Scalp micropigmentation (SMP) is a cosmetic treatment that can help create the appearance of hair in people with baldness or thinning hair.

SMP uses a fine needle and ink to apply a tattoo of tiny dots to the scalp. This creates the appearance of short-cut hair.

SMP can provide a “buzz cut” or stubble effect on a bald head, or give the appearance of a denser head of hair beneath thinning hair.

This article looks at how SMP works, whom SMP may suit, potential risks, and what to look for in a practitioner.

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SMP works by tattooing a pattern of dots onto the scalp to create the appearance of hair. The tattoo patterns resemble closely cut hair follicles.

The stippled effect of the tattoo can give the appearance of a full head of shaved or closely cut hair in a person with no hair. Or, it can provide depth behind thinning hair to create the appearance of a more dense head of hair.

SMP is different from a tattoo. SMP uses a fine needle, which injects pigment into the dermis layer of the skin. It does not inject as deep as a traditional tattoo.

People who want to change the appearance of balding or thinning hair may choose to have SMP. SMP may be suitable for people who have:

  • genetic balding
  • alopecia
  • a scar or birthmark on the scalp they want to cover
  • male or female pattern hair loss
  • hair loss from cancer treatments

SMP may be an alternative option for people who do not want hair transplantation or who have not achieved the results they wanted through hair transplantation.

A trained practitioner will perform SMP. Before starting the procedure, they will apply a local anesthetic or topical numbing cream to the scalp to reduce pain.

Some people may not experience any pain, but it may depend on each person’s pain threshold.

Before their first SMP treatment, most people will have had a consultation to discuss the process and the results they can expect. A practitioner will also provide instructions on how to prepare the scalp before treatment.

To begin SMP, a practitioner will apply a numbing cream to the scalp. They will then inject a fine needle into the scalp to apply pigment to the dermis layer of the skin. They will create a stippled pattern of dots over the area of the scalp requiring treatment.

According to SMP practitioners, people will need a series of treatments, which may occur over the course of a few weeks. Depending on the type of hair loss people have, an SMP session may last 2–4 hours.

People will need to follow any aftercare instructions from a practitioner to protect the scalp and aid healing.

According to SMP practitioners, the procedure may range from around $2,000–$4,000. Costs may depend on the location of the clinic, the area of the scalp that requires treatment, and the experience level of the practitioner.

In some cases, practitioners with more experience, a good reputation, and who consistently deliver good quality results may be more expensive than practitioners with less experience.

A 2021 study looked at the effects of SMP in 22 people. Participants were having SMP to address:

Every participant had three weekly sessions of SMP, followed by a fourth touch-up session a month later.

In the follow-up period of 7–32 months following SMP, fading of the tattoo was minimal. If SMP fades over time, people may require a touch-up session.

SMP falls into the category of permanent cosmetics, so people widely consider it a semi-permanent to permanent procedure.

In the same 2021 study mentioned above, people receiving SMP found the procedure did not result in any serious adverse events or complications. One participant had an allergic reaction to SMP.

In a follow-up questionnaire, 80% of participants reported they were very satisfied with the outcome, and 100% of participants would recommend the procedure to people facing similar issues.

SMP may come with risks. The Food and Drug Administration (FDA) lists the following as potential risks of tattoos and permanent makeup:

  • Infection: Unsterile equipment or contaminated inks can transmit infections, including HIV, hepatitis, and bacterial skin infections.
  • Allergic reactions: Although rare, some people may have an allergic reaction to the pigments in the ink.
  • Keloid formation: If people are prone to keloid scars, they may not be suitable for SMP. Keloid scars are thick, raised scars that some people may develop after injury or trauma to the skin.
  • Granulomas: Granulomas are areas of inflammation that can form around a foreign substance, such as tattoo pigment.
  • MRI interference: Although rare, there have been some reports of tattoos or permanent makeup causing swelling or burning when people have had an MRI scan. Although the risk may be low, people can inform a radiologist beforehand.

To remove SMP, people may require laser removal. It may require multiple sessions and can cause side effects.

Since there are no official regulations for SMP, it is important to find a trained practitioner to carry out SMP safely and effectively, and to minimize certain risks, such as infection.

It is important that people do not seek SMP treatments at a tattoo studio. They should consult a healthcare professional or trained SMP specialist. SMP uses specialized pigments specifically for the procedure.

People will need to do research to find a suitable practitioner. Looking at a practitioner’s website, testimonials, and social media for examples of their work may help.

A good practitioner will specialize in SMP and be able to clearly explain the technique to a client before booking a procedure, as well as show proof of their training and experience.

People can look for practitioners who offer a free consultation to discuss the treatment and desired results.

The Society of Permanent Cosmetic Professionals also advises people to do the following:

  • Visit the clinic or site where the procedure will take place and check for cleanliness and signs of a sterile environment.
  • Check that a practitioner uses new, sterile needles and ink for each client, and carries out proper hygiene practices, such as glove-wearing and frequent handwashing.
  • Ask a practitioner how long they have been performing SMP, about their training and certificates of education, and whether they are part of a licensed board.
  • Look for continuing education and someone with over a year of experience.
  • Ask to see a portfolio of their work and assess whether the results are similar to what’s desired.
  • Make sure to feel comfortable with a practitioner and happy with their work environment.

SMP is a form of permanent cosmetic treatment. It applies a series of dots to the head with a needle and ink to create the appearance of hair.

SMP may be suitable for people looking to alter the appearance of alopecia, male or female pattern hair loss, or hair loss from cancer treatments. SMP can also cover scalp scars, such as those from a hair transplant.

SMP can come with risks, such as infections from unsterile equipment. SMP may not be suitable for people prone to keloid scars.

Due to a lack of regulation on SMP, people will need to do their own thorough research into finding a trained SMP practitioner who can do the procedure safely and effectively.