Scalp Micropigmentation done by Dr William Rassman at NHI

[Dr. William Rassman]

We've been perfecting our procedure for scalp micropigmentation and it's getting a lot of great results and reviews from our patients. In this instance, we've used SMP to conceal hair loss the same way that a product like Toppik does, but without having to apply it every day (and often multiple times during the day if you're active).

 

For some women and men, hair transplantation may not be an option. We want to provide our patients with as many options as we can provide, and most importantly provide the patient with the pros and cons of each option to come to a solution that both the patient and doctor find to be productive.

 

Many rely on temporary cosmetic products such as DermMatch or Toppik. But these products wash off and can get messy on the pillow or finger tips when you touch the hair. SMP is a great permanent solution to decrease the contrast between dark hair and light skin. Notice the dramatic fullness with only SMP alone.

 

We hope you enjoy our work. We are very excited about this and other procedures we're working on. Thanks for reading!

 

 

[Blake Bloxham]

NHI,

 

I think this is my favorite example of scalp micro-pigmentation presented thus far. Nicely done! Thank you for sharing this case; I know the community really enjoys reviewing examples of the new procedure.

[hairthere]

How much would a procedure like this example cost?

[Ellie]

It looks good but is it truly permanent or does it fade over the years? Also, what happens if the patient loses more hair and just the pigment is visible, does it look OK or unnatural?

[bonkerstonker]

Yes i'm very interested! The theroy is simple but seems to be highly effective can you copy paste some information here or give us a website url for information.

[Dutch]

Yes pls, if you can provide info and cost for something like this, that would be wonderful

[aaron1234]

Yup, the best SMP result so far. Prefer this much more than the shaved head examples. Well done!

[mars]

Too risky getting this done when hair may not be permanent i do think it would complement a ht tho.

[Blake Bloxham]

Guys,

 

For those who are interested in more information (costs, procedure descriptions, etc) about scalp micropigmentation (SMP), I recommend contacting Dr. Rassman's clinic (New Hair Institute in Los Angeles).

[Dr. Ron Shapiro]

I have been following the improvements in micro pigmentation over the last year. Dr Rassman is one of the few HT physicians trying to see where this technique fits in the armamentarium of patients with hair loss. I have talked with him about the potential risk / benefits of the procedure and know that he is doing a good job of moving ahead carefully as he keeps exploring its use.

 

I would like to share the limited experience I have had with this technique so far.

 

I was first exposed to this technique when a patient about a year ago. An old patient of mine had had it done and came into my office. I had last seen him 17 years ago. He had been a repair case. At that time he wore a hair piece due to poor hair transplant at another clinic that left him with multiple scars in the donor area, a depleted donor area, and poor growth on top. He had very little donor left. 17 years ago we had very little options for him and what we decided was to do a hairline in front of his hair piece so at least the hair piece would look more natural. It worked well and I did not see him for the last 17 years

 

About a year ago he walked into my office without the hair piece, his head shaved, and with the micro pigmentation. I was surprised at how it looked…. much better than I had expected this to look. From about 3 feet it looked like a person had shaved his head and let it grow for about a week...like stubble. It was very hard to see the scars. I did not like the look of the hairline...to abrupt. This type of hairline made sense in a young afro American but not an older Caucasian. In addition when I was closer than 3 feet I could tell there was something wrong because it had no depth. HOWEVER this patient liked this look. He was happy…He felt much better about himself.

 

I had the same concerns that have been expressed above about the dye changing color, what happens if he turns grey, what would happen if this was done on a younger person and then they lost their hair

 

But I could also see the potential for how it could help at least a sub population of HT patients. This sub population includes:

· Patient with donor scars that prevent them from cutting their hair short

· Patients who have done transplants but who still look thinner than they like. The reason for this could be one of many: poor donor supply, fine hair, poor growth, etc.

Over the last year I have sent 6 patients who were in the above situation to have the micro pigmentation done. Because they were almost out of donor, they had very few options so we felt comfortable trying this.

 

My experience so far is that these patients are very happy with their early experience. It was especially good for hiding donor scars...even with the hair short. It made them more comfortable with the appearance of density on the top as it blended with their old transplanted hair.

 

 

In some cases the micro pigmentation enabled me to get a little more donor out because the donor area looked so much better and the new harvesting would be hidden.

