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

At our most recent open house event, we had three of our Scalp MicroPigmentation (SMP) patients show up along with numerous other people exploring the hair transplant option. As the guests interacted with each other, I overheard a conversation between one of our SMP patients (Alex) and another man at the event (let’s call him Bruce).

Bruce had sarcastically asked Alex if he came to the event just to make balding people like him feel bad about themselves, and the two began a seemingly heated debate about hair loss. Alex told Bruce that he was actually very bald and that he had SMP done. Bruce did not believe him, so as the conversation frustrated Alex, he was invited to feel the front and top of Alex’s head, which was very smooth. Alex then told him to feel the hair stubble on the back of his head, which looked just like the front and top of his head. That was Bruce’s introduction to SMP, and the two of them laughed loudly enough for others to curiously join the conversation.

Bruce actually signed up for an SMP procedure before he left our open house, as he became a believer. Seeing is believing.

SMP before and after

Tags: smp, scalp micropigmentation, pigment, hairloss, hair loss

Hey docs, I swear I think these are your SMP photos on this other site: [link removed]

If this isn’t your website I’m not sure what you can do, but I just wanted to let you know. I didn’t know if maybe you were going under a different name for different markets or something.

Those are our photos, but that is not our site. We have become aware that many of our photographs on our Scalp MicroPigmentation (SMP) site have been copied by some people, tattooists, doctors, etc.. who want the public to believe that they have extensive experience with SMP. I am personally affronted and taking the proper legal action; however, the great crime is that many people who see our photos on these sites where these representations are made, may be tricked into a procedure with one of these criminal groups.

These groups clearly don’t know what they are doing or they would show their own work. If you are not careful on selecting a proven provider, you could become a victim. As we have always said on this site, “Let the Buyer Beware,” and here you must do your diligence to avoid becoming a victim.

When a doctor from overseas stole one of my books and published it under his name, he could not understand why I was so upset. He felt that this was the greatest form of flattery (i.e. he felt so strongly that my book was the best on the market so he did the natural thing and republished it under his name as if it was an ‘endorsement’).

Tags: scalp micropigmentation, smp, photos, theft, fraud

I’m really interested in the scalp micro pigments / SMP and I’ve reviewed the results of SMP on your sites along with some of your competitors. There’s clear differences in the results, even on your site alone. How do you explain these differences?

How do you deal with scarring from previous surgeries of the transplant variety and can SMP do a good job covering it up for everyone with such scars?

I’m going to reference a couple patients found on our SMP Photo Gallery and explain why the results are so different and so obvious…

Patient 20 is the ideal patient result with a scar from a previous hair transplant. The scar was flat and uniform and was the result of a single surgical procedure with bad healing which caused the scar to stretch. The surgeon who did this patient did nothing wrong. When we did the SMP, we worked on a uniform scar surface, there were no divots or elevated areas on the scar, so the process worked perfectly. Contrary to what you see, the scar is still there and just as big as before, and if you ran you finger over it you would feel what you can not see.

Patient 51 had great results as well with the old drilled holes in his scalp from the old fashioned (now abandoned) surgical procedure called Open Donor Technique. He also had a strip surgery which accounted for the horizontal scar. The skin on the Open Donor Wounds turned out to be relatively flat, so the pigment was taken up well and uniformly, providing great results; however, the horizontal scar from the strip procedure was elevated and even though the skin took the pigment very well, the elevated scar could be soon.

These patients shaved their head for the procedure. They may have intended to grow out their hair and if they did, Patient 51 would have no obvious scar seen; however, Patient 20 would have to be careful, because the invisible scar would not grow any hair while the scalp above and below the scar would grow hair. This would be seen in the transition of early growth of the hair above and below the scar. When the hair is long enough, it will not be a problem because his hair stylist will account for the absence of hair from the scar.

We don’t always shave the head. As a matter of fact, we don’t shave the entire scalp in the area we work much of the time. That becomes a choice of the patient.

