The number of SMP sessions you are likely to need.

Maximum coverage - combining Scalp Micro-Pigmentation with a hair transplant

Have you been to see a hair transplant surgeon and he has informed you that he simply cannot achieve what you want, in fact, may even refuse to do any transplant as he knows the outcome would not be aesthetically good? If yes then well done you have been to see the right surgeon. The most likely reason you have been given this answer is due to the fact that you simply don’t have enough donor hair to fill the desired space. Now, I’m no expert but I’ve seen quite a few guys tell me they are off to get a transplant in x European country but they clearly don’t have enough existing hair to be donated to the extensive hairless area, this is a classic case of ‘they’ll tell you anything you want to get you to part with your money’.

In contrast, when I meet a new client in my SMP clinic I will be quite excited to see they have some diffused hair across their larger balding area. This is due to it creating a much more natural look of the smp by adding texture and a little less light bounce. It got me to thinking about the clients with no diffuse thinning hair across the top and how they would benefit from a low graft transplant to add texture to this area. There was bourne the idea of setting out a plan from the beginning to bring together SMP and a hair transplant as a combined package. I have seen a fair few clients who have been told they were unsuitable for a hair transplant. Dr Ball and his team from The Maitland Clinic in Portsmouth refer many of these clients to me looking for an alternative treatment. I approached Dr Ball with the idea and we have since made plans to offer this to clients he may have previously declined. Dr Ball says:

“The combination of an FUE hair transplant and SMP is a great option for men who wouldn't traditionally be candidates for hair transplantation because of insufficient donor supply. It's a lovely way to get the textural benefits of a hair transplant, even when grafted at low density, along with the addition of pigment from scalp micro-pigmentation. It has the potential to add an extra element of naturalness by creating a 3D aspect to the SMP technique”.

In which order should it ideally be executed? This has been something I have debated about for a little while. SMP has instant gratification with very low downtime, which means there is less time before moving on to the transplant rather than the other way round. However I’ve heard that the pigment impressions can be distracting to the surgeon, I asked Dr Ball of The Maitland Clinic what his thoughts are: “...I have found the skin a bit more difficult to work on if there is thick dark ink from SMP but as long as the pigment deposits are sharp and the patient allows a full shave of the head (to grade 0) this shouldn't be an issue during surgery. I agree with you that it is nice for the patient to have at least one SMP session first, this allows them to check that they like the shaved look with SMP before committing to surgery and gets them started on their journey with results sooner than if they waited until after surgery. Then after surgery reinforce the recipient area and cover the FUE scars in the donor area with further SMP treatment.”

Surely this combination is already in practice? Yes, I have myself provided the SMP treatment on clients post transplant, this has produced excellent results in creating the illusion of denser hair where the scalp was visible through the grafts. However this new combination package is based on the new grafts supporting the shaven look of the SMP by breaking up light bounce creating a more 3D appearance. The transplanted hair, along with the remaining hair, would need to be kept extremely short (0.5 - 1mm length).

What about any scars from the donor area? It would most likely be FUE that the surgeon has chosen for you. This technique leaves very small scars which can be treated by micro-needling to speed up the healing time and decrease their visibility. These small gaps within the donor area can be camouflaged with SMP later on.

Here is an example of small FUE scars in the donor area. Follicles were transferred to the top of the head 12 months prior. This was taken prior to embarking on SMP for the scars and follicle impressions in the crown and front area.

Completed SMP treatment

Cost for this combination procedure will, as always, depend on the number of grafts and the size of the treatment area. For 1,000 grafts at The Maitland Clinic you are looking at £5,000 (a little more if some are harvested from the beard area), the SMP would be between £1,650-£1,950.

Dr Ball and his team can be contacted here: