Can I have a Scalp Micropigmentation (SMP) and later a hair transplant surgery? What if I want to grow out my hair as well? I don’t want to always keep my hair shaved.

You ask a great question! We have been combining SMP with hair transplant surgeries using FUE or Strip FUT. After all we are a medical practice that specialize in all aspect of hair restoration!

This patient came to us with a old hair transplant surgery scar. He had a strip FUT surgery which didn’t really give him a full head of hair and he just gave up with the idea of having a full head of hair. But he had the strip scar which he couldn’t hide when he decided to cut his hair short. So he went to local doctor for FUE to the strip scar. As we tell all our patients, FUE to the strip scar doesn’t really give perfect results when you are looking to shave your head. So he ended up with MORE SCAR, many ‘punctate scars’ from the FUE surgery. Needless to say he was angry and was very skeptical when he came to see us. We didn’t blame him. He didn’t trust any doctors at this point. Although Dr. Pak thought he would be a great candidate for the SMP procedure, he actually turned him down because the patient’s expectations seemed unrealistic with a bad attitude.

Eventually, the patient came back for another consultation and even saw other SMP patients in person at our monthly Open House Seminars (where prospective patients can meet with former patients and see an actual SMP or Hair Transplant surgery taking place).

This patient eventually had SMP to the entire scalp and covered his FUE scar and strip scar with great results. In the process he came to know and befriend Dr. Pak to trust his work. So after about a year he came back to Dr. Pak for a FUE procedure (about 1500 graft) to add density to the top and soften (corrective surgery) his front hair line from the old transplant work.

While the FUE transplant didn’t give him the full density, the SMP provided a cosmetic benefit to provide a look of fullness. Now he has the option to shave or grow his hair out long.

Old FUE and FUT Strip Scar addressed with SMP Scalp Micropigmenation

Old FUE and FUT Strip Scar addressed with SMP Scalp Micropigmenation

SMP Scalp Micropigment for a shaved look

SMP Scalp Micropigment for a shaved look

SMP Scalp Micropigment with FUE Hair Transplant for Fullness for Long Hair

SMP Scalp Micropigment with FUE Hair Transplant for Fullness for Long Hair

I recently performed beard and sideburn transplants on this African American man who did not have complete facial hair due to a genetic issue. I have been asked many times about this problem, so I thought I would show photos from the day after surgery. He received a total of 769 grafts (each side got about 380 grafts) to create what you see in these pictures. His natural curly hair made the results look better than if his hair was straight. Black hair on dark skin also helped.

hair transplant side burn

Tags: hair transplant, beard, eyebrow, sideburn

Hi Doctor,

I underwent a FUE treatment 3 months ago, around 2000 grafts. i’m 38 and always had a good skin quality. All went well, but i remarked “yellow shadows” over the recipient area very early. My GP said it was all ok.

At 2 months post op i remarked i lost small 1cm hair, trapped in balls of dry sebum. Also had red pimples with pus for one week and itchy. Went to a dermatologist, he gave me antibiotics and a sebiprox shampoo. I had to stop the use of the shampoo because it made me lose a lot of hair very quickly. I still take antibiotics for 15 days now. No more red pustules, BUT still losing some hair trapped in sebum balls and recipient area still red and itchy.

You cannot see with natural eyes, but if you use a looking glass you can see that almost every pore that is hosting small hair is bathed into a yellow substance. Sebum i guess. I fear this will prevent the hair from growing and make it fall.

What should i do? the surgeon who operated on me said it was a skin problem not a follicle problem and told me to see the dermatologist! I dont know what to do! Thank you for your advice. I see some hair growing from the transplant and i dont want to lose them.

As it is nice to see and not infected can we exclude the terrible folliculis decalvans ?

Best Regards.

Click the photo to enlarge:


I don’t want to just brush your question off, but I don’t and I can’t diagnose medical conditions via the web. I think you should listen to your surgeon and make an appointment to see a dermatologist… or you could see another hair transplant surgeon or even your primary care doctor. This isn’t something I would want to guess about just based on a photo.

