SMP and alopecia.

Scalp micropigmentation changes how a scalp affected by alopecia looks, and it treats nothing. Alopecia areata is a disease in which the immune system attacks hair follicles, and pigment sitting in the skin has no effect on that, on regrowth, or on the course of the condition. It puts the colour of hair where the skin is bare.

What alopecia areata is, and where this treatment sits

Alopecia areata is a disease in which the immune system attacks hair follicles and causes hair loss, as the National Institute of Arthritis and Musculoskeletal and Skin Diseases describes it. The most common form takes hair in one or more coin-sized patches on the scalp or elsewhere on the body. In alopecia totalis, all or nearly all the hair on the scalp goes. In alopecia universalis, which is rare, the loss is complete or nearly complete across the scalp, the face and the rest of the body.

None of that is what we work on. Scalp micropigmentation is a cosmetic procedure that places pigment impressions, each the size of a real follicle, into the upper layers of the skin, which is explained in what SMP is. It sits above the follicle and alongside the condition, and it changes one thing: how much bare scalp you can see. We are not a medical practice and nothing on this page is medical advice.

Patchy loss

Patchy alopecia is treated as a set of bordered fields, and the border is where the skill goes. A patch is bare skin surrounded by hair that is still growing, so the centre is built to the density of the hair ringing it and the edge is graded outward in impression size, spacing and value until the work disappears into that growth. Done properly there is no ring where the pigment stops, which is the single thing that gives patchy work away.

Hair colour, length and skin undertone all feed into the mix. The ink is blended for your skin, with a corrective shade read from your undertone added to the black, so the healed impressions settle at the neutral tone of a follicle and hold it instead of drifting grey or blue. Under longer hair the impressions sit between existing hairs and darken the skin beneath them. On a close crop they stand in for follicles outright.

Why unpredictable regrowth changes the plan

Regrowth is the one thing nobody can promise you, and the plan has to allow for it. The NIAMS says recovery is unpredictable, with hair regrowing fully in some people and not in others, and that some people have bouts of hair loss throughout their lives while others have a single episode. The American Academy of Dermatology notes that many people relapse within a year of regrowing their hair, and that most relapses happen within five years.

So we ask how your pattern has behaved, over how long, and we plan from that rather than from an assumption. Where loss has been stable for a long stretch, a patch can be treated confidently. Where patches have been coming and going, we are more conservative: a lighter base density, a plan built so later sessions can go either way, and a frank conversation that a patch you treat today may be growing hair in six months.

What happens if it does is worth knowing. The impressions are in the skin and the follicles are their own structures, so returning hair simply grows up through the pigment. On most heads that looks like more density, because the pigment was imitating hair and now there is hair as well. If one patch comes back thick while the field around it stays bare, the balance between them can be evened out at a later session. The work is not wasted and nothing has to be undone.

Complete loss: totalis and universalis

With no hair on the scalp at all, the whole field is treated, and the result is a head that passes for a closely shaved one. That means a hairline designed for your face rather than copied from a chart, temples and corners placed where a mature line carries them, and an even shadow across the top, sides and back, so the head looks cropped instead of bare. There is no existing hair to match, which removes one problem and adds another: the colour has only your skin to sit against, so the undertone reading and the mix matter more, not less.

It takes a minimum of three sessions, including the final refinement, spaced ten to fourteen days apart, and the density is built gradually across them so the field carries the unevenness real growth has. A scalp with no hair anywhere also shows the work’s weaknesses more plainly than a thinning one does, which is why the only photographs worth judging are healed ones in ordinary light, a point made in does SMP look real. Our portfolio has healed heads shot from the front and the side without filters.

A full scalp is from $2,500 with every session included, the exact figure given in writing after a free consultation.

Eyebrows

Brows are a separate discipline and they are not part of scalp work. They use different pigments, different needles and a different technique, and anyone treating them well has trained specifically for it. Alopecia universalis takes brows and lashes too, so clients reasonably ask. Take that question to a brow specialist on its own terms rather than attaching it to a scalp appointment.

Working alongside your dermatologist

Whatever your dermatologist recommends comes first, and SMP fits around it. If you are on a treatment, stay on it; the pigment has nothing to do with it either way. If your scalp is inflamed, sore, flaking or being treated on the skin itself, we wait until the skin is calm and clear, because pigment goes into skin and skin that is dealing with something else neither takes it nor heals it predictably. If you want your doctor’s view first, get it; a consultation here is free and does not expire.

What it is actually like

People with alopecia usually know their own situation better than anyone else in the room, and they tend to arrive with the questions already worked out. So we answer them directly and skip the sympathy, which nobody asked for. The practical change is not complicated. Hats come off indoors. Photographs stop being something to manage. One client had worn a cap inside for years, drove home without it after his last session, and reported that the only person to say anything was his barber, who assumed he had started shaving his head.

Women with patchy loss or diffuse thinning are treated on the same principles, under their own length, and the women’s page covers that work. If you want to know what this would mean for your scalp specifically, including the possibility that we say wait, send us photographs in daylight and tell us how your pattern has moved over the last couple of years. You can ask for a quote or reach us through contact, and you will get a straight read on it either way.

Can you get scalp micropigmentation with alopecia areata?

Often yes, and we treat both patchy loss and complete loss. Scalp micropigmentation places pigment in the skin to change how the scalp looks, and it has no effect on the condition, on your follicles or on whether hair returns. Whether it suits you depends on how settled your pattern has been, which is a conversation at a consultation.

Does SMP treat or cure alopecia?

No. It is a cosmetic treatment and it treats nothing. Alopecia areata is a disease in which the immune system attacks hair follicles, and pigment sitting in the skin does not touch that process, slow it, speed it or change the odds of regrowth. Anything to do with the condition itself belongs with a dermatologist.

What happens to SMP if my hair grows back?

The hair grows through the pigment, because the impressions sit in the skin and the follicles are separate from them. On a patchy case that often looks like what you want, since returning hair adds to the density already there. If a patch comes back thick and the surrounding area has stayed bare, the balance can be adjusted at a later session.

Can SMP help alopecia totalis or universalis?

It can change how the scalp looks. With no hair anywhere on the scalp, the whole field is treated and the result is a head that passes for a closely shaved one, with a hairline, temples and the shadow a cropped head carries. Nothing is restored and no hair returns; what changes is what you see in a mirror.

Do you do eyebrows for alopecia?

Not as part of scalp work. Brows are a separate discipline with their own technique, pigments and training, and this page is about the scalp only. If brows matter to you, ask a brow specialist about them directly rather than treating them as an add-on to a scalp appointment.

Should I talk to my dermatologist before having SMP?

Yes, and we would rather you did. We are not a medical practice, we give no medical advice, and we work around whatever your dermatologist recommends, including treatment that is ongoing. If your scalp is inflamed, sore or currently being treated on the skin itself, that comes first and we wait.

Sources

• NIAMS, National Institutes of Health: Alopecia Areata
• American Academy of Dermatology: Alopecia areata