NicH0le007

You are correct, there are many different causes for pigment migration outside of scar tissue. But, if it is present, scar tissue just complicates things further and definitely affects the predictability of the result. Since permanent pigmentation is deposited deeper into the skin the chances of migration increase with placement alone. A few other factors to take into consideration are the pigment micron size and the machine that each individual institution uses. If the machine setting is running too quickly or aggressively it can cause excessive trauma to the impression. When the pigment is deposited into the impression it lays in a small "pool" at the bottom of the impression. If the trauma is more than the tissue between the impressions can handle, they all settle or "pool together" and form the larger "blobs" you are describing. Another thing that can exasperate this is the use of the popular 3-prong needle, which lays 3 tiny impressions very close together that resemble one dot. If the micron size of the pigment is small its even easier for it to migrate because the particles easily slip out of cell walls. I'm yet to see any impression not grow slightly during healing. Permanent and non-permanent, single and multiple group cluster needles, shallow and deep placement, big/medium/small micron size. Our goal has been to be able to predicate and anticipate these changes with the healed result in mind. The road to this goal is bumpy. Color change can also be caused by many things other than scar tissue. But again if present, it just complicates things further. Placement depth can cause color change, as well as, wrong color choices, natural skin undertones, sun exposure, skin damage, fading, etc. etc. etc. These are all the things that make SMP so complex. Those "dots" are way more complicated than meets the eye. And, a large learning curve still exists. With that, I myself continue to stand behind a slow and non-aggressive approach to SMP including temporary pigment, and a multi-session treatment schedule. Makes it much easier to analyze should an instance like this happen. And, provides a little breathing room knowing it will soon be totally gone. Leaving us with a clean slate of options for repair. If your SMP is still fading my fingers are crossed that they used a permanent cosmetic pigment which will hopefully be gone 3-5 years. I know you are on top of things but you can call them and ask. The pigment company they use should have a website full of info you might find helpful.

If you would like to contact me I would be happy to talk to you and share information, discuss results, theories, etc. I honestly believe, that this is the best way to give our patients the best possible results that exist - eliminate transparency, communicate, and share information. Msg me anytime. I look forward to talking to you.

An F? Oh man, that's unacceptable. I want to work on this grade immediately. When you have time give me a call. FYI, when I say "when you have time", I mean, CALL ME ASAP. Because you do have a great deal of scar tissue in your recipient zone from the multiple surgeries it obviously did change the outcome of your SMP result. Scar tissue is very unpredictable and it definitely fades more unevenly because it lacks proper circulation and its tissue depths can vary greatly in comparison to regular healthy scalp tissue. It's easy to point this out in strip scars results, but, the result you are describing on recipient/top sounds about the same. When we are working with scars we expect and anticipate irregular, patchy fading, and irregular pigment acceptance because of the abnormalities in the tissue. This is why we suggest only doing one pass per session and suggest multiple (min. three) sessions before an ideal result can be seen in scars. (Your B- donor area might need yet another pass). Although color change can be caused by many different reasons, in scar tissue, my first instinct would be question if even .05 was even too deep in some areas because of the varying tissue depths. This causes our eye to perceive it as "blue" much like we perceive our blood running in our veins to be blue. Unfortunately, we can't see this on Day 1 because it happens as the pigment settles and heals under the skin. This is why SMP never looks the same on day 1-2 as it does on Day 30-45. The healing process changes it. Because SMP is relatively new procedure to us we have been trying to go very slow and cautiously while monitoring our results with a very open mind. Our approach is very much research based and our theory has been to "question anything and everything we hear" from an educational standpoint and "always error on the side of caution" from a procedure standpoint. We are currently testing a smaller needle, and ongoing will always continue testing pigments and techniques until we find one that produces a predictable and consistent result. We know and respect that there is still a lot to be learned. This is why we have also have chosen (and likely will always stay with) to do our SMP with temporary pigment. Because, in an instance like this a bright side still exists that does not involve another intrusive procedure. It will fade totally on its own over the course of the next year. The pigment was only placed .05 mm deep and is itself was designed to be "ate up" by your body’s own natural functions. It should be totally gone within the next year. With all that being said, we still NEVER like to hear that someone is unhappy with a result. Your satisfaction is sincerely our number one priority. Again, please call me as soon as you can so we can discuss this further and arrangements can be made to rectify this.

You took the words right out of my mouth - Thank You!

