During the past year, I have received a few requests to write a detailed blog post on scalp micropigmentation (SMP), sometimes also termed as scalp hair tattooing. Earlier this year, I told several blog commentators who asked that I would try to do so by fall. However, I had to keep delaying this post due to other more pressing developments in the hair loss world as well as some laziness on my part in researching a topic in which I had very limited interest. In general, SMP is used to give a look of a shaven head that still has all its hair follicles (shadow) intact, although increasingly, people are also getting SMP to enhance the appearance of a hair transplant.
Because scalp micropigmentation procedures have become extremely popular during the past several years, I could not delay this post any longer. Moreover, one of the world’s most respected hair transplant surgeons e-mailed me several months ago and told me that I should write something about this subject matter as soon as possible because their was a lot of confusion in the field. He said that clinics were hiding their proprietary methods from competitors and there is no official regulatory governing body when it comes to the SMP world. i.e., the still nascent world of SMP is not at all transparent at present, much to the detriment of consumers. It should be noted that despite some bad work out there, numerous people have been very pleased with their SMP procedures and I have seen some superb before and after photos online. Just like with hair transplants and hairpieces, for some people, tattooed hair on their scalps is almost as good as a cure for hair loss. I think head shape and facial skin type/condition also impacts the final satisfaction rate when it comes to SMP.
Tricopigmentation Versus Scalp Micropigmentation (SMP)
Immediately after I started researching this post, I realized that I might have to write at least two posts on scalp hair pigmentation/ tattooing procedures: one on tricopigmentation and one on scalp micropigmentation. This particular post will focus on tricopigmentation.
At a bare bones level of understanding, tricopigmentation is just a “temporary” form of “permanent” scalp micropigmentation. However, the definition of “temporary” and “permanent” varies depending on clinic and method being utilized. It seems like “temporary” tricopigmentation ink marks can last anywhere from 6 months to 2-3 years. At the same time, some (but not all) of the so-called “permanent” ink marks in SMP can fade or even disappear within 5 years and often require further touch-up procedures. However, I will save the details of the SMP discussion for another post.
Milena Lardi, Beauty Medical and Tricopigmentation
The person that is most widely associated with tricopigmentation is Italian Milena Lardi, the founder, teacher and technical director at Beauty Medical (Italy). While I am not sure if Ms. Lardi is the inventor of temporary forms of scalp hair tattooing (surely numerous people must have tried in the past?), she has nowadays become synonymous with the term “tricopigmentation”. Her reputation in the industry seems to be unmatched and stellar. However, it does not seem like she has any kind of registered trademark or copyright to the name “tricopigmentation”. As a side note, HIS Hair Clinic claims to be the world’s first company that offered SMP, 14 years ago. However, even they do not seem to have the rights to the term “scalp micropigmentation”.
According to Ms. Lardi’s Beauty Medical website, tricopigmentation is performed in the upper layer of the dermis. Note that the dermis is the second layer of human skin beneath the epidermis first layer. Skin damage to the epidermis can often be reversed, but skin damage to the dermis is much harder to reverse. It is therefore crucial to do thorough research before embarking on a scalp tricopigmentation procedure. According to Beauty Medical, “tricopigmentation is reversible, non-allergenic and bio-compatible thanks to the use of specific pigments which can be absorbed by the body”. The pigments are microscopic and in the shape of dots. Most patients will require at least one touch-up procedure within the first year after the initial tricopigmentation procedure.
Is Temporary the Superior Choice?
According to numerous online opinions, temporary hair tattooing (aka tricopigmentation) is the way to go while permanent hair tattooing (aka SMP) can be a bit dangerous in some instances. At first glance this seems obvious, just like with any form of body tattooing. However, permanent SMP does offer its own advantages that I will discuss in an upcoming post, and there are numerous clinics around the world that offer SMP. If there were hundreds of customers having major regrets several years after getting SMP procedures, we would be seeing far more online negativity as well as lawsuits against clinics by now. At the same time, SMP is far too recent a procedure to know for sure what people will feel like 10-20 years down the road (when the complaints might really proliferate), and for now I would definitely go for temporary over permanent if I had to choose. But I am always very conservative in such matters. In 2014, Dr. Arvind Poswal (India) who got training from Milena Lardi started an excellent thread on Hairsite about this subject and Ms. Lardi also posted a detailed response in there towards the bottom. Both of these two professionals seem to prefer temporary tricopigmentation to permanent SMP.
