Author Bio: Dr. Sanusi Umar MD is the author of this article.
Last Updated on July 15, 2021 by Dr Sanusi Umar MD
The Top Reasons Why People Regret Their SMP Results
When faced with hair loss, many men are anxious to fix their problems quickly and even as cheaply as possible.
Yet, rushing into the process and failing to do your research to find a real expert can lead to regret due to the following reasons:
1. Inexperienced Technicians The person applying scalp pigment must be able to adjust their techniques based on individual variables such as ethnicity, gender, and shape (of the hair cross-section)
2. Poor Coloration Outcomes As noted, pigment needs to be properly prepared for each person in terms of their natural hair color. It also needs to be injected at the correct depth to avoid the Tyndall light effect (i.e. bending of light rays within the scalp) which results in a green or blue appearance.
3. Wrong Needle Sizes Using the wrong needle applicator size will produce hair cross-section results that appear too big or too small.
Final outcomes will not look realistic Before deciding on a scalp pigmentation provider, it will be well worth the effort to learn about the factors that contribute to the most natural-looking results possible. Although the concept behind SMP may seem simple and straightforward, a one-size-fits-all approach, coupled with the wrong expertise can lead to an outcome that will need to be fixed .
What is Trichopigmentation?
Trichopigmentation is a type of scalp pigmentation and one of the three main categories of micropigmentation. The other two main categories are Esthetical micro pigmentation (used as permanent makeup) and paramedical micropigmentation (used to camouflage scars, reconstruct areola, and darken areas drained of color by vitiligo).
Trichopigmentation involves injecting tiny points of brown or black coloration into the skin to simulate the appearance of soft, growing stubble. This process requires the use of specialized equipment and specific mixing of an organic pigment formula. It is intended to avoid the unwanted issue that arises with regular scalp micropigmentation. These are:
- blueish and greenish discoloration
- difficulties in removing unwanted results
- unnatural looking stubble that looks painted onto the skin
The Tyndall Effect and the Skin
Many patients who opt to receive scalp micropigmentation feel disappointed and underwhelmed with the results of their procedure. This is because the above described blue or greenish appearance called the Tyndall Effect occurs over time. This occurs for several reasons. But, before we can talk about why this happens, we need to discuss the basics of skin.
Tattoo pigment appearance is largely dependent on how deeply it is injected into the skin. To fully grasp how this works with scalp micropigmentation, we have to discuss the different layers of skin.
The outermost layer of skin. It is .5mm thick, and the cells are constantly changing. The life cycle of cells is 28 days, and it transitions upwards from the basal to the cornified layer.
The five sublayers of the epidermis are:
- stratum corneum (cornified layer)
- germinal (basal) layer
- stratum spinosum (spinous layer)
- stratum granulosum (granular layer)
- stratum basale/germinativum (translucent, clear layer)
The middle layer.
Between 3 and 8mm in thickness. It has two sublayers: the superficial papillar dermis and the deeper reticular dermis. It is mostly made of adipose (fat) tissue, collagen, and elastin fibers. It serves to protect the body, regulate temperature, and provide nutrition to the skin.
Scalp micropigmentation inserts pigment into the lower layers of the epidermis (stratum basale). As the skin ages and regenerates, the particles injected into the skin migrate towards the middle layer (stratum spinosum). This occurs primarily because of the white blood cells engulfing the pigment and moving the fragments to deeper regions under the skin’s surface. This means that the actual color of the pigment particles remains the same in the tissue matrix.
This process, aided by the body’s white blood cells, creates a change in how light interacts with the particles. Light rays bend as they pass through the skin, creating the appearance of blueish or greenish hues (blueish being more likely). This phenomenon in physics is known as the Tyndall effect. The deeper the pigment is injected into the skin, the more apparent the discoloration appears. Needless to say, this discoloration is unwanted for the scalp.
Besides the depth of the pigment, it is also important to consider the unique characteristics of the scalp due to pilosebaceous oil-secreting glands. These glands make it more difficult to control where each pigment dot is placed completely.