In addition I was careful to instruct the clinic doing the work to stay about 1 cm behind the hairline and fade away into it as I do not think it looks good at the hairline. I think this helped a lot.

 

 

I think over time this technique has the potential to be a good adjunct to be used with HT.

But we have to move slow and be careful and I am glad there are physicians with a lot of experience in HT exploring it like Dr Rassman.

 

 

Here are a summary of my thoughts and a few precautions I have at this time:

· I don’t think it is good as a primary treatment for a patient that is beginning to thin because he will be stuck with it after he balds and may not like the look. He will then be forced to do a HT

· I also do not currently like it as a primary treatment for a bald patient because I don’t think it can create a good hairline.

· With respect to the HT fading....Even if it faded in 4 years and they had to do it again the patients I talked were ok with this compared to where they were before having to use dermatch daily. A bigger concern was that it would change color over time.

· With respect to color change…I don’t have a good feel for that at this time. Some of the patients I saw who had been out 2-3 years had a slight bluish or greyish tinge develop when I looked close…but surprisingly it did not affect the overall look and the patients were still happier than they were before the micro pigmentation I saw a man who had grey hair and with the light grey tattoo it made his hair salt and pepper looking…However I don’t have enough experience to know how much of a problem this will really be…and unfortunately the clinics I have worked with have not really helped me understand this.

· I do think that it will be good for patients who have scars.

· I do think that it may enable us to get more hair out of the donor to use on the recipient area in some patients

· I think if one does it on top that it should only be done AFTER one has done hair transplants that have taken them 70 percent of where they want to go....this would be to improve them if they did not have enough donor to get them further

· I think people that do this need to stay away from the hairline and learn how to fade away as they get close ( lowering density and lightening color)

· I think that it is difficult to learn how to make the micropigmentation so it stays as a discrete pinpoint dot that imitates a stubble of hair.... there is a risk of it "bleeding" and coalescing which does not look good. This is dependent on the ink used, the needle used, the depth into the epidermis that the needle is inserted and probably other things. Dr Rassman would probably know more as he does this himself. I think a lot of clinics say they do it well….. But as was true with HT clinics in the past there are probably many don’t do it as well as they say. So until a good track record is developed by certain clinics I would say to be cautious.....

One last note….this tattooing is not a discrete localized tattoo that would be noticed. When done it has to be done throughout the entire donor area or the entire recipient area so it creates a background….if it is done in a discrete localized area it would be noticeable.

These are some of my thoughts so far....I will let you what I think as I continue to follow patients....for now I am only recommending it for patients that have very little choice.

 

I will try and collect some photo to attach when these patients come back

 

Ron Shapiro

[aaron1234]

Dr. Ron,

 

Thank you for taking the time to give a write-up on micro-pigmentation. I have been eager to get other doctor's perspectives on this new technique since Dr. Rassman had begun to offer it this past year. In fact, I had a chance to discuss it with your brother in our pre-op consultation last week as I am prone to larger scars. As with FUE, I agree that caution needs to be applied to this newer potential option in fighting hair loss.

 

You stated one thing that I would just like to be clear on. As you were saying:

 

"In some cases the micro pigmentation enabled me to get a little more donor out because the donor area looked so much better and the new harvesting would be hidden."

 

Is this a case where you excised a new donor strip from an area that already had micro-pigmentation done? Or do you mean that you were able to harvest more hairs (i.e. get a larger strip) because of the option to disguise the scar in the future?

 

Much thanks!

[mars]

For fue scarring i think it is ideal..their is a clinic in the uk called 'his hair clinic',they have by far the most pictures and videos and are good quality and very clear,the owner of the company has had it done and it looks perfect,will def be getting my fue scars filled in there next yr,imo they seem to be the top clinic for smp at the moment.

[TakingThePlunge]

Dr. Shapiro,

 

Thanks you for taking the time to share your insights! I'm quite interested in the procedures but remaining cautious at this time.

 

What to you think of patients opting for a lower density hair transplant that wouldn't necessarily stand on its own, spreading their donor supply over a larger area and then filling it in with SMP? I've heard talk of this as it would, in theory, provide for the missing appearance of depth in a buzz cut.