Having said all that, please stay tuned for my future post on SMP since it is probably a bit biased on my part to favor temporary over permanent without as yet having even completed my research on SMP.
Tricopigmentation in Combination with a Hair Transplant
Numerous hair transplant surgeons have now started to offer tricopigmentation in tandem with a hair transplant in order to make the final results even better, especially in those with extensive areas of baldness that can not entirely be covered with a hair transplant. It seems like most hair transplant surgeons prefer tricopigmentation over SMP. One surgeon e-mailed me that his clinic offers procedures that can last 1-2 years, or 3-4 years, but anything permanent is not good. I will add more here if I get feedback on details regarding when ink lasts 1-2 years versus 3-4 years. Of course some of that will depend on the biology of individual patients and their scalps as well as their lifestyle. Rain will not remove the ink, but too much direct sunlight can potentially impact the duration of results it seems.
One blog reader e-mailed me in the past that he was curious if a scalp micropigmentation procedure could cover his bad linear scar at the back of his scalp from a strip (FUT) hair transplant procedure. That is an interesting idea and Dr. Poswal has a good video on the viability of such a procedure.
Tricopigmentation Technique Variations
Tricopigmentation techniques vary depending on clinic and practitioner. The two main differences are probably in the type of ink/pigment used and in the type of tools used. I doubt that the depth of treatment varies too much between experienced practitioners when it comes to temporary scalp hair tattooing, but I will refrain from making any conclusions here. It is imperative that one goes to a highly reputable and experienced person or clinic for this treatment in order to get a quality hairline design and ensure a natural looking appearance. Some clinics claim to use software and computers (which reminds me of the ARTAS hair transplant robot, although that is much more sophisticated and expensive).
Beauty Medical has proprietary “Trico Skin Care” machines and 0.2 milimeter diameter “Tricoinjector” needles which it sells to practitioners that it has trained and licensed. It seems like the machines are set to inject at precisely 0.5 millimeter depth each time with no room for variation (as would be the case with purely human hands and no machine assistance).
According to Nicole Large from the Shapiro Medical Group in an e-mail to me:
Custom Needles: we have a 1 and a 3pt needle (both are smallest on the market). Big difference is that our needles do not deposit pigment at the bottom of the injection but rather it collects along the injection walls. Therefore it’s not a large pool of pigment sitting at the bottom of the impression – with more chance to spread. Also, we use guarded needles that we set to .05. With permanent SMP they use a method of injection that is based on “feel”. It’s much harder to learn and chances of error are increased. This was how I learned and literally I remember my first “teacher” telling me “just inject it until you feel it in the upper dermis. You will be able to tell by vibration” I remember thinking “wt%\^?~, how do I know what that feels like”. The perm SMP market standard for needle size is 3pt round. The Beauty Medical needles are smaller. The 1 pt is extremely small compared to the rest of the market which is extremely nice for Caucasian skin whose hair diameter is much smaller in comparison to other ethnicities. But, the 3pt is much better for thickening procedures, and ethnic skin. Permanent SMP also injects from 1-2 mm.
I will add more details to this section and the one(s) below as I get more responses from clinics.
Type of Ink used in Tricopigmentation
According to Milena Lardi from the earlier link that I posted in red:
The pigment is composed of a powder part and a liquid part:
Powder part = iron oxide and titanium bioxide.
Liquid part = water, alcohol, isopropyl and glycerine (coming from soya).
According to Nicole Large:
Trico pigment is brown and not black. Also, trico can give you a full ingredient list and system of manufacturing. No secrets. It is manufactured in the EU, which has the strictest laws in the world for cosmetic pigment manufacturing. The EU has a banned ingredient list 150+ ingredients compared to the US FDA, which has 17. Trico pigment is designed to fade completely over the course of 6-24 months because the pigment particle size is so small it can slip through your cell walls allowing your immune system to sweep it. When trico pigment is injected during the healing process, the pigment grows slightly. That is why it is very important to let the patient go home and heal between sessions so that we can monitor exactly how everything is healing. In permanent SMP, the dots should shrink down during the healing process. Also, every SMP company is using a different pigment. Some are using “scalp pigments”, which are mostly carbon based pigments which break down to grey as they fade. Some are using permanent cosmetic pigments and or tattoo ink. Both have a high, high probability of pigment discoloration with time.
Cost of Tricopigmentation
The cost of tricopigmentation varies depending on area that needs to be covered. Online estimates seem to generally range from $1,000 to $4,000 per session.