Generally, oil makes surfaces slippery. This means that the tools used to perform the procedure must be specialized for the scalp. Without this specialized equipment, the method will lack control over pigment placement. Lack of proper tools can lead to stains and irregular patches of color on the scalp.
Consistency in Pigment Coloration with Trichopigmentation
With Trichopigmentation, a type of scalp micropigmentation, special needles are used to insert the pigment shallowly into the epidermis securely. Because of the pigment’s location, patients can expect their color to stay consistent and vibrant typically.
Organic Pigment: Why it Matters
Pigment formulation is critical to the consistency and overall quality of a patient’s procedure. Trichopigmentation uses a unique technology to create a bioabsorbable pigment and seamless integration into the surrounding tissue. It is chemically designed to absorb, maintain color stability, and have high tolerability.
If the results aren’t satisfactory or the patient decides that it is not what they wanted, the coloring fades away with time, typically lasting no more than 2 years.
Trichopigmentation needles (TRICO INJECTOR) are designed to create realistic-looking hair in the cross-section while also helping to safeguard the patient from hand tremors during the application process.
One key feature of the needle is that two different textures, flat and rough, can be applied with the same needle. The rough texture is meant to hold and collect the excess pigment that would otherwise destroy the visual result of the procedure.
Applying Pigment Is Not Tattooing
Given the specifics of the procedure above, it is clear that trichopigmentation is injections of ink into the skin. These injections may seem similar to tattooing, but it is not tattooing.
While tattoo pigment can be applied to the skin to form designs and images, it is not ideal for creating the appearance of closely shaven hair density. Tattoo ink is placed much deeper in the dermis layer and increases the likelihood of discoloration and pigment appearing blue or green over time.
Tattoo needles also tend to appear round in shape, this can create larger deposits of ink underneath the skin, and these tend to look unrealistic when compared with the thin appearance of hair.
Those seriously considering the option of pigmentation to reverse the appearance of hair loss should seek the help of specialized hair loss experts instead of turning to their local tattoo parlor.
Trichopigmentation and Pattern Baldness
Trichopigmentation can be performed to create an effect of a shaved head, with hair appearing to grow back and improving hair density. The procedure gives the appearance of hair growing up through the scalp by placing pigment strategically across the scalp. You can see a close-up photo of this below.
Alternatively, the pigment can be placed in the thinning areas of the scalp to give the appearance of a fuller, denser head of hair. This would be achieved by creating a larger concentration of pigment points.
Picking between the shaved effect and the effect of greater density depends on the current stage of baldness in the patient. Shaved would be most appropriate when there is less hair present or in cases of severe balding. However, if the intention is to improve the appearance of density on a fuller head of hair with lower volume, the patient would ideally prefer density.
When there is more hair present, it increases the believable appearance of Trichopigmentation. This is a theory that also applies to hair concealers like Toppik. When more hair is present, it is easier to create convincing coverage.
Another variable that Providers must take into account is skin color. The use of scalp tattooing on darker skin looks far more realistic than a patient with a fair skin tone.
Hair Density and Color Contrast
Hair density is defined as the number of hairs within a given surface area. However, patients that come to Dr. U’s practice often desire to achieve the appearance of fullness on the scalp, not an improvement on the number of hairs or pigment dots on the scalp.
Something important to consider is the contrast between the hair color and the skin tone of the scalp. Two people can have the same hair density, but one may appear to have fuller hair than the other. This could be for two separate reasons: light hair against light-colored skin or dark hair against dark-colored skin.
Hairline and Temple Recession
Trichopigmentation will not work as a solution for hairline and temple recession. Placing pigment in an area that is already bordered by hair ends up looking obvious and artificial. It would be effortless for anyone passing by to differentiate between the pigmented region and the hair itself.
Temporary Duration of Trichopigmentation
Since the results of Trichopigmentation last around 2 years, any changes desired for the next procedure or placement of micropigmentation dots can be made, something basic scalp micropigmentation cannot do. This means that patients can experiment with fullness and density, and they don’t have to commit to any particular style for too long as the effects of the procedure are not permanent.