Finally, SMP is not real hair. SMP is applied under the skin, like a tattoo. It cannot possibly remove, erase, or make scars completely invisible. We do our best to blend in the scar and make it look less obvious, but the scar will always be there and will be noticed in certain lighting and at certain viewing angles. The goal is for the casual observer to not notice the scar.

Tags: scarring, scar, hair transplant, hairloss, hair loss, smp, scalp micro pigment, pigmentation

I think I’m what one would call a Norwood 7 balding pattern. There is no hair almost throughout my head and its been years since I had a hairline. I am concerned that if I have scalp micro pigmentation, that everyone I know will be able to tell that I had something done. My temple points are also not there, as the hair that is left does not go past my ears.

What has been your experience with SMP for this type of most extreme balding?

We have done Scalp MicroPigmentation (SMP) on many people like you. The detectability of it depends upon many factors, especially your hair color. If it is jet black, then the SMP will make an appreciable difference in your look; however, what I have found in doing hair transplants and SMP procedures over the years is that unless what you see looks abnormal, many people will not detect that you had anything done. The key to undetectability is a normal, natural look, especially in the hairline.

What I’ve seen on various SMP websites where the operators only know one style of look, the hairline appears abnormal, with harshly straight edges, like it was shaved with a straight razor. That type of look is not normal and if you don’t believe me, look at some of the people who walk around you at shopping centers and try to find the shaved frontal leading edge of the hairline on anyone with normal hair. The hairline must be designed with an irregular frontal leading edge, and that type of skill is something we developed after performing thousands of hair transplant procedures.

I have always been amazed how poorly hairlines are designed, even amongst the hair transplant community; nevertheless, our experience in creating hairlines makes our skills far beyond what a tattooist has in performing SMP on a man like you. To see what I am talking about, look at the following hair transplant in a Norwood class 7 patient, and note that this is a completely transplanted hairline done in the baldest of men. Proper SMP should be just the closely cropped look of that hairline.

Tags: hairloss, hair loss, smp, scalp micropigmentation, temples

I have noticed that there are a lot of clinics now offering SMP and each day there seem to be more. I am looking into having it done. In reflection I like the competition but I don’t like it because it gets confusing. Can you help me here? What’s the difference between what you offer and what a tattoo shop can do?

There appear to be many clinics that are offering Scalp Micropigmentation (SMP), but the word “clinics” may be confusing. These clinics may not have any medical affiliation and many of them are tattoo parlors with a more “upper crust” office decor. First of all, tattooists can not administer anesthesia, as only an medical doctor (MD) is allowed to use anesthesia, so you would have to endure pain when SMP is done by a tattooist. When you see us,you get examined by an MD, interviewed by an MD, and evaluated by an MD. When the SMP process is done, the doctor is integrally involved in every part of the process, from giving the anesthesia to actually performing parts of the procedure.

These MDs are assisted by medical technicians who fully understand sterile techniques. We are careful about the pigments we use, for example, and although we purchase them in sterile bottles, we re-sterilize them to assure that there are no living bacteria in the bottles. When this is combined with sterile management, you are assured that your risk of infection is minimized. On the other hand, not uncommon risks and complications in the hands of those tattooists who were not trained in sterile techniques and may be sloppy in the delivery of SMP, include:

  1. infection, where reported outbreaks of non-tuberculous mycobacterial infections associated with contaminated tattoo inks have raised questions about the adequacy of packaging, sterilization, the use of dirty or reused needles, and faulty techniques at the tattoo-parlor level
  2. mycobacterium chelonae infection
  3. allergies to the component in the pigments producing scarring, granulomas from foreign body reactions
  4. MRI complications, such as swelling and pain from the metals in the pigments when exposed to the powerful MRI magnets

It has been reported that unsterile tattooing equipment and needles can transmit infectious diseases, such as HIV, hepatitis, and skin infections caused by staphylococcus aureus (“staph”) and other bacteria. This discussion alone should call attention to the need to have the process done by experienced MDs in this field.