[Jotronic]

I'm really glad to see Dr. Shapiro's thoughts on this and his observations on some patients he has seen 2-3 years out. The discoloration is what has worried me the most. I have had several people ask me about this procedure and my number one warning was for them to consider the long term and that the ink may change color. Also, as time passes, the ink tends to spread or "leak" into the surrounding tissue so that the area that is inked becomes larger. I first noticed this on old sailors when I was a Merchant Marine on my first ship. That dragon tattoo that seemed perfect to get in Bankok 20 years ago now looks like a smudge with a tail:) I also know of one patient from several years ago that told me he had this done for his whole head and eventually his entire scalp turned blue from discoloration and bleed out. I cannot comment on the quality of the work nor on the type of ink used as I never saw it. I know there are "cosmetic" inks available for eyebrows and such but I don't know enough about them to know whether or not they last longer and keep their shape.

 

The second thing that bothers me is what Dr. Shapiro referred to as a lack of "depth" on shaved patients. I had been thinking of how best to describe this and he nailed it for me. The guys that want to shave their head and have this procedure done so it looks like they have lots of stubble will have this issue. I mean, when someone is standing close to you, be it in a grocery store line up or sitting behind you at a ball game, the "stubble" will be there but it will have no depth as Dr. Shapiro put it. I can only image what it would look like if it is sunny out and the scalp gets that "glisten" that occurs when starting to sweat. Also, what if someone runs their hands over your head expecting to feel the stubble? Surprise! How does one explain this?

 

This particular case looks ok but the first thing that jumped out at me was the hairline. I immediately was drawn to the dots in the area just behind the hairline as it gives the appearance that thicker graft placement would give had mini-grafts been used from a hair transplant. In other words, it stands out to me. Dr. Shapiro's recommendation to not tattoo in the immediate hairline fringe should be taken seriously. If the dots are any larger in diameter than the surrounding hairs shaft diameter they will stand out and draw the eye.

 

I would imagine, assuming there is an ink available that does not bleed or change color, that smaller dots would make a more natural effect. Bottom line, if one is interested in this, give it time to mature for what you are looking for it to accomplish then see patients that have had it done for a few years.

[azazelgs]

I was very interested in this since I'm buzzing my head at lowest clipper and been researching about it for 2 years now. Let me tell everyone what I think:

 

In pictures, some of them look really good but Dr. Shapiro and Joe adressed my main concern; "depth"! Hair is something that has 3 dimensions but tattoo does not. I sent some mails to the clinics that offer this service that if is there any trick/artisty to look like 3 dimensional or just putting dots on to head. I think it's just dots.

 

Other thing as Dr. Shapiro mentioned was hairlines. I think they are also too well defined and unreal. From a distance it may look good but closer... I really don't know since I haven't seen anyone in person.

 

Also, many clinics seem to offer the "removal" of this procedure. I e-mailed and talked about it but none of them seem to give a decent answer. Is it a normal tattoo removal procedure? Will it be completely removed? Scars ? Healing time? I got no answer to those.

 

However, I believe this procedure will eliminate "you can never shave your head with the strip scar" idea. The most effective way to use this tattoo is to cover the scar as if I ever go down to ht route, tattooing a scar will be my last stop if I will be unhappy with my ht.

 

PS: Thank you Dr. Shapiro and Joe for your thoughts and I'd love to hear some ideas from other clinics!

[TomCruise]

It may be ok from a distance, but from what people are describing, seems like in up-close & personal situations, one would have the same fear of detection as a person who wears a toupee or use Couvre. No depth, no stubble, no actual hair, and it's permanent.

[bonkerstonker]

The research I've done has told me that it's not actually a tattoo apparently it doesn't go as deep into your skin so common sense tells me 1 it's easier to remove and 2 it's more likely to fade and smudge like tattoos do over time as the new skin layers grow over.

[Dutch]

If it doesn't go deep below the scalp surface and the ink is not permanent, you'd need a top up every couple of years.

Would this procedure not harm existing/newly placed grafts?

[bonkerstonker]

That's a point would you trust someone other than a surgeon prodding around Ht hairs I'd imagine Ht follicles would be closer to the surface than normal follicles.

[TC17]

I've never been impressed with SMP in anything other than as a scar filler, and I don't think that doctors should be moonlighting as tattoo parlors.

[haircut]

Dr Shapiro,

 

Thank you for that very thorough explanation of your position on SMP. I have been considering it as a fill in for a rather depleted donor area.

[trinder]

Why cant i access the pics?

[urmomma]

pics are gone/dead