Trichopigmentation and Hair Transplant Surgery
Hair transplant patients are required to shave their heads before the procedure. This can be completed well before the procedure, in some cases. This can cause some concern for patients about their appearance. Trichopigmentation can help simulate the appearance of growing hair if the completely shaven look is not what they desire. This also helps the look of hair post-procedure as the pigment remains to create soft hair growth while the results become fully apparent in the transplanted hair.
Covering Post-Surgery Scarring
Scarring is an inevitable side effect of any surgery. This is particularly true of those who decide to undergo hair transplantation. When the skin is injured, it creates new collagen fibers. Sometimes this is in the form of thick bundles, depending on the severity of the injury. The tissue, while unsightly, protects the skin from future damage. After a hair transplant, several scar types can occur:
- depressed scars
- stretched scars
- flat scars
- raised of 3D hypertrophic scars
Patients can, if they wish, camouflage their scar tissue with the use of Trichopigmentation in conjunction with Follicular Unit Extraction (FUE) hair grafts.
This is a particularly effective approach to concealing the visibility of scars. Two major factors contribute to the visibility of scars on the scalp: line of emptiness and line of whiteness.
Line of Emptiness is best addressed through the use of FUE that will add hair along the scar. After studying over 100 patients treated with beard hair over scar tissue, Dr. U found that this was a more successful approach that leads to a 70-80% level of patient satisfaction. Covering the line of emptiness with hair yields better results and is the most natural option for solving scar visibility. Using only scalp micropigmentation or Trichopigmentation to address the appearance of scarring left the look unnatural for the patient.
Hair does not grow through scar tissue, but follicular groupings can be extracted and planted directly into the scar tissue. This technique gives a natural appearance while also being less invasive to the patient. Dr. U has given many of his patients the confidence to wear their hair as a buzz cut by covering their scars with natural hair.
Dr. U has performed many FUE repair procedures, often working on cases that no other doctor will take. His repair procedures have exceeded patient expectations and have vastly improved the scars left by other surgeons.
In cases where the scar is visible due to a line of whiteness, the scar stands out from the scalp due to its pigmentation. Therefore, it could still be visible, even as the hair grows out of it. As an example, onlookers may be able to see the scar tissue through the growing hair. This means that the next step that must be taken by the patient and the surgeon is to discuss the method of Trichopigmentation.
As discussed earlier, Trichopigmentation is a great alternative for dark-haired individuals with darker skin who face low hair density challenges. This works because of the lower contrast between skin color and hair color. This makes areas of hair loss and thinning appear less noticeable to the naked eye. This doesn’t mean that amazing natural-looking results cannot be created for individuals with light-colored skin and darker hair.
Ultimately, Trichopigmentation can help the right patient achieve the desired look of hair fullness while minimizing the appearance and visibility of linear scars that sometimes accompany more outdated hair transplant procedures.
It is important to note that strip surgery repair methods can greatly reduce the quality of linear scarring. Still, the final results of the procedure cannot be expected to make the scar invisible. This is because strip surgery permanently changes the anatomy of the scalp by removing sections of the surface skin. Improvement can be made to the hair density with hair grafts, and Trichopigmentation can give the scalp a fuller look, but that will not erase the strip scar altogether. Overall visibility depends on how the patient styles their hair and the length that they keep it.
Also, for the patient to receive the correct camouflage, the coloration of the scar must be taken into account. An example of this will be if the scar is already some shade of white. The line shouldn’t be replaced with an unnatural pigment color that doesn’t correspond to their skin tone. The patient, in this case, would be advised to attain more natural-looking results through Follicular Unit Extraction (FUE) and have these grafts inserted into the scar tissue.
When camouflaging scars with Trichopigmentation, another factor that has to be considered is the type of scar being covered; this method is most effective with flat or 3D scars. Scars that are depressed into the scalp run the risk of pigment spreading or running past the intended area.
It is advised that the surgeon provide the patient with a preliminary test area a little over a week before the actual procedure. Both the patient and surgeon can confirm that this is an effective procedure that will yield the patient’s results.