For us in particular, we have taught this process at medical meetings to many doctor. At one of these meetings, we have given a course on the do’s and don’ts of the process. Although being a doctor delivering the service protects you from the infections discussed above, there is really no way a doctor can learn this process other than to get trained by another knowledgeable doctor. We have trained doctors in our office along with their technical staff. We have also published articles in medical journals on the subject. To say the least, we have the credentials to do it. Now we have five doctors involved in the process — three in Korea and two in Los Angeles.

Tags: smp, scalp micropigmentation, tattoo, hairloss, hair loss

There are many providers of SMP on the web that discuss how many procedures it takes and how long the procedures will be to get a good result. Since the answer seems to be all over the map, can you tell me your answer and please justify it as well?

Just trying to get an idea of what I’m possibly in store for. Thanks

There are two classes of SMP: (1) for a donor area scar or set of scars, and (2) for the entire head. Obviously, the entire head will take longer for each session (6-8 hours) than just the scar area, which might take up to 3-4 hours. The number of sessions also vary, from 2-4 sessions depending upon the many variables that each patient presents with. The first session is usually done lighter in color and is more delicate than sessions 2-3. We go lighter on the first session because we do not want to induce pigment bleeding in the surrounding area. Some person’s skin takes up the pigment easier than others, so the touch we develop is based upon the take up of the pigment. After the first session, we get the ‘feel’ and for further sessions we adjust the technique to match what we learned on the first session. Some people absorb the ink quickly, so the pigment can fade after session #1, so we have to again, adjust what we do on subsequent sessions.

You must remember that the tattoo pigments we use are foreign bodies which precipitate a reaction in each person who has it done such that the person’s immune system attacks the pigment. This attack can cause the pigment that you see to fade. Also, areas of scar tissue will react differently to the pigment than non-scarred areas. This can be ‘felt’ by the person doing the SMP, so adjustments for scarring is something that each person learns as they do the SMP. The area of the scar is significantly smaller than the area of the rest of the head, so the costs for the process more than doubles for en entire head.

We generally invest between 20-25 hours for an entire head SMP and about 12-15 hours for a scarred area. The scarring is approached with pigment placed not only in the scar itself, but also in the surrounding normal scalp, because there must be blending of the colors so that the pigment can not be seen distinctly from the surrounding area. This process is not perfect, because the scars are still there. Be sure that you don’t expect the scar to completely disappear, because it never will. SMP only camouflages the scar.

Check out Scalp Scars with SMP and you will see a huge variation in the results of the SMP based mostly on the degree of scarring and the skin deformities that go with that scarring. We are starting to use permanent fillers to try to correct some of the skin deformities that show up after a complete SMP patient is finished; however, we are not able to fully camouflage every scar, as shown on the referenced link.

Tags: smp, scalp micropigment, micropigmentation, scarring, hairloss, hair loss, repair

I have seen a number of clinics that claim that they invented the term Scalp Micropigmentation. Who is the true inventor of the name.

Alvaro Traquina, M.D. used the term “micropigmentation of the scalp” in an article published in the Dermatologic Surgery medical publication back in 2001 (see Micropigmentation as an Adjuvant in Cosmetic Surgery of the Scalp). His title, text, and pictures clearly define the use of the pigment as a concealer.

We started using the term Scalp MicroPigmentation in 2010 and started referring to it as “SMP” and purchased the Internet domain names since the terminology was not being used. Since then the term “SMP” and “Scalp MicroPigmentation” caught on all over the world. We did apply for the SMP trademark and the (R) symbol with the U.S. Patent office but were denied trademarking a common terminology abbreviation. Thus no one can claim TM or (R) symbols.

For those who claim that they invented the SMP term or place the TM or (R) symbol, you know that they have poor moral character.

Tags: scalp micropigmentation, smp

My eyebrows are very thin and light, but my hair is black so I feel that I would like to darken by eyebrows. Would SMP be able to do this?

