Which Comes First in a Master Plan — SMP or Hair Transplant?

Dr. Rassman / Dr. Pak,
If, after consulting with you and establishing a masterplan, a patient were to undergo SMP with the intention of having a hair transplant in the near future, are there aspects of the procedure that require particular consideration?

For example:-
(a) Would the SMP hairline have to be positioned slightly further back than the original hairline to allow for the creation of a transition zone during an HT?
(b) Are the SMP dots used as a template for an HT?
(c) Would the integrity and visual effect of SMP ink be damaged or compromised by HT-surgery incisions?
(d) Do you advocate using a darker pigment to provide better camouflage to the scalp, or do you always match the ink to the patient’s existing hair colour, even if it’s greying/white?

Or is it advisable to have SMP after a hair transplant? Thank you.

Merry Christmas & Happy New Year!

Each and every patient is different and there is no rule. You can have Scalp MicroPigmentation (SMP) first and a hair transplant later. Or you can have the transplant first and SMP later. I have had patients who had SMP on a completely bald scalp and later had a small FUE surgery to add texture to the hairline.

The hairline for SMP and a hair transplant is placed in the same proportionate height according to what the patient and doctor agrees on. If a patient ever considers having a full HT later on in life they should let the doctor know of this possibility so the SMP hairline can be placed slightly back to make room for some transition zone… but in my experience (in practice) this rarely happens, because most bald patients who are undergoing SMP will never consider a full HT since it will never give them complete full hair coverage. Most bald SMP patients would rather have a good hairline and later consider an FUE option for added texture (not fullness).

I do not advocate darker ink for better camouflage. I advocate a specific shade of ink that matches the complexion of skin and hair combination. If the patient’s hair turns grey later on in life, the SMP shade will make the roots look dark. If you apply SMP all over the scalp it would not matter if the hair turns grey, because there is a base SMP color. Many patients with grey hair have SMP and it actually makes their hair look less grey and they look a little younger. If there is ever a drastic mismatch where your hair turns completely white (not grey) like Santa Claus, then I suppose one must consider dying their hair. Completely white hair will not work with SMP unless you shave the white hair.