A wide hair transplant scar before SMP

Scalp micropigmentation for hair transplant scars

The scalp micropigmentation process has applications far beyond the restoration of a full-looking head of hair. For many years now the technique has also been used by those with alopecia areata, long term skin conditions and other scalp imperfections. One of the most common applications is the concealment of scars caused by hair transplant surgery.

Despite advancements in surgical hair restoration techniques, scars are an inevitable by-product of any transplant procedure. There are a number of pioneering surgeons who use multiple techniques to reduce the appearance of scars during or after the procedure, however claims of zero scarring are commonplace and entirely untrue. Whilst scars can be reduced, they are never eliminated entirely and some transplant scars from procedures performed years ago are simply horrific. The embarrassment and mental anguish caused, by ‘strip method’ scars in particular, can be more severe than hair loss was in the first place, and it does beg the question of whether surgery is really worth the risk.

What patterns of scarring are most common?

It depends on the procedure that was performed, and to what level of competency. The most common are those caused by follicular unit transplantation (FUT) and follicular unit extraction (FUE) surgery.

The FUT procedure is more commonly referred to as the strip method, and results in a linear scar across the donor area, usually the back of the head. The width of the scar is largely decided by the surgeons skill level. FUE scars are minimal in the recipient area, but can be seen as multiple round scars in the donor area.

Good Look Ink FUE scars
This is a client of Good Look Ink, showing classic FUE scarring. So much for FUE scars being undetectable! A clear improvement is seen after his scalp micropigmentation treatment

Plug or pitted scars are usually the result of older techniques that were largely phased out in the 1990’s. Implanted in bunches, these procedures created the ‘dolls hair’ effect and are no longer used to my knowledge. The scars borne by the recipients however, remain in evidence.

What are the options for hiding scars?

Current methods include scar revision (excising or changing the direction of a scar), and implanting hairs directly into the scar tissue. Cortisone injections are sometimes used to flatten the tissue, and dermal fillers are used when the incision is indented. Dermabrasion and fraxel laser repair techniques can also be used to great effect in many patients.

New Hair Institute strip scar
This is a classic strip scar caused by a FUT procedure. The result shown was delivered by New Hair Institute and achieves a camouflage of around 80%, by my estimation.

Scalp micropigmentation is a scar camouflage option that is growing in popularity, and in many cases may be more suitable than some of the more traditional techniques. If the person is happy to embrace a full head scalp micropigmentation treatment, this is usually the most effective option. Further enhancements can be made by using dermal fillers or fraxel laser repair prior to SMP, as this can often result in a smoother canvas with a reduction in indentation or protrusion of the scar tissue. This makes scars easier to hide using SMP.

Are realistic results achievable with SMP?

Yes, however SMP can be used in two ways.

If your scar camouflage is part of a complete SMP treatment (your whole head), then the effectiveness of your result is decided by how raised or indented the scars are, how smooth they are, how closely their shade matches the surrounding skin and of course, the skill of your technician. Depending on your circumstances it is worth considering dermal fillers or fraxel laser repair before your SMP procedure, although this is not usually necessary if the scar tissue is already relatively flat.

If you want to keep your hair longer and you’re not planning a full SMP treatment, then the state of your scar tissue is less important. You should note however that SMP for scars delivers the best result when the head is shaved and preferably treated with SMP.

Scars are more unpredictable than normal skin from a pigmentation point of view, due to the irregular cellular structure of the tissue. The level of retention and fading can vary a lot from person to person, and even from one scar to the next in the same subject. Multiple sessions are usually needed, however when delivered by a highly skilled technician, some of the results achievable are nothing short of astonishing.

The video above was created by the Shadow Clinic in Sydney, Australia.

What advice can we offer?

A scar camouflage process is usually part of a wider plan, be it a full head SMP treatment or the end of a longer process involving other scar revision techniques beforehand. With this in mind, it is important to consider how effective your camouflage could ultimately become before you embark on that journey. You need to be realistic. If you have dark skin and wide, pink and indented scar tissue, you’re not going to achieve the same results as someone who has a thin, flat scar that matches their skin colour.

Your scalp micropigmentation consultant should be able to provide some sort of estimate as to what could be achieved. Every scar is unique, so it is important to base your expectations on your own individual case, not on those you’ve seen achieved by other people. Camouflaging scars is something of a specialism, so ask to see evidence that the person conducting your treatment has specific experience in treating scars.

Laurie Downing