I think the use of SMP on this patient was a good, smart move considering his NW scale. He's able to do a conservative approach to both SMP and FUE procedures. We're anxious to follow his progress to see how the SMP looks in the next couple of years. Dr. Shapiro recommended him to do the SMP before the FUE procedure. Otherwise, he would have had to wait until all the hairs grew from the FUE procedure before doing the SMP on top. The back of the scalp is another story. For the back, it may be better to do the FUE first so that you can "color" within the white dots. However, by doing the SMP first, the back of the head may end up looking much thicker because of SMP.
What happens if an incision is made on an ink dot?i can see the smp looks very 2D with this guys hair not shaved all around to zero guard,but the quality of smp looks good i muat say,the fue he got now will give it a 3D look so i think this will look great!
Can you explain a bit more what is going on in the last picture. The close Up imaging. 1 square has 144 singles and the other has 82 singles, no doubles? or is this a count on the Micro-Pigmentation Dots? (Sorry just a little confused)
Also, This is the type of case I was discussing with you before in regards to splitting grafts. You have done so much with such a low amount of grafts.
This is the approach I was planning, except I was hoping 2000 grafts would give me 4000 3D dots with 2D dots making up the rest of the density.
Any Plans for SMG to start performing Scalp Micropigmentation?
The 144 and 82 counts are for the dots of micro pigmentation. We then added grafts via an FUE procedure a month later.
I recall you talking about your approach to splitting all the grafts to singles. I'm still not sure that's the best approach. once you extract and then split the 2,3,4 hair grafts to all singles, make incisions, and plant them, you put unnecessary risks to all those split grafts because they are then handled more. Some risks are: partial dehydration, transection, more risk of follicles getting crushed during planting, etc. Not to mention the cost factor due to the session size. To work with 4000 grafts will take twice as long as a 2000 graft procedure.
Of course single hair grafts are manufactured in almost all FUE cases but it's an absolute necessity in order to create a natural hairline. I happen to believe its better to thinly spread out the naturally occurring grafts from an FUE procedure so that you will always have a natural result even tho it may look thin. You can opt to do the SMP but you don't have to depend on it. SMP is relatively new and we don't know how long the pigmentation lasts.
Janna, I would like to know why the color of the pigmentation appears to be blue/violet? I would also like to know the diameter of the pigmentation dots as they do look fairly large when compared to the surrounding hair under magnification. Not trying to be aggressive here just curious.
Maybe the close ups skews the coloring a bit but the SMP does not look blue or violet in person.
Each dot is actually three micro dots when you do the extreme close ups but I'd guess the diameter to be around .7 to .9mm.
Yes, the two procedures can work well together if the patient goes into it with a solid plan and knows exactly what to expect. At this point, there are few unknowns like will the pigmentation change color or how much of the color will fade and how fast it will fade. We're not comfortable recommending it on everyone but for those who are desperate due to lack of donor or are repair cases, its an option worth checking into.
This is a really interesting case, I am really looking forward to following this guys progress and I would imagine there will be a lot of interest in this guy, as there's been a lot of talk about using SMP as a permanent concealer. Thanks for posting Janna
Since SMP uses permanent ink, I would think any chemicals have the potential to diminsh the ink with repeated use but you can't help but shampoo on a regular basis and the positive effect you get from Rogaine foam would be worth it. SMP no doubt fades with time just like permanent make up. I would think you have to have touch up sessions.
The combination of a HT (FUT OR FUE) + SMP has so far been mostly discussed online in the context of SMP concealing the scarring after the HT.
This combination is exactly what I was thinking myself to do, but was not sure if technically it would work. Seeing the pics and hearing this case seems promising for my scenario as well.
I am an approximately NW 3, with minimal (easily concealed) loss at the crown, and, as my name applies, I have a receded hairline. I have concealed this well though for years through clever haircutting and products (including a tiny bit of dermatch). I have a faux hawk ish style by keeping my rear hairs a bit longer than the fronts and then brushing forward.
Anyways, when I get a HT, I want to do so without people knowing that I have the amount of hairloss I have. I was thinking I could get 1 HT at the temples only and comb my hair forward like a casesar/george clooney style, but that if I have shock loss at the front that might look too thin and wispy.
So what do you think of, as this patient has done, shaving my head, getting SMP, and then getting an FUE... would having the SMP before the HT help give the illusion of hair even after shockloss? What about, if an incision is made at a pigment point, and then the hairs fall out after 3-4 weeks at that point how will that area look? Would the incision 'mess up' the pigmented dot?
I hope this post is not confusing.... it might help if you could please share a photo of the same patient AFTER his transplanted hairs have fallen out.