There is a thread with Dr. Rassman's result with SMP on HTN. The result looks very natural. Dr. Ron wrote an extensive reply on his thoughts of it since there is a SMP clinic near our clinic. I'll copy and paste his post here soon.
We've been referring some of our patients who have ht scarring or depleted donor area for SMP work. So far these patients have reported that they are happy with SMP (about 5 or 6 patients). Our concern is discoloring down the road but so far we notice more of it fading than discoloring at 7-8 months. The procedure is not cheap and they may need touch up's, but for many it beats having to put on toppiks or dermatch everyday.
Here is Dr Ron's post regarding MICRO PIGMENTATION-
I have been following the improvements in micro pigmenation over the last year. Dr Rassman is one of the few HT physicians trying to see where this technique fits in the armamentarium of patients with hair loss. I have talked with him about the potential risk / benefits of the procedure and know that he is doing a good job of moving ahead carefully as he keeps exploring its use.
I would like to share the limited experience I have had with this technique so far.
I was first exposed to this technique when a patient about a year ago. An old patient of mine had had it done and came into my office. I had last seen him 17 years ago. He had been a repair case. At that time he wore a hair piece due to poor hair transplant at another clinic that left him with multiple scars in the donor area, a depleted donor area, and poor growth on top. He had very little donor left. 17 years ago we had very little options for him and what we decided was to do a hairline in front of his hair piece so at least the hair piece would look more natural. It worked well and I did not see him for the last 17 years
About a year ago he walked into my office without the hair piece, his head shaved, and with the micro pigmentation. I was surprised at how it looked ¦. much better than I had expected this to look. From about 3 feet it looked like a person had shaved his head and let it grow for about a week...like stubble. It was very hard to see the scars. I did not like the look of the hairline...to abrupt. This type of hairline made sense in a young afro American but not an older Caucasian. In addition when I was closer than 3 feet I could tell there was something wrong because it had no depth. HOWEVER this patient liked this look. He was happy ¦He felt much better about himself.
I had the same concerns that have been expressed above about the dye changing color, what happens if he turns grey, what would happen if this was done on a younger person and then they lost their hair
But I could also see the potential for how it could help at least a sub population of HT patients. This sub population includes:
· Patient with donor scars that prevent them from cutting their hair short
· Patients who have done transplants but who still look thinner than they like. The reason for this could be one of many: poor donor supply, fine hair, poor growth, etc.
Over the last year I have sent 6 patients who were in the above situation to have the micro pigmentation done. Because they were almost out of donor, they had very few options so we felt comfortable trying this.
My experience so far is that these patients are very happy with their early experience. It was especially good for hiding donor scars...even with the hair short. It made them more comfortable with the appearance of density on the top as it blended with their old transplanted hair.
In some cases the micro pigmentation enabled me to get a little more donor out because the donor area looked so much better and the new harvesting would be hidden.
In addition I was careful to instruct the clinic doing the work to stay about 1 cm behind the hairline and fade away into it as I do not think it looks good at the hairline. I think this helped a lot.
I think over time this technique has the potential to be a good adjunct to be used with HT.
But we have to move slow and be careful and I am glad there are physicians with a lot of experience in HT exploring it like Dr Rassman.
Here are a summary of my thoughts and a few precautions I have at this time:
· I don t think it is good as a primary treatment for a patient that is beginning to thin because he will be stuck with it after he balds and may not like the look. He will then be forced to do a HT
· I also do not currently like it as a primary treatment for a bald patient because I don t think it can create a good hairline.
· With respect to the HT fading....Even if it faded in 4 years and they had to do it again the patients I talked were ok with this compared to where they were before having to use dermatch daily. A bigger concern was that it would change color over time.
· With respect to color change ¦I don t have a good feel for that at this time. Some of the patients I saw who had been out 2-3 years had a slight bluish or greyish tinge develop when I looked close ¦but surprisingly it did not affect the overall look and the patients were still happier than they were before the micro pigmentation. I saw a man who had grey hair and with the light grey tattoo it made his hair salt and pepper looking ¦However I don t have enough experience to know how much of a problem this will really be ¦and unfortunately the clinics I have worked with have not really helped me understand this.
· I do think that it will be good for patients who have scars.
· I do think that it may enable us to get more hair out of the donor to use on the recipient area in some patients
· I think if one does it on top that it should only be done AFTER one has done hair transplants that have taken them 70 percent of where they want to go....this would be to improve them if they did not have enough donor to get them further
· I think people that do this need to stay away from the hairline and learn how to fade away as they get close ( lowering density and lightening color)
· I think that it is difficult to learn how to make the micropigmentation so it stays as a discrete pinpoint dot that imitates a stubble of hair.... there is a risk of it "bleeding" and coalescing which does not look good. This is dependent on the ink used, the needle used, the depth into the epidermis that the needle is inserted and probably other things. Dr Rassman would probably know more as he does this himself. I think a lot of clinics say they do it well ¦.. But as was true with HT clinics in the past there are probably many don t do it as well as they say. So until a good track record is developed by certain clinics I would say to be cautious.....
One last note ¦.this tattooing is not a discrete localized tattoo that would be noticed. When done it has to be done throughout the entire donor area or the entire recipient area so it creates a background ¦.if it is done in a discrete localized area it would be noticeable.
These are some of my thoughts so far....I will let you what I think as I continue to follow patients....for now I am only recommending it for patients that have very little choice.
I will try and collect some photo to attach when these patients come back
Ron Shapiro
