SMP before FUE

[newbie33]

One of my apprehensions about any sort of surgery is having to go through the ugly duckling phase. So I wondered, assuming I get FUE and shave everything down, what would be the disadvantages of getting temporary SMP before a procedure, so that afterwards I can maintain the shaved down look when the transplanted grafts start to fall out and my scalp looks red raw.

 

Does it make FUE more difficult, or even impossible for the surgeon to implant into a tattooed area? Any other reasons why it makes it more difficult/inadvisable/a non starter?

 

Thoughts welcome, especially from any docs or other professionals.

[Dr Blake Bloxham]

Newbie,

 

As usual, very interesting. I do see how this could be advantageous in the immediate post-operative period.

 

The only problem coming to mind at the moment -- from the HT doc perspective -- is the fact that we would really goof up your new SMP making slits into it. Especially because the SMP is done at a more superficial level, so the blade would really move through all of it.

 

I'm not sure if this would create a smudged or smeared kind of appearance or if the ink would be pushed deeper, or if it would simply just mess up the work and it would look like you didn't have any SMP done after.

 

I also wonder if there could ever be a scenario where the ink could be caught up in any sort of deeper healing scar from the slit and this could prevent the body from breaking it down properly (kind of how if you get ink into a cut, the body will scar around it and create a sort of "prison yard" tattoo)? The SMP is degradable pigment and not ink, but I wonder if something like this could happen.

 

I may also want additional anti-septic/anti-bacterial coverage pre and post-op if it was done really close to the surgery.

 

I hope HairThere stops by because he can probably provide some more insight. I refer all my SMP related inquires to him -- not to mention I pick his brain about SMP and it's applications in this field quite often!

[getting4000]

Thanks Newbie for posting this, Ive been researching this as well and am very interested in the same information regarding having smp prior to fue. I talked with Dr. Vories about this and he said he has had some patients do this before and he said that if I were to have the smp before the fue surgery, to make sure it was at least 2 weeks prior to surgery. I agree with you Newbie that hopefully the smp prior to the fue would camouflage the redness and ugly duckling phase. I've searched and searched though and there are few examples of this type of procedure in the smp then fue afterwards. There is an example on here of Dr. Shapiro doing this for a patient and also Dr. Wesley, which can be found on this forum and also their websites. I haven't found many other examples. There is a Dr. Yates in Chicago that has some examples from a few years ago on youtube but only a few and in my research he has had mixed reviews. For those of us who can't take a month or more off work and don't want to let anyone know about the procedure maybe this would be a way to hide it? Hopefully we'll hear some additional information from the forum. Thanks again Newbie for asking this.

[newbie33]

Thanks Blake. Would it actually make the hair transplant procedure itself more difficult if the area had been smp-ed? (Rounds these parts, we'd probably call a prison yard tattoo a 'coal miner's tattoo', on account of the coal dust creating a black-line scar).

 

Thanks Getting. I'll see if I can find those examples.

 

I had already put this into the pile marked 'why take the risk'. But I can't help myself from asking 'what if...'.

 

The sensible thing, obviously, is to focus on the prize: the long-term result of the HT. And not the short term affects of looking a bit rough. But the vanity - the vanity! - and the shame of admitting a procedure. What a piece of work is man, huh?

 

Another question: how long after a HT can you get temporary smp? Or more, correctly, how long before there isn't any risk to the long-term result of the HT?

[hairthere]

The only issue I see with this approach is that the SMP might make it more difficult for the surgeon in terms of obscuring the field of view, and as Blake mentioned the scalpel could potentially damage some of the dots.

 

"Another question: how long after a HT can you get temporary smp? Or more, correctly, how long before there isn't any risk to the long-term result of the HT?"

 

I would wait for the HT to be a finished product.

[NicH0le007]

Hi Newbie,

 

This is not a new concept and I'm glad you brought it up. We have been successfully doing many combinations of SMP (Trico) and FUE very regularly at Shapiro Medical Group since 2012. Many patients are opting to do exactly what you are thinking of. They use the trico to get them through the "ugly duckling" stage and/or camouflage a strip scar before shaving their head prior to FUE. Feel free to email me and I can give you all the details.

