result therefore “temporary”.

Looks great, is that your result after 2 sessions?

We have had a lot of success camouflaging FUE scaring with the tricopigmentation technique. I have posted some photos. IME, with trico bleeding and migration are not so much the concern in scars as pigment retention. Because the pigment is injected so shallow the incidence of migration is much lower. Scar tissue is still tricky at any rate because it is not normal healthy tissue.

I'm sorry, I should have been more clear above that I was referencing recommendations for tricopigmentation not permanent smp. At, SMG we stand behind tricopigmentation as the safest (in our hands) SMP procedure at this time to provide our patients. However, if you feel like it makes the most sense for you to do permanent than I think you should chat with some of the reps on here and they can give you some great info on how they do things. The rep from Vinci and Matt from ScalpMicro always have good info and they also do great work. As far as FUE/SMP combo goes, I don't think an exact answer of what procedure should come first exists. We have done it both ways depending on the needs of different patients. I think this is something you need to consult with the physician you choose to work with about.

I usually book a 1/2 of a day or 4 hours for a strip. Does it take this whole time always - no. But, I want to include time for anesthesia if the patient is uncomfortable. Sometimes scar tissue can be very hyper-sensitive. Also, I don't do rushing on anything. I do not treat scars on consecutive days. I wait 4 weeks between each session to allow full healing so that I can monitor the healed results to better predict what the outcome is going to be. Scar tissue is not normal tissue -- some scars will reject a lot of ink on the first pass and then I know I am safe to be more aggressive. Others, will accept every drop of ink (and find more, I swear) . These need to be treated more conservatively. These result can not be seen until it is healed. If we as technicians are too hasty and impatient and just move forward trying to cover the scar quickly instead of respecting the process the chances of migration increase dramatically.

Thanks, Arrie! This hairline was a bit of a challenge because the pt really wanted something a bit "edgy" and it is our policy to keep them natural as if they were created by nature. All of our hairlines are created by either Dr. Ron Shapiro, Dr. Paul Shapiro, or Dr. David Josephitis. I replicated their visions. Art + Science

A picture is always worth a thousand words! If you could post a photo that would be great. Like hairthere said, scars can be a bit unpredictable because they are not normal tissue. Generally, 3 sessions does the trick with trico but that's not a gaurentee.

I think Matt likes the Andies edger. I usually recommend the wahl t-edger. The andies edger will get you as close as a wet shave but dry. The wahl will be just slightly longer. (Less than an 1/8 inch difference between the two). Check with him to see what he thinks would be best. Sometimes its tricky doing a wet shaved look because it "erases" the follicles - so if he just worked on your top and blended your density to match the sides and back then you can have the appearance of an "smp cap". The wahl leaves just enough stubble to make everything match without erasing the follicle on the side. Hope that makes sense! He'll help you with your decision.

As usual, Nice Work Matt!

Your always welcome to call us at Shapiro and consult.

Very Nice!

I have an example under FUE/Tricopigmentation combo on page 2. It might be worth sitting down and discussing your options with a dr. so that they can discuss all our options with you, all the risks, and do some future planning with you. If your starting to thin more you may want to also discuss that with them. You could start with phone consults. They just require photos. Often, a combo of these procedures will give you the best result. But, you want to discuss the order etc. with a dr. so it is planned correctly taking future hairloss, complications, risks all into consideration.

Shapiro Medical Group - FUE Scar Camouflage

Shapiro Medical Group - Shaved Effect

Shapiro Medical Group - 2 year Case Study Tricopigmentation

Also, this is a great result! I love how tiny the follicle replications turned out -- they look very natural.

Hi Ken and everyone, First, I apologize I have been away from the forums for a bit. I have been very busy in procedures. My first priority is always to my patients. SMG has plenty of photo's we can show you of our patients at different stages of their SMP journey (be patient with me as I gather these)and plenty of information we would like to add to these conversations that I have been browsing through. Ken, BM has trained plenty of technicians who are practicing tricho who have achieved many advanced certifications in other areas of pigmentation before taking her course. For instance, I trained for 2 years doing permanent SMP and have many advanced certifications in paramedical tattooing, skin revision, and permanent cosmetics. All which required many hours of apprenticeship before training with Milena. Also, off the top of my head I can tell you Debbie Clifford, who works out of Manchester England is one of the worlds foremost experts in permanent cosmetics and paramedical tattooing with 25 years of prior experience. We have been practicing tricopigmentation for almost 3 years now here at SMG and have been to Italy three times (most recently in December) and Milena has been here once. While I don't think we know it all, I do think we know A LOT. A LOT! I'll start sorting through the posts as soon as I can. But, as always I do agree with you that you have to do your research. I appreciate that you keep me on my toes with getting all this information out to you guys.