Dr. Muhammet Özgehan
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Medical Hair Encyclopedia

Dermatological pathologies and evidence-based clinical guidelines at international standards.

CONCEALMENT METHODS & COMPLICATION MANAGEMENT

Scalp Micropigmentation (SMP) Procedure: Application Techniques, Color Changes, Laser Risks, and Scar Management

Prepared by: Dr. Muhammet Özgehan | Turkish Hair and Scalp Diseases Association

This guide has been compiled by Dr. Muhammet Özgehan, referencing current trichology literature.

📌 Patient Information Section: What is Scalp Micropigmentation (SMP) and What are its Risks?

Scalp Micropigmentation (SMP): This procedure involves the application of special micro-needles and biocompatible pigments into the dermal layer of the scalp to optically camouflage hair loss, creating the appearance of real hair follicles. It is typically performed to achieve a shaved hair look or to reduce contrast in sparse areas.

However, certain undesirable complications may arise after the procedure or in subsequent years:

  • Color Change and Pigment Loss Over Time: Due to low-quality pigments, errors in deep application, or UV exposure, the pigments can molecularly degrade over the years, transforming into undesirable blue, gray, green, or purplish tones.
  • Damage to Healthy Hair from Laser Removal: Q-switched or Picosecond lasers used to remove discolored or poorly executed simulations can cause thermal damage to healthy and living hair follicles in the area while fragmenting the pigment in the dermis, potentially leading to permanent hair loss.
  • Scar Risk: Deep or aggressive laser sessions can lead to tissue damage, hypopigmentation (loss of color), and hypertrophic scar development in the skin.
Scalp Micropigmentation (SMP) and its Risks Infographic - Dr. Muhammet Özgehan

Figure: SMP micropigmentation processes, color changes over time (blue/gray tones), thermal effects of laser removal sessions on healthy hair follicles, and scar risks.

🩺 Clinical & Medical Guide for Physicians

  • SMP Procedural Mechanism: Deposition of pigments in micro-dots at a depth of 1.0 - 1.5 mm in the dermis. Risk of pigment diffusion (blobbing) and color distortion if accidentally extended into the subcutaneous fat tissue.
  • Pigment Photo-Degradation: Phagocytosis of non-organic iron oxide or heavy metal-based pigments by macrophages and their shift to the blue-gray color spectrum via photochemical reaction under the sunlight spectrum.
  • Laser Removal and Follicular Toxicity: Competitive targeting of pigment by 1064 nm / 532 nm wavelengths against melanin. Thermal energy transmitted to the stem cells and bulb region of anagen-phase hair follicles during this process can trigger cicatricial alopecia.
  • Scar Management and Alternative Revisions: Careful selection of fluence (energy flux) parameters in laser applications, and support of dermal regeneration with fractional laser combinations. Additionally, expertise and treatment approaches for clinical and surgical evaluations can be reviewed.

Scientific References and Bibliography

  • Rassman WR, Pak JP, Kim J. Scalp micropigmentation: a useful treatment for hair loss. Facial Plast Surg Clin North Am. 2013 Aug;21(3):497-503. doi: 10.1016/j.fsc.2013.05.010. PMID: 24017991. PubMed Link
  • Dhurat RS, Shanshanwal SJS, Dandale AL. Standardization of SMP Procedure and Its Impact On Outcome. J Cutan Aesthet Surg. 2017 Jul-Sep;10(3):145-149. doi: 10.4103/JCAS.JCAS_116_16. PMID: 29403185; PMCID: PMC5782438. PubMed Link
  • Wu DC. Successful Treatment of Scalp Micropigmentation With 1064 nm Picosecond Nd:YAG Laser. Lasers Surg Med. 2020 Dec;53(3):331-335. doi: 10.1002/lsm.23364. PMID: 33289086. PubMed Link