Raised scars can be pigmented by Trichopigmentation successfully, but the raised scarring can make the scar more visible. It is recommended that the scar be flattened with steroid injections before receiving an FUE hair transplant or Trichopigmentation.
Dr. U has found that hypertrophic scars may lead to fewer results when grafted with hair. SMP should also not be used on keloid scar tissue, and the stretched scars should first be camouflaged with hair with FUE. If not, the scar width should be decreased before scalp micropigmentation of Trichopigmentation is considered.
Other Applications for Trichopigmentation
While Trichopigmentation is well known for its use with pattern baldness (androgenic alopecia) and camouflaging scars, several other conditions can benefit from Trichopigmentation. These include:
- Immune disorders that lead to hair loss, including alopecia areata and universal alopecia
- Thinning in women around the scalp that doesn’t qualify for hair transplantation
- Hair transplant patients with low donor supply can augment the result of their transplant with trichopigmentation
Treatment Series for Pigmentation with the Trichopigmentation Method
Patients who undergo the Trichopigmentation method can expect to go through several appointments.
Before each session
Before each treatment session, the following should be practiced to help prepare the skin:
- Wash hair on the day before the session (if looking to improve the density of hair
- Shave hair on the day before the session (if looking to create the appearance of a newly shaved scalp)
- Avoid too much exposure to the sun.
- Refrain from using grooming products with alcohol (for at least a week before the session). This includes colognes, perfume, hair spray, and toner.
- Avoid spicy food
- Avoid the intake of prescription drugs (speak with your physician before ceasing any medication for guidance to make sure that it is safe to do so)
- Avoid excessive use of alcohol.
Additional instructions will be given on a case-by-case basis by Dr. U or the patient’s Trichopigmentation practitioner.
Each appointment for trichopigmentation with Dr. Umar is broken down into treatment sessions, all specifically designed to give the patient a feeling of ease and comfort when it relates to their procedure and progress. Through each session, Dr. U encourages the patient to ask questions and engage as each session progresses to receive the best results and appearance that they could hope for. Below you will find how each session works in-depth and what is expected of Dr. Umar on each visit to his clinic.
In the first session, the practitioner will create a natural-looking configuration of dots on the skin. The arrangement is in irregular clusters of pigment points with a hexagonal shape. These points are also inserted, more sparsely, near the outside of the scalp, including the hairline, temples, and periaural areas.
In the second session, additional pigment points are added to create a fuller and better-desired outcome. This includes:
- mimicking hair density along with different areas of the scalp.
- Blending and harmonizing the pigmented areas with naturally growing hair.
- Camouflaging any scars present.
- Creating natural-looking densities in thinning areas.
A mandatory check-up is performed one month following the second treatment for the surgeon to view the results and do any enhancements and corrections that may be necessary.
This last session is optional. It is usually booked if there are any density issues and desired effect after the patient has had the scalp micropigmentation for several months. This might be because of several different factors, including sunlight exposure, products with alcohol, excess sweating, or dermatitis.
Patients who choose Trichopigmentation need to follow a strict and important regimen to facilitate the longevity of their results. This list includes:
- Use Tricho shampoo to wash and clean the treated area
- Avoid artificial and natural sunlight on the scalp to avoid fading
- Apply the Post Trico serum regularly
- Avoid exposure to saltwater or chlorinated water
- Avoid any situation that would lead to an excessive amount of sweat
- Reduce visits to the gym, saunas, or Turkish baths
- Avoid the use of microfibers for the first week of healing
- Refrain from the use of hair products that contain alcohol (this should be started one week before the first session of the scalp micropigmentation procedure.
- Avoid the use of prosthetic caps or anything that rubs against the scalp.
Reapplications or touch-ups of the Trichopigmentation are recommended every six months or so. Fading will happen due to the above factors but will also occur with a process known as phagocytosis. This process is where the white blood cells in the body engulf the foreign particles, attempting to keep the skin and body safe from harm. Pigment particles also become engulfed in this process.
