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My Transplant + SMP Journey



I’ll try to keep this as short as possible, but my hair loss journey involved three main phases - medication and microneedling only (1 year), transplant and medication combined (1 year) and most recently, SMP (still on medication). I’m a 50 year old male and had reached the point that I’d either have to shave it all off or take serious corrective action. I basically had the hairline of Jack Nicholson in the Shining and it wasn’t doing me any favors.

I did one year of 2x daily minoxidil/1mg daily fin/ and 1x weekly microneedling to set a realistic base line prior to getting a transplant. I’d recommend this to anyone considering a transplant because it puts to rest the issue of whether a transplant is actually needed and if so, gives a clear picture to the surgeon of what your medically stabilized hair line looks like. In my case, it was clear that the self treatment wasn’t going to be enough and the first pics are after a year of just this protocol.

In phase two, I traveled to Budapest, Hungary to have a transplant performed by Thomas Mantse at PROHAIR clinic.

I chose Dr. Mantse because I’d be in Hungary anyway, and that I wanted an experienced surgeon handling my entire procedure from beginning to end for comparable money to what the Turkish clinics charge, where the majority of the work is done be assistants and not the surgeon himself. Dr. Mantse was very patient with me and helpful in putting me in touch with past clients with whom I was able to talk and have video conferences with.

The surgery itself consisted of about 2,500 grafts done via FUE with the majority going to my frontal hairline and mid scalp and a few hundred in my crown. It took place over two 12 hour days and was done very professionally with particular attention paid to the fact that I wanted as natural looking of a hairline as possible, and something appropriate to my age. I’m not a fan of the overly straight pluggy looking hairlines.

Surgery is surgery and it’s not to be taken lightly. It was painful and there was months of recovery ahead with significant shock loss along the way. My scabbing also lasted for a really long time - just the peculiarity of my scalp. At his request, I sent weekly updates to Dr. Mantse for an entire year via WhatsApp and he personally responded to all of them. At the end of it all, the hairs came in, the hairline looked natural, and I had zero scarring on my donor zone. I remained on fin after surgery but dropped minox and microneedling in the weeks leading up to the transplant and have not resumed either since.

After a year post transplant I perceived that my crown could benefit from a second transplant to match the newly augmented hairline and mid scalp. I also had a desire for just a touch more density in the hairline and mid scalp as well since I am fair skinned with brown hair and my scalp showed through in photos because of the contrast.

This brings me to phase three.

I live in the San Francisco Bay Area and consulted with Priscilla at Nude By P in Pacifica about augmenting my transplant with SMP (scalp micro pigmentation).

Her portfolio was impressive and she gave me a very thorough and thoughtful in person evaluation. My thinking was that if it worked, I could avoid the pain and months of recovery of a second transplant and if not, I’d go ahead with the second transplant. I confirmed with Dr. Mantse that SMP would not rule out a subsequent procedure and went through four sessions of SMP ranging between 2 1/2 to 3 1/2 hours each with each session about three weeks apart.

There was no real downtime associated with SMP other than not washing my hair for four days after each session. It goes without saying that SMP is nowhere near as painful or as invasive as FUE surgery. It’s not a one and done deal, requiring 3-5 sessions spread out many weeks apart, but downtime is basically non existent.

I’m not yet at the point of having fully healed results as my last session was about a week ago so my scalp is a bit dry and flaky still. In my experience, the ink also fades a bit as it settles in so it will look even more natural in the coming weeks. Having said that, I’m very happy with my results and am now a believer in density fill SMP.

My conclusions are that there’s no substitute for a skilled transplant surgeon at least as far as getting an initial transplant. The pain, expense and down time are not trivial and it will require being on meds indefinitely. I personally would not get a transplant before testing fin for at least 6 months to a year pre-transplant to make sure there are no sides and that you’re OK being on it essentially forever.

However, I don’t necessarily believe that second, third or even fourth transplants are always the best option as long as hair loss is stabilized. In these cases, I see SMP as a time and cost effective alternative and that eliminates or greatly reduces the need for hair fibers to mask the lack of density from a transplant. Some may argue against SMP as being a a visual trick, and it is, but so is a hair transplant as best case scenario density from a transplant will be 50% of what the native hair was.

Anyway, I’m happy to answer questions and respond to comments.



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2024 update


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Having said that, I’m very happy with my results and am now a believer in density fill SMP.
I'm considering SMP for the back of my head. I've only seen it done when the hair is buzzed short, but I see that you wear your longer, so I was wondering, how well does it blend with your native hair? Is it easily detectable or difficult to distinguish? Thanks.