Some patients get infections and some have bad skin issues. You may or may not have both. Usually, within a few days, the evidence of a hair transplant in the recipient area is gone. Good washing techniques are critical to that process. At two months, you should be washing your hair, but not with too much pressure. Leave the shampoo on for around 5 minutes before you wash it off.

Tags: hair transplant, infection, hairloss, hair loss, hair restoration


I am 24 years old and over the past year I have seen a huge change in my hair. When my hair is wet and when I wake up in the morning I can see parts of my scalp. I have always had a high hair line and I have noticed on the website a lot of talk surrounding your highest wrinkle and a mature hairline, however, my hairline has always been a good bit above this even during primary school. My highest wrinkle lies at the freckle on my forehead.

What has been worrying me is that when my hair is wet I can see my scalp on both the top and sides of scalp.. My hair has always been medium length, but now that I have cut the sides shorter I can even see my scalp through the side of my hair when it is wet and I style it in certain ways. There is no MPB on either side of my family at all, my father has thinning hair, but he is in his 50’s.

I appreciate any help, my GP will not refer me to a dermatologist as I am male.

I have attached photos of my hair when dry and wet.

Click the photos to enlarge:


First, I have no idea what being male has to do with being referred to a dermatologist. Dermatology is for men and women. Maybe you’re thinking of a gynecologist.

What does this mean?

It’s not unusual to see the scalp when your hair is wet, and it will particularly stand out for those with high contrast between skin and hair color, like yourself. That said, based on the few photos you sent it does appear that you’re thinning at the hairline. The photos aren’t very clear so I can’t really provide much info about whether it is a maturing hairline or something more advanced.

How to do a Hair Check Test

I would like to see you get a HAIRCHECK test which can actually measure the degree of hair loss that you think you have.  From that measurement, treatments can be planned and followed yearly with repeat HAIRCHECK tests to see if you are gaining or losing ground.

You can find a doctor that specializes in hair loss by using the doctor search at the site (they are transplant surgeons, but you shouldn’t rush into surgery — these doctors just know hair loss).

Set up a Virtual Consultation

Get a virtual consultation with Dr. William Rassman and Dr. Jae Pak for hair loss options. You can learn more at

Tags: hairloss, hair loss

Dear Dr. Rassman,

I am a 25 year male. For the last 3-4 years I’ve been experiencing temple hair loss, as exhibited in the attached photos. As far as genetics are concerned, my father at 55 is a thinning NW3 since his mid-thirties (his father a NW7 though, and on granny’s side no hair loss) and my mother is solid NW2(father’s side NW3 – turned NW4 in his 80s, and granny’s brothers NW2s). Judging by these photos, should I be concerned about my hair loss at this moment? Feel free to post my photos.

Click the photos to enlarge:


The temple peaks may have receded (I have no earlier photos to compare to), and your hairline appears to be maturing at the corners. I don’t consider that balding and you probably have no cause for concern, but there’s only so much I can tell from photos. The corners might have gone a little beyond the maturing hairline, but the photos aren’t much help in this case.

If you do have concerns, you can consider measuring the bulk of hair in specific areas of your scalp and comparing it to other parts of your scalp. More importantly, following up one year after the measurement to see if there is a change. Just one bulk measurement in time will not give you much information, so following up is a must. You can also consider a miniaturization assessment to see if the hairs have different morphology (miniaturization) around certain areas on your scalp.

In any case, you don’t appear to be balding to me, but we can let the readers comment.

Tags: hairline, hairloss, hair loss, mature hairline

Hi Doctor,

I have been reading your blog and it is really informative, Awesome job by you. Coming to my concern, I had my HT done back in India in January 23rd 2014 and I see dried pimples like thing from last couple of weeks and they don’t heal. I am attaching two pics of my scalp. Can you please look at them and tell me if any infection has happened or does it look normal. If you examine pic_2 attached, I see some fluid like thing at couple of places near the graft. As, I can’t see the doctor back in India now, I need your help.

Thank You Very Much

Click the photos to enlarge:


It looks like you have crusting from the transplant (this is usually gone on our patients in a few days) and the crusting has caused an infection. You need to see a doctor and get this treated, even if it is not your transplant surgeon. You should wash your hair gently and get the crusts off, for as long as it takes to get a good wash.

Cleanliness is critical following a hair transplant surgery, and what I see is not a clean post-operative wound.