SMP versus Trichopigmentation
As stated above, Trichopigmentation is an advanced version of scalp micropigmentation. During a preliminary appointment, the patient and surgeon will discuss which option is best suited to the patient. SMP allows for the patient to have a more lasting look, injecting ink deep into the skin to promote a lasting color. Trichopigmentation does the opposite, going only two layers deep, allowing the pigmentation to fade more quickly.
The issue that is associated with longer-lasting ink injections is the Tyndall effect. The discolorations that appear underneath the skin over time will continue to discolor due to the interaction between pigment and light combined with the body’s natural white blood cells.
Because of the nature and depth of skin micropigmentation, mistakes are often permanent, along with the discoloration that comes with the pigment being attacked by white blood cells. It also means that a hand slip could give the patient an unnatural look evident to the naked eye.
Trichopigmentation is available as a superior version of the basic scalp micropigmentation process. It improves the quality of injection while also giving a shallower injection of ink into the skin that helps prevent the Tyndall effect. The procedure lasts for two years and the session schedule, along with maintenance every six months, allows the patient control over the look and population of pigmentation on the scalp.
Many patients prefer the flexibility and reliability of Trichopgimentation over scalp micropigmentation, but it is up to the patient and the micropigmentation specialist to decide what fits their goals.
Correcting Scalp Micropigmentation Mistakes with Dr.UGraft™
Even with the advanced Trichopigmentation method, scalp pigmentation needs to be applied in a natural and specific way for the patient to have a natural-looking final result.
This practice in no way replaces a hair transplant, and it has limits on how it can be used. This is especially true in the circumstance of hairline and temple recession.
Below you will find an example of a patient who wanted to reduce the recession of his hair in both of the above-stated areas. He thought that Scalp Micropigmentation would help him fulfill his objective. This did not give him the necessary coverage and left his hair with an undesirable discoloration.
The texture of his existing hair contrasted with the pigmented regions, seen below. Due to the conspicuous appearance of the pigmentation, the patient was extremely self-conscious about his appearance.
In addition, the scalp micropigmentation pigment had begun to turn a greenish hue. This meant that the ink was deposited deep below the layers Trichopigmentation would implant into, creating a Tyndall effect on his scalp.
Although the patient had chosen scalp micropigmentation to avoid the need for surgery, he ultimately decided that the best option available to him would be an FUE (with Dr. U’s UGraft process) hair transplant. This procedure would cover the unwanted ink on his temples and hairline while also giving him the coverage that he originally wanted with his first procedure.
Poor Candidates for Trichopigmentation
While Trichopigmentation can be beneficial for many patients with various hair and hair loss situations, this treatment is not meant for everyone. In fact, there are certain hair colors for which this technique would be ill-advised.
Trichopigmentation can mimic darker hair, like black, dark brown, or auburn, but some shades do not render well with this method. Those include Red, blonde, grey, and white.
However, if color contrast mistakes are made, the advantage of Trichopigmentation means that any shading would fade away completely after two years due to the temporary nature of the application.
Why Choose Dr. U?
Doctor Umar is a world-renowned surgeon with experience in all manner of hair restoration. Patients come to him when other surgeons turn them down because he does everything he can to improve the lives and outcomes of his patients.
Trichopigmentation has all the positives of basic scalp micropigmentation without nearly as many downsides.
With Dr. U, you can be sure that his experience and foresight will give you a look that you have been looking for without the added complication of surgery if that is what you want from your procedure. He is experienced in the art of injecting pigment into the correct skin layers while also ensuring that the scalp has an even and natural look.
It is essential to know your surgeon’s capabilities, and Dr. Umar’s website is full of success stories of every kind. He is delighted with his results and knowing that he is changing the look of his patients.
Click here if you would like a free online consultation for a Trichopigmentation procedure.
If you’ve got questions about trichopigmentation that haven’t been answered in this article, Dr. U is happy to answer them himself. You can submit them to our office through the button below:
- Staff, I. M. (2018, October 10). Insanely Awful Hair Tattoo Fails. Tattoo Ideas, Artists and Models. https://www.inkedmag.com/culture/insanely-awful-hair-tattoo-fails