Basically, as long as you wait 4-6 weeks until your smp is completely healed you will be fine. I have all my patients complete a successful start (meaning I have them do three rounds each one month apart) then just schedule the FUE 30 days after the SMP is completed. That way I can plan for the fading that will occur during the surgery.

 

It will not cause any type of bleeding or smudging like mentioned above. Nor does it make the surgery any more complicated for the physicians if they are using surgical loops. We all use very powerful loops that basicly gives us 6x normal vision or "super vision" as I like to call it. Many other clinics are actually doing same days procedures although from an infection standpoint that seems a little risky to me, unless they were working on separate areas of the scalp.

 

Feel free to msg me and I can go through all the details and protocols that you should be looking for. And, I can refer you to some clinics other than us who have been successfully doing this already.

 

Like I said before, you don't have to be too worried this is not a foreign concept and it has been successfully been being done for awhile now at most of the top clinics by top doctors.

[Bill - Seemiller]

That's a very interesting question and I would like to hear responses from those who administer SMP. That said, I'm a firm believer in that it is better to do what is best for the long term and not the short-term. For instance, I know that people are concerned about the ugly duckling syndrome, the first couple months after surgery. However, we all know this is temporary and long term, results will grow in and provide patients with the results they've hoped for.

 

Personally, I think scalp micropigmentation should be used as a filler at the end rather than before with hair transplanted around and in between the tattooing. To me that just seems backwards. While it may solve a temporary issue, I think the end result would be better if this is flip-flopped.

 

That's just my opinion.

 

Best wishes,

 

Bill

[NicH0le007]

That's a very interesting question and I would like to hear responses from those who administer SMP. That said, I'm a firm believer in that it is better to do what is best for the long term and not the short-term. For instance, I know that people are concerned about the ugly duckling syndrome, the first couple months after surgery. However, we all know this is temporary and long term, results will grow in and provide patients with the results they've hoped for.

 

Personally, I think scalp micropigmentation should be used as a filler at the end rather than before with hair transplanted around and in between the tattooing. To me that just seems backwards. While it may solve a temporary issue, I think the end result would be better if this is flip-flopped.

 

That's just my opinion.

 

Best wishes,

 

Bill

 

Just so there is no confusion, I have been practicing SMP for 7 years. My first years as a permanent technician and now trico for the last 4. We are the only clinic in North America trained and who will soon be practicing in both tricopigmentaiton and permanent SMP techniques. Currently, we are only offering tricopigmentaiton at SMG. But, after completing an intense advanced training partnering with HIS we will begin offering an alternative permanent procedure hopefully by the end of the summer. This procedure will be also be "semi-permanent" but it will last closer to 2-5 years vs. 6 months to 24 months. We will be offering both the tricopigmentation and the HIS technique based on patient needs and qualifications.

 

Piggy backing on what I said above, as far as using smp to get you through the ugly duckling syndrome. I would only recommend using the trico technique to do this. The reason being is that when your body is healing from the surgery it will affect the SMP in the exact same way as if it were healing naturally on it's own after a fresh SMP procedure. The cells will attempt to break down the pigment as if they were causing an infection. Because the pigment particles are so small they can slip through the cell walls and the body will just rid itself of them. Because the pigment is designed to fade via this exact process it will lighten it and make it disappear worse case scenario. Since, with the more permanent versions the pigment has bigger particle sizes designed to withstand these attacks by being to big to escape the cell walls it might cause a discoloration with pre-mature or forced fading (Particularly, if they use the color black) or because it may migrate lower into the dermis or sub-cutaneous tissue with the incision it might not even form an impression it will just migrate and look like a stain on the skin.

