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SMP versus HT

  • Post published:October 14, 2022

Scalp Micropigmentation or Hair Transplant?

No one wants to lose their hair. It can be both physically and emotionally traumatic for most people. Thankfully there are a few more quality and realistic solutions for battling baldness these days than ever before. Perhaps the two most popular and effective hair loss treatments currently are Scalp Micropigmentation and hair transplant surgery. In this article we will discuss the pros and cons of both procedures and hopefully help you decided if either is a good fit.

Hair Transplant Surgery

Often referred to as “plugs,” hair transplants have actually come a long way since the days of the dreaded doll-head hair-do. Whereas patients once had to endure a pluggy, unnatural appearance as a result of using large circular punches to extract hair grafts, the introduction of new surgical techniques and tools has made the modern hair transplant nearly undetectable. 

There are two surgical procedures currently being used: FUT (Follicular Unit Transplant) and FUE (Follicular Unit Extraction). The former has been around longer and is still the more popular method with most surgeons because it allows for better yield/graft survival rates and is easier and less time consuming for the surgeon and staff. This procedure involves removing a horizontal strip from the safe donor zone of your scalp and then dividing the hair grafts into naturally occurring follicular units (singles, doubles, and threes and fours). This is done commonly by surgical technicians under high-powered microscopes. In the meantime the surgeon makes incisions in the recipient area for the refined units to be placed in. Thousands of hairs will be transplanted often recreating a hairline and providing density to thinned areas. The strip that was removed will concurrently be closed up using sutures or staples. 

The latter method involves a surgical tool that is a punch much like the one used for old school plugs, except the new tools have much smaller openings allowing the doctor to extract much more refined grafts. The scarring in the donor zone results in tiny white dots that if done properly should be mostly undetectable to the naked eye even when the hair hair is shaved or cropped very short. These grafts are then transplanted the same way they are for the FUT method.

The Pros and Cons of a Hair Transplant

As already mentioned, the modern hair transplant can look nearly as natural as your original, native hairline—if done properly! Consumers should do their due diligence and find a qualified, top surgeon. We highly recommend seeing surgeons that perform hair transplants exclusively and that are members of The International Society of Hair Restoration Surgery (ISHRS). Unfortunately there are many doctors performing this procedure that are either not using modern surgical techniques and tools or are using the proper methods incorrectly (usually because they are cutting corners). But as long as you go with a top surgeon, the results should look amazing and you’ll have real hair growing that is permanent. You will be able to cut and style this hair just as you would your native hair and very few people will be able to tell you’ve had this procedure done.

While the biggest pitfall with surgery is having it done improperly by an inexperienced, incompetent or immoral surgeon, there are other drawbacks to think about. Firstly, the permanent, irreversible scarring should always be considered. While FUT strip scars can be undetectable, they will visible if you shave your sides/back very close—even thin scars. And there are no guarantees your strip scar will be pencil thin. Some people have a naturally elastic skin type and their scars can be prone to stretching. Also, if you have more than one surgery, there is a good chance the scar will widen, and these can be tough to conceal even with long hair. FUE scars are barely visible when the hair is kept short, but when shaved close they can be detectable. Also, if more than one surgery is required and too many grafts are extracted, the donor can  become over harvested causing the sides and back to have a patchy, moth-eaten appearance. We’ve also seen surgeons who will extract the units in tight clusters rather than spread them throughout the donor zone. This may result in defined shapes of hair missing from the back or side of your head. 

Remember, your donor hair is a limited supply, so you only have so much available to move from the back and sides to the front, top and crown zones. You will never have enough to recreate the same density you once had. The goal is to move just enough and strategically place and layer those hairs that they create the illusion of density. That’s why it’s important that if you choose the surgical route you consider taking a DHT blocker such as Finasteride to prevent the loss of existing native hair.  This will ensure you won’t lose more of your existing hair and need another surgery right away. There are potential side effects to taking these drugs so we recommend doing plenty of research and speaking with your doctor first. 

Once the hair transplant surgery is done, the client will need to wait a year to see the final result. There are periods during the shedding and regrowth phase that can be physically awkward (referred to as the ugly duckling phase), and it is common for patients to experience remorse or regret. Potential patients should also consider that the cost involved with surgery will likely be in the tens of thousands, especially if more than one procedure is required. Some clients travel abroad to countries like Turkey for bargain-rates, but once again you need to make sure the clinic you’re going to is legitimate. You also should consider that if something does go wrong you will be far from home And how’s the pain level? Other than pre-op local anesthesia injections there should not be much pain involved with hair transplant surgery. 

Scalp Micropigmentaion (SMP, Tricopigmentation, Hair Tattoo)

Much like hair transplant surgery, Scalp Micropigmentation has come a long way since its inception and looks much more natural these days thanks to advancements in techniques, tools and pigments. This procedure is performed much like permanent make-up (PMU) where a technician uses a needle and device to inject micro pigments into the upper dermis of the scalp. The resulting impressions should mimic the appearance of shaved hair stubble and will restore your hair line as well as provide density from the front zone to your crown (eliminating the horseshoe pattern). 

While there has been debate about the permanence of this procedure, it’s our opinion that all SMP should be temporary. This means that if done properly the pigments should fade and disappear from the dermis over time. The timeline on this will vary from person to person and is dependent on several factors including pigments and needles used, etc. If clients wish to keep their hair long SMP may be used to give the illusion of denser, fuller hair with a Thickening Effect.

The Pros and Cons of SMP

Scalp Micropigmentation is best suited for men and women who shave their heads (with either a number one or zero guard), and the biggest bang for your buck comes down to the hairline. Restoring a hairline can drastically change a person’s appearance, instantly making them look years younger. Simply framing the face also makes facial features “pop” more and gives an overall more defined look. 

Unlike with hair transplants, SMP clients are not limited by available grafts/hairs, so you can go as low or high as you see fit with hair line placement. (You also may choose any hairline shape you want or have always wanted.) Commonly referred to as the “black hole” by hair transplant professionals because it requires a large number of hairs, filling the crown is also not an issue with SMP.

The effects of SMP are instant. After the very first session clients will see their new hairline, however proper density and realism will not be fully realized until all three sessions are completed. There is virtually no downtime associated with this procedure either aside from some post-procedure redness that typically goes away after 1-3 days. Clients should be mindful of excessive sweating, getting direct sunlight and swimming in chlorine for at least one week while the SMP heals. (Every clinic will have their own aftercare instructions.) 

Costwise, SMP will be a fraction of what you would pay for a hair transplant. A three-session package will vary in price but expect to pay anywhere from $1500-$5000 depending on your technician’s level of experience and your Norwood level of hair loss. Also you will need to pay for touchups through out the years if you decided to maintain the look. The good news is this typically will be a fraction of the price and take much less time/sessions.

While SMP seems a wonderful option, we realize a shaved head look is not for everyone. We recommend just shaving your hair first before committing to SMP to ensure you like the appearance and are ok with performing routine shaving.