Tags: hair transplant, post-operative, infection

ok, here is my situation. i am a 23 year old male. i am black and mexican and have naturally thin hair like my parents. about two years ago i noticed that the left edge of my hairline looked a little thin while looking in the mirror. i never really noticed it before so i began to obsess over it. i spend every day examining my head not really noticing any change some days. then other days i begin to think i’ve lost a lot of hair. i’m not sure what to look for in terms of a receding hairline. my dad is 48 and my grandfather is 76 and they both have normal looking hairlines for their age as well as my grandmothers on both sides of my family including my mother.

i have been obsessing and stressing non stop over this and its beginning to get depressing. i’m losing sleep over this every night because i cant keep my mind off of it. also the part of the hairline that runs downward on the sides of my head have always been at a slant for as long as i can remember. i’m not sure if that’s even normal or not. i’m not sure if i’m just making things up in my head or if my hairline is really receding.

please help me find some answers, please! here are photos of my head.. feel free to post them

Click the photos to enlarge:


Unfortunately, the pictures do not help me to help you. Even with the short haircut, it appears that you have a normal young man’s hair density, but a good examination for miniaturization (with a hand microscope) will show if there is any early balding.

What you might be noticing is slight hairline maturation, which is completely normal and nothing to stress about. You could do yourself more harm by stressing over possible loss, as stress could cause thinning.

Tags: hairline, mature hairline, stress

Hey Dr,

Thank you for the baldingblog! Here are some photos of concern of my hairline and just want to know if it is mature or thinning? You may publish if, you would like. Thank you!

30 yrs old, Male


The hairline corners do not appear to be too far beyond a mature hairline, but if it bothers you, you can restore the corners with hair transplantation surgery. If it does not bother you, I would wait it out and see how it evolves. Some men will lose hair in the pattern you present, with no further loss. Some will see continued recession or thinning. Not sure which camp you fall into, but if you have your hair bulk analyzed you will be able to get a metric to it… then have it analyzed again in a year to compare the numbers. What is most interesting about your hairline is the location of the ‘center point’ which is touching the highest crease of your furrowed brow. That was where your mid-line hairline was when you were 10 years old, but the sides did move upward to its mature position. As you wait this out, you should see the mid-line location move up as well.

Tags: hairline, hairloss, hair loss

This patient is clearly not balding, or marginally so. He is in his mid 30’s and he did not like the corner ‘recession’. At worst, he may be a Norwood class 2 or 3. He just wanted a cosmetic improvement to lower his hairline the way it always was before it moved upward. His hair was medium coarse so only 800 grafts were needed and the probability will be that this one session might meet his orbjective because of the medium-coarse hair. The risk of shock loss was discussed and was considered minimum. He is not on Propecia (finasteride). He did not experience any shock loss anytime after the procedure.

The following results photos were taken only 5 days after follicular unit extraction (FUE) surgery of 800 grafts. What you see are small scabs with short hair stubble. These scabs and hairs will fall out within a week from the date of surgery and he will look like he never had surgery by that time. The transplanted hairs will start to grow in the coming months.

The reason I wanted to show these photos is to point out how easy it was for the patient and his recovery. You can barely notice anything in his donor or his recipient areas.

Click the photos to enlarge.

After (just 5 days post-surgery):




Tags: fue, hair transplant, results, hairloss, hair loss

Dear Dr. Rassman,

I am a 27 year old male who experienced extensive hair loss following the use of Accutane about 6 years ago. The hair loss stopped after about 18 months, but the original volume never recovered. I’ve been using Rogaine and Propecia for about 5 years. While my hair loss seems to have slowed (it’s been very gradually thinning ever since), the crown remains very thin to the point where it appears as an obvious bald spot, and my hair color (dark brown) exacerbates the problem.

I’ve attached some photos. I had a hair transplant evaluation two years ago by a dermatologist who specializes in hair science- he told me that while I have a thin crown, it wasn’t thin/bald enough to justify a hair transplant because the transplant would likely damage/destroy too many of my remaining crown hairs for there to be marginal gains in density. At the time of the evaluation, I had mistakenly left some hair thickening product in which may have influenced that evaluation.