Scalp MicroPigmentation (SMP) may work well to fill out the eyebrows, provided that there is enough hair in the eyebrows and the hair on your eyebrows is dark. If you darken the skin underneath the eyebrow with SMP and the eyebrow hair is lighter in color than the pigment used below, it will be problematic as the dots will show through it (I am assuming that you want a fuller, darker eyebrow).

You can dye the eyebrow a darker color and see if it is full enough. If there is not enough hair in the eyebrow, an eyebrow transplant is the best solution, not a tattoo. Most of the eyebrow transplants I have done usually put in enough hair to fill it up. We often fix defects in the eyebrow or complete the entire eyebrow if there are missing parts.

See these links below to find out just how important eyebrows are to one’s overall appearance:

Tags: eyebrows, smp, scalp micropigmentation, hairloss, hair loss, eyebrow transplant

After listening to what each individual has to say, my general approach to surgery or any treatment (including Scalp MicroPigmentation / SMP) is to ask myself, “What would I do if it was me?” or “What would I do for my brother or best friend?” It may not always equate to a good business plan or making money.

When I see patients who are considering SMP, I know from experience they are usually people who don’t trust doctors or believe in a “miracle” fix. Most of them have seen it, done it, and spent countless nights and days researching info on the Internet. Most of them have been obsessing over their hair/scar situation for many years and have been living under a hat or hair piece that consumes part of their lives. They probably have a backup hat in their car, at work, and at home. Some have never let their significant other see them without a hair piece. Most of them probably know about this industry and the major players (competition), and have probably even spoken with or have seen other doctors and clinics, spending a small fortune in the process without satisfaction. They look at everything with skepticism. If you see the horror I haven seen committed on people’s heads, I don’t blame them!

I also see a good number of young Norwood class 6 men who thought a hair transplant was the “cure” and wound up discovering that you don’t get a full head of hair. The results may be great, as they now have a good frontal hairline and the work looks natural, but it’s just not what they signed up for. They thought a hair transplant was a solution to give them all their hair back. Doctors may not have explained it to them or they never understood that a hair transplant is basically rearranging what you already have. If you lost most of your hair, you have to work with the remaining hairs and consider a new way of styling (not a short buzz cut). And no matter how much money you spend or how many surgeries you have, you still have a thinning look you must work with (keep it longer or style it a certain way). When you cut your hair short or want a young look, you still end up with a relatively bald spot on the top.
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This patient had one Scalp MicroPigmentation (SMP) treatment on his hair transplant scar. The AFTER video was taken immediately after SMP, so you can see some redness on the scalp, which will go away in a day or two.


In general, SMP to a scalp scar takes two to three sessions. The patient above will come back in one week to make sure everything blends in. The redness you see in this patient is due to the fact that it was taken immediately after it was done and there was a little bleeding present. He will be able to shave his head or keep his hair long without worrying about the scar. For more information you can visit or email us at You can include a photo of yourself for a consultation. The most common questions asked about SMP can be found here.

Tags: smp, scalp micropigmentation, scarring, hair transplant, hairloss, hair loss

I found on the Internet reviews of SMP — What is your take on all these sites that offer SMP?

They claim they are “the worlds only unbiased source of guidance and information on the fastest growing hair loss solution in recent history, a solution known as scalp micropigmentation.

Hair Transplant Network is supposed to be an unbiased review of doctors, but the doctors on the site all pay a monthly fee (over a thousand dollars) to be on the site. Yelp is supposed to be an unbiased review of most places, but even they have come into scrutiny when they favor (with positive reviews) those who pay them a monthly service fee.

I think that unless there are hundreds or thousands of independent reviews, a few polarized reviewers are always going to seem suspect. We maintain that you should visit us, as we hold free monthly open house events that provide access to our clients/patients so you can see the quality of what we do for yourself. Seeing is believing!