We do recommend touch-ups yearly as we are using temporary pigment. But, keep in mind that results can be variable depending on the patient and age, lifestyle, etc. Because, I am recommending a touch-up every year does not mean it is going to be totally faded all over the scalp. We may just need to touch-up "spots". I just met with a patient late last week who came in for a yearly touch-up and all we worked on was his crown and temples. Everything else was holding strong. So the touch-up cost was only 50% of 1 zone - or $400. (Reminder, that may not always be the case but just an example of how each patient experiences fading slightly different.) I have also worked on patients who have experienced large amounts of fading and we have re-touched their entire scalps. Again, than it is 50% or, $1200. I hope this makes sense and helps

From my experience, If you are working with a reputable clinic that has the patients needs in mind they are always willing to work with patients on the cost. We want our patients happy and successful. Their needs are important. I agree with you and have seen exactly what you said happen over the past 5 years (in the US anyway). 5 years ago a patient might pay $4,000 - $8,000 on average for a full head SMP. But, there were only about 2 clinics offering this procedure here in the US and those clinics had zero transparency in sharing their information (sometimes even with their own techs). Some clinics have kept those prices ( this price may include anesthesia now) but in general as SMP artists we have really been advocating for more training, more education, and more sharing of information between providers. This is helping bring prices down because more people are trained and trained well for that matter. Nobody holds the "golden egg of information" anymore. And, if they do (and they are reputable) they want to teach so that everyone is providing 5 star techniques for patients. Which obviously helps SMP as whole. 3 cheers for that.

I took the liberty of helping this patient post his photos. I sincerely thank him for his courage to share his story and help other patients who are considering traveling down the SMP road.

We are not currently offering permanent SMP at Shapiro Medical Group.

Hi Jorden, I have the same questions as the gentleman above. If you would like to send me your pictures I would love to offer you my thoughts. Patchy fading is extremely common with SMP, as is mild migration. Take a deep breath and know that there are solutions available to help you! Nicole

Your SMP will go through many changes as it "settles" and heals in the next 45 days. With any permanent cosmetic procedure (SMP in particular) you can expect that there will be some uneven and "patchy" fading due to the unevenness of your dermal layer. This is perfectly normal. So is a possible 30%-50% fading. Touch-ups are important. What were your aftercare instructions? If you are happy I am happy for you! I hope you continue to post your results and keep in touch with the people in this community! I personally would like to continue to monitor your results for color change. Permanent Brown pigment has a tendency to fade to an orange color. Maybe, just because I am a freak about hairline design, If I were you I would think about making it look slightly more irregular. It's more fitting for a Caucasian male to have a soft hairline. I think although you are happy. You could be "happier"!

The pigment that we use at SMG is an organic temporary pigment that is manufactured in Europe. The benefit of using pigment from Europe is that the pigment manufacturing industry is far more regulated. It contains no iron oxides nor metallic particles. This decreases the risk of color change during the fading process. And, is safer all around. The pigmentation industry is big business, so many times as artists we don't even know all the ingredients, unfortunately. Every company wants to protect their "proprietary ingredients". It's frustrating across the board, not only to patients but to the specialists as well.

If anyone, has questions about SMP. I am the micro-pigmentation specialist for Shapiro Medical Group and am MORE THAN HAPPY to also help! Anyone, can msg me anytime! Or, email me directly at nicole@shapiromedical.com. If I can post my obviously biased opinion of Janna -- she is fantastic! Always willing to help, always fair, always honest, and she contains a wealth of knowledge.

I think those prices are a reflection of the permanent SMP market. At Shapiro Medical we are offering SMP at $800.00 per zone (3 zones). $2400.00 for a full head. Our treatment timetable includes your initial first two days and one touch-up. We suggest touch-ups yearly touch-ups after your third session. They are 50% of the cost. You would have to ask Joe from H&W his exact pricing schedule but I think they are charging "per pass" and only after several years of "passes" would your cost rack up to $4000-$7000. All these pricing structures make my head spin!!!!! ___________________________________________ I am employed as a Pigmentation Specialist for Shapiro Medical Group. MSG me for any additional information.

temporary pigment. I should have clarified that.

Hi everyone, Thank You for taking a look at our photos. I will continue to post photos to document this patients journey with you all. Today I am adding a closer photo, I think it is slightly clearer. This patient came in for 3 SMP sessions slowly building the titration of pigment. I am showing you the photos of his him pre-procedure, and then post healed from sessions 1 and 2. It is important for us to look at photos of this procedure healed (post procedure 6 weeks) because it does change in appearance slightly in the healing process. The patients hair in all fairness is 1/8 of an inch different. The longer length is his ideal length. But, I think the blending from the SMP has really helped to soften and thicken the appearance of the donor area overall. We have been moving very slow and building density slowly and strategically in our scar camouflage procedures because we have found that the excessive swelling mid-procedure can cause pigment migration during healing. By slowing down and allowing the tissue to completely heal between sessions it has yielded us the safest and best result. I am patiently waiting for his 3rd session to heal and will post his final healed result as soon as I have them. Thanks again, Nicole

Shapiro Medical Group