My question is as follows: at what point in the balding process would most reputable doctors determine that the marginal gains of a hair transplant to the crown justify any damage/loss to whats left of the original hair in that area? Is there a certain metric that’s used (ie hairs per centimeter in the area)? Furthermore, I was just curious about the typical number of grafts required to restore a natural crown, given that the crown is very thin but not completely bald? Thanks!


Generally, men your age will respond to finasteride (Propecia) with regrowth in the crown, but clearly from your email, this was not your case. A good doctor should work with you through the specific logic and goals in your case. Treatment options may include Scalp MicroPigmentation / SMP (as long as you have hair there, this is a good option) or a hair transplant with between 1500-2000 grafts. The higher number is for individuals with fine hair.

Without an examination, it’s difficult for me to tell just how thin your crown is or what appropriate action you could take. There’s no exact metric to determine when the right time to transplant is. Everyone is different. Since it has been 2 years since your last evaluation with a physician, you should consider seeing a doctor again to find out if your options have changed.

Tags: hair loss, hairloss, crown, hair transplant

Hey Doc,

I’m a little confused, and concerned about my hair. I went to a dermatologist last year as my scalp is inflamed and scabby, and was prescribed Ketopine shampoo. I also asked about my hair as I had been concerned about it, and was told I was not suffering from hair loss. However, I’ve recently had a hair cut, and it’s shorter than normal, and decided I’d take some pics, just to see what it was like. I’m a little uncomfortable by what I’ve seen, and I’m now I’m really quite worried as to whether I am suffering from hair loss, or whether the fact my hair was damp at the time of taking the (worse) pictures have contributed to my hair looking the way it does.

These pics were right after my hair cut, with damp hair. Different pics with flash, and others without: Photo. These are from before my hair cut, using the webcam on my computer to take the pics: Photo.

Finally, these two pics are from today, whilst my hair is dry. I have product in – I tend to always wear product to control my hair. This is just after getting up this morning, so I’ve not wash my hair or anything. Photo 1, Photo 2

As you can see, I’m a little confused as to whether it’s an illusion that my hair appears to be thinner, or if there genuinely is something going on. And I’m more confused by my dermatologist saying it was ‘fine’.

I appreciate that this is long and that there are many pics, but I don’t mind if you post anything. I’d just like to know if I’m worrying about nothing, or have a genuine reason to be concerned.


I’ve only posted a couple of the photos here, though I kept all the links to additional pictures in your above letter for those that are curious.


I don’t know that you have anything to be worried about, nor do I know anything about your hair loss history (or even your age)… but if you were confused by what your dermatologist told you, you probably should’ve asked him/her for clarification.

Wet hair and harsh lighting could make your hair appear thinner, but by what I can see in the photos you sent, I am not seeing any loss even with the lighting and damp hair. That said, I have written about the hair bulk analysis we provide by using an instrument called HairCheck. When tested with this instrument, your donor area is compared to other parts of your scalp so that you will know with reasonable certainty if you are suffering from the balding process, even before you can see it.

Tags: hairloss, hair loss, hair bulk

Hi Dr. Rassman.

First of all thank you for taking the time to post here, it has been an invaluable source of information for me regarding hairloss, and is much appreciated.

Secondly, could you please take a look at my included photographs (you may publish these if you wish) and give me an approximation of my hairloss?

My hairline has definitely changed since I was a juvenile as I had a freckle on my original hairline which has moved higher since my childhood. In some photographs the hairline looks ok, but in others when I pull back the hair you can see some corner/temple recession.

I was just wondering if I was still in the bounds of Norwood 2/mature hairline category or if my hair exceeds this? The density is pretty good on top.

I am 32 years of age. Thanks

Click the photos to enlarge:


People sure are sending in some blurry, poor quality photos lately. Regardless, thanks for letting me publish these.

You have early changes consistent with a mature hairline, or a Norwood class 2. If you are concerned, see a doctor who will be able to examine you in person, map your scalp for miniaturization, and provide hair bulk analysis to give you a better sense of your hair loss (or lack thereof).

At 32 years old with a strong hairline and good density on top, you probably don’t have much to be concerned about, though.