Tags: smp debate, scalp micropigmentation, hairloss, hair loss

Do you have any cases where SMP was used to treat traction alopecia ? Is it feasible ?

Scalp MicroPigmentation (SMP) may work for treating traction alopecia, though it likely depends on the style you plan on having. It could look just fine if the hair is kept short. Hair transplantation is a good treatment for traction alopecia, providing that the cause of the traction is gone.

Tags: traction alopecia, hairloss, hair loss, pigment, smp, scalp micropigmentation

Hi Doc,
I have been following your blog closely & am really grateful to you for all your help. I had a FUE surgery done 2 years ago but now I wish I hadn’t. Basically I have a big bald spot & after reading the articles should have had strip. Now my problem is I dont like to have my hair long as its thin & doesn’t look good. Wearing them short as I do now exposes the donor & the recipient areas..By short I mean buzz. I dont shave my head.

What do you suggest i should do? Please help as I am losing my self confidence & getting depressed.

When there are large follicular unit extraction (FUE) sessions done on a patient with low density hair, it will show thinning in the donor area and a leave the patient with a more see-through back of the head. We have treated many FUE patients with Scalp MicroPigmentation (SMP) in the donor area to add some contrast to the skin. It also works wonders on the recipient area, making the hair look fuller in both locations.

Take a look at the site SMP site and see the many patients who have been treated with this modality. Particularly, look at this patient below, which shows a before and after treatment for FUE scars. This patient and many more can be found in our SMP gallery.


Tags: fue, follicular unit extraction, smp, scalp micropigmentation, scarring

We received some Scalp MicroPigmentation (SMP) questions:

1) The results pictures on the website all seem to show everyone with shaved heads. Should I expect the ability to cut my hair that short after the procedure and not have the scar visible? or are those atypical, “best case” scenarios? I know there will always be some irregularity but the pictures show it being very difficult to discern. This isn’t a make it/break it question. I’d be happy to cut my hair down to 1/8″ without the scar visible. I just want to make sure my expectations are in line with reality.

2) Must I shave my head for the procedure itself?

3) If I do have my head shaved and I expose the SMP’d scar to the sun, will it fade?

4) Is the SMP permanent? Permanent as in, I do this once (the 3 sessions) and it lasts for 50+ years? Or is there an expected life span for the SMP?

1. The photos on the SMP website show most people shaved, because that is what makes the scar blend in with the stubble of hair and the flat pigment of SMP underneath your skin.

Keep in mind, if you get SMP for a scar, it is not hair and that there will be a “step” in the hair where there is a scar. SMP will only make the scalp darker so you wont notice the white line. If you keep your hair 1/8 inch long you may see the step of where the hair starts and ends. Most patients shave or buzz their hair around the scar with an electric shaver set at zero guard or they keep their hair long enough to cover the invisible scar. Everyone is different in their degree of how they hide the scar, but you must remember that you will always still have a scar. SMP only helps hide it to most casual observers. No matter how good we get your SMP, you will always notice the scar in certain lighting and certain angles… and you will notice it more because you know how to look for it.

2. You don’t have to shave, but if you are ever going to shave later it will help us blend it in better. We work with longer hair all the time (this is not an issue). It is when we finish the job with long hair and later you decide to shave it, you will notice some areas that don’t look perfectly blended in. So if you are ever going to shave it, we recommend you have SMP done with the area shaved, because that is how we get it almost perfect. If you are never going to shave, then it is not an issue.

3. SMP will fade with or without sun. UV light makes it fade a bit more, but it won’t erase. If you ever need a touch-up in the future because you think it has faded too much, the fee is $300.

4. SMP is permanent just like a tattoo is permanent, though you may want a touch-up in the years to come. In our experience over the last 4+ years, most people do not return for touch-ups. When we follow up with our SMP clients, we find that most say it has not faded to a degree to warrant a touch-up.

We’ve answered many more SMP questions on our FAQ.

Tags: scalp micropigmentation, smp, pigment, hairloss, hair loss, scarring