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Scalp Micro Pigmentation (SMP) is a medical tattoo process that recreates an appearance of naturally growing hair for people who are balding or have thinning hair. While remotely similar in principle to traditional tattooing and/or permanent cosmetics procedures there are number of critical differences that make SMP unique and specifically suited for the scalp. The pigments and machines are much more sophisticated and specifically designed to limit pigment depth, color change, and migration. The impressions are extremely discrete and are comparable in diameter to a single hair or follicular unit. The goal is to exactly replicate the appearance of shaved hair follicles or stubble of hair.

There are currently 3 main ways that SMP can be used:

  1. To create a shaved look that mimics the look of shaved or closely cropped hair with the appearance of stubble.
  2. To create a thickening effect or increase the illusion of density in areas of thinning hair by decreasing the color contrast between the scalp and hair. This is similar to the effect of cosmetic concealers like Dermatch and Toppix but with the advantage not having to be applied daily. This can be particularly beneficial for transplant patients who have undergone previous surgeries, but who are still looking thinner than they would like, as well as, women.
  3. To camouflage & hide scars from either Strip or FUE surgery

Shaved Look Created with SMP

Fill-in with SMP Example #1

Fill-in with SMP Example #2

Donor Scar Treated with SMP


Currently if a patient research’s SMP they will find references to both “permanent” & “temporary” techniques.

  • “Permanent” SMP is what most people refer too when they use the general term SMP. While there are some differences in methodology between different clinics that perform permanent SMP the unifying characteristic is that the pigment used is meant to last 2-5 years and may never fade completely, needing laser for complete removal.
  • “Temporary” SMP is a very specific technique, developed by Milena Lardi from Beauty Medical in Milan, Italy. The main characteristic of this technique is the use of sophisticated pigments specifically designed to break down and fade completely within 6-24 month. Milena named this technique Scalp Tricho-Pigmentation (STP) to differentiate it from permanent SMP.

Shapiro Medical Group has the distinction of being the first medical clinics to be trained in this technique in the USA and are currently the only Trico-Pigmentation Training Center in North America.

There are other technical differences between these two techniques include the type and size of needle used, size of the ink impressions, depth of ink delivery, and more. For those that are interested in more details about the differences, these are explained in detail in the SMP Q&A section of this site.


Shapiro Medical Group is one of the few, if not only groups in the world, that has been extensively trained in both techniques. Both techniques have their advantages and disadvantage and it is important to be experts at both procedures to give patients the best options based on their own specific needs.

Our SMG physicians will work with you and our SMP specialist Nicole to design the best individualized treatment plan based on your current and possible future needs.


It will take a minimum of three SMP sessions to achieve the optimal results that SMP has to offer. It is risky to try to be too aggressive too fast with implantation of the pigment because it can cause the impressions to bleed together (migration) and look like a “solid blob” instead of micro-dots. To avoid this, it is imperative that the procedure sessions are spread apart and healing time is allowed. Doing SMP is like placing filters sequential on top of each other to create a gradually darker look. It can take 3-5 sessions to achieve the desired look sometimes. More sessions are needed if a patient wants a darker look to increase the density of thin hair. Creating a shaved look take less visits.

How long will my temporary SMP last?
Because every individual is unique this is not a question that has a definitive answer. With proper care and treatment, temporary SMP will commonly last 1-2 years. We do recommend you come in for a “touch-up” every year.

Will SMP fade?
YES. Temporary pigment is designed to fade completely over the course of 24 months because the particles it is made of are small enough for your cell defense system to “eat” and eliminate. We expect the pigments to fade 30%-50% after procedure days 1-2. This is why we suggest you come back for a third “finishing procedure” 6 weeks (minimally) after your initial procedure. Due to different levels of dermal thickness on your scalp your SMP will not fade evenly. We will want to enhance any areas of fading or rejected pigment.

What pigments or inks are used in an SMP treatment at SMG?
Shapiro Medical Group uses proprietary medical grade organic pigments that were designed by Milena Milardi and Beauty Medical of Milan. These pigments are temporary and specifically designed to gradually fade and disappear within 6-24 months after the procedure.

Temporary SMP is designed to fade and DISAPPEAR over the course of 24 months so that the pigment does not turn blue or green. Additionally, our pigments do not contain any black. (The color black is made up of many levels of the color blue) Because, black pigment can eventually fade into blue or green tone, it would inevitably produce an unnatural looking result as it gradually fades and disappears. Many permanent SMP companies will talk about fading but they avoid the issue of color change and they simply say they’ll give you a “touch-up”. The problem with this is that the more ink you put into an impression that has “faded” (changed color) the bigger the impression gets which means it does not look natural. If pigment is not designed to disappear it will change color.

Is temporary SMP reversible?
One advantage of using temporary pigment is that you have the ability to redesign or discontinue the process if the results are not satisfactory because the pigment will naturally disappear within. 6-24 months. If you wanted the ink to disappear sooner it is possible to use a laser to remove the ink also.

What does the SMP treatment timeline look like?
SMP is completed over a series of sessions and your ideal outcome will be achieved after the third session. The first two days are consecutive and I like to schedule the finishing procedure roughly six weeks later.

How long is a typical appointment?
All appointments, including touch-ups are 6-8 hours.

What happens during my procedure at my 1st appointment?
Your day 1 or initial appointment will last 6-8 hours. Essentially, Day 1 of your SMP procedure the technicians are “laying your base”. The contrast in scalp coloration between areas of full hair density and areas of hair loss are neutralized and a very light application of “dots or impressions” is applied to the scalp. Day 1 procedure is preparing the scalp for the treatments to come.

What happens during my procedure at my 2nd appointment?
Your second appointment (Day 2) will last approximately 8 hours. Your second appointment will be made the day after your initial appointment. The practitioner will go between the pigmentation that was added on day 1 and add even more to darken the hue and add more definition to your exiting your base. Finishing touches are added to your hairline and any scar camouflaging.

What happens during my procedure at my 3rd appointment?
Day 3 is often referred to as your “finishing procedure” and is scheduled 6 weeks and/or up to 6 months after your initial procedure. We expect that the pigment will fade 30%-50% between the end of the second procedure and this third procedure. During this appointment any areas of fading or pigment rejection are addressed, and, final touches and fine details are readdressed and added to your density, hairline, and scars. Although the third procedure is called the “finishing procedure” some people need another 1-2 sessions depending on the degree of darkness they want and their own individual degree of fading.

How soon after my SMP treatment can I return to work?
Technically, you could return to work the next day after receiving an SMP procedure. The redness and swelling will subside around days 3-5. If you had a scar treated, the redness and swelling will last a bit longer and subside after around 10-14 days.

Do I have to shave my head for my SMP treatment, or can it be done without cutting your hair?
No. It is not necessary to shave your head for an SMP procedure. Although, our practitioners do recommend that for your day 3 procedure you come to the clinic wearing your hair to the shortest length you ever plan on wearing it. That way they can achieve the greatest amount of blending and camouflage with that length.

How much does SMP cost?
It depends upon the thinning and balding pattern, the area of the scalp to be covered, and if any scars are present. The price range for SMP at SMG is normally $800.00 to $2400.00.