Tags: hairline, mature hairline, photos

Really quick question. Can I go to work after a hair transplant in less than a week without it being swollen and scabby? Thanks!

Not everyone will heal the same, but this is an example of a patient from last week who had 3,169 grafts just 3 days from the day these pictures were taken. Please note that this was a large procedure and he had no post-operative scabbing or swelling. The secret to this type of post-operative look is the washing we do during the procedure and the daily washing we do after the procedure.

Click the photos to enlarge:

Just 3 days after hair transplant of 3169 grafts:




Tags: hair transplant, hairloss, hair loss, hair restoration

Dear Dr. Rassman
I’m a 54 years old male. I had a hair transplant operation on 30 June 2013 by FUT method followed by FIT method on 1st July to complete the transplantation. From the second day after operation I noticed that a big area in recipient part between crown and front of my head, the skin is so irritated (fig.1) and after 1 week it became completely black and was necrosed (fig.2).

Photos: Figure 1, Figure 2

I rang to my surgeon to consult on this issue. He said at your age this problem sometimes happens and I should wait until the skin being repaired and to speed up this procedure I should put warm towel on the necrosis area as well as making it oily by Vaseline to avoid dryness. I really don’t believe in the opinion of my doctor to relate this problem to my age, so I would highly appreciate if you let me know your opinion regarding the reason of this problem, is there any special treatment for such necrosis?

As the recovery procedure of the skin is so slow as shown in figs 3 and 4, I’m not sure that the transplanted follicles are not damaged. I thank you so much if receiving your valuable comments.

Photos: Figure 3, Figure 4

Sincerely yours

I am not clear on your history as you note a FUT (as in strip surgery) and FIT (as in Follicular Isolation Technique). There are some doctors who combined FUT and FUE (called FIT by one particular surgeon).

In my 23 years in this industry, we have performed hair restoration surgery in over 15,000 patients (with as many as 8 doctors working for the New Hair Institute at one time), so my experience is in the thousands of patients we have treated at NHI. Although I have never personally seen this complication in any patient that I have treated, I have been aware of this complication in patients who have either consulted with me or I have heard about it through other doctors’ reports at medical meetings. This problem was more common in the 1993-1996 time frame, as doctors were increasing the number of grafts they were performing and not reducing the size of the punch or slit equipment. These doctors devascularized the scalp because their wound areas were too large. Based upon this, I have assumed that the blood supply was negatively impacted for this problem.

The central area of the scalp (where your problem is demonstrated) was the place where this complication has been seen. The least vascular area of the head is probably at that exact location. As you may know, balding produces an atrophic skin that is thin and not vascular with little infrastructure (fat) under the skin (where a normal scalp would be rich in blood supply, with many nerves per follicle, many hair follicles, considerable amounts of fat, etc..). The reason that the skin becomes atrophic in balding men is because the bald scalp does not need a rich blood supply, so the body withdraws the blood vessels in response to lack of demand. When a hair transplant is done, the demand of the new hair increases the blood supply and eventually the scalp is no longer atrophic and becomes rich in blood supply again.

I am certain that age is not an issue. My oldest patients have been in their 80’s and we routinely operate on men in their 60s and 70s. I have done surgery on diabetics and in these people, I have not seen vascular problems either, but I often do not ‘dense pack’ these diabetic people for fear of such a complication. I personally had a hair transplant last year (at the age of 70) with no issue. I had an atrophic scalp resulting from 3 scalp reductions done in 1991-1992 that left my skin very, very thin and atrophic, yet I suffered no vascular effects from the transplant into my atrophic skin.

Read more

This is a follow-up of a patient we posted about a couple years ago. He recently came in for a visit and we took some updated photos of his crown now that more time has passed since his hair transplant.

He had a 3.5″ by 3.5″ very thin area in the crown, which was transplanted over 3 years ago with 1870 grafts. I measured his hair bulk as well and it showed that the transplanted area reflected 50% of the donor hair bulk. The results speak for themselves and I personally identified with him, as that was my status before my ~2400 grafts in my crown.

Click the photos below to enlarge.

After (1 procedure of 1870 grafts) on left // Before on right:


Tags: hair transplant, hair restoration, surgery, hairloss, hair loss, crown