 

Bill, SMP is great tool to augment the surgery afterwards so that the practitioners can use very exact specific patterns to maximize what the surgery could or did not do. But, with trico, since everything is changeable because of the fading it provides more freedom with a beginning point in this type of a scenario. Often if they do it before an FUE, by the time the hair really starts to grow at a year (if they haven't done any touch-ups) it allows for that exact game planning that you are speaking of because realistically over 50% will be faded.

 

The other thing I wanted to mention was that Dr. Blake made a good point above by mentioning that you would not want to do anything in a same day procedure because the pigment would in fact also fill in the incisions during the wiping process. Creating very large and odd shaped impressions that resemble blobs. Also, because the transplant incisions are much deeper they more than likely will be discolored immediately or create that migration stain I mentioned above. (Think touching a marker to a white sheet and the ring of pigment bleeding that causes) It should be noted that even if trico pigment is used if placed too deep it is still susceptible to migration and color change and the guarantee on fading then becomes a wild card. It's very important that you have a completed SMP procedure before you start the FUE. If they cut through a healed SMP (trico) impression it will just fade.

[Dr Blake Bloxham]

Newbie,

 

Just put up a presentation that you may find helpful. I actually put it together after you had asked this question because I thought the timing was perfect and you may find it helpful:

 

Hair Transplant AFTER SMP?

 

Hope it's helpful!

[newbie33]

Thank you all. Maybe more possible than I had previously thought. Only really crosses my mind to have it done if I don't get a huge amount of time off after a HT. I'd really like to engineer a good three months off if I could, though that is of course fairly difficult to achieve. Or, if possible, to never have to work again. If anyone has any ideas on this...

[mocachin]

I had SMP, then later grew my hair out and used a bit of toppik.

 

When I don't have a bit of topic, my skalp (around the vertex area) doesn't look anywhere near as thin as it did with hair before SMP.

[Dr Blake Bloxham]

I don't think you'd necessarily need 3 months off after an FUE. Even if you didn't do SMP beforehand. Even in fair skinned guys, the redness has usually subsided pretty well by this point.

 

I'll update you on the patient who I just did a procedure on when he comes in for staple removal. It will probably give you a pretty good idea on how the SMP helps camouflage the redness. I was pretty surprised by how non-red his scalp looked throughout the day. In fact, it threw me off a few times!

[newbie33]

Please do keep us up to date with that guy's progress Blake. And you're right, I don't need to take three months off. I'd just like to do it. Though I reckon three weeks is probably the most I could take unless I changed jobs or took some sort of career break - which actually quite appeals to me.

[Dr Blake Bloxham]

Newbie,

 

Will do!

 

Good point about the want versus need there. We'll hire you if all else fails. I bet an engineer like yourself could place a graft or two quite well!

[newbie33]

You flatter me, Blake. (I'm not actually an engineer - but I work for an engineering/construction company. I myself have no discernible capabilities and therefore form a layer of middle management who, by and large, spend their time plotting to become senior management.)

[Dr Blake Bloxham]

Hey Newbie,

 

Just updated the HT after SMP thread with some new pictures of the patient at day 14. There may definitely be something to your plan there.

 

Take a look: http://www.hairrestorationnetwork.com/eve/183241-%2Avideo-pics%2A-hair-transplant-after-smp-dr-bloxham-feller-bloxham-ny.html#post2470797

[newbie33]

Cheers Blake. He looks quite dark-skinned so would fair better than me in the redness stakes, but for 14 days that really looks very good. Did the guy get temporary SMP or permanent?

 

His hairline reminds me of another of my little theories - a good hairdresser is the best person to draw the hairline. (Reminds me because his SMP is unadvisedly low).

 

The guy who cuts my hair does a wonderful job of making a few wisps seem like a receding hairline (as long as it's viewed directly from the front and not the back, sides or top, on a windless, rainless day in half light). My point - I'm going to rely on this guy every month to make whatever is the best of my hair. And by and large he does a very good job, taking into account my face shape and what is achievable within the realms of physics. I would, in any event, want his counsel about a suitable hairline. And hope that some sort of agreement with what I, the doctor and my hairdresser thinks natural is possible.

 

I also conclude I have far too much time on my hands.