Scalp micro-pigmentation, or scalp tattooing, is a semi-permanent micro-pigmenting technique that offers an alternative option for both
men and women suffering from hair loss, who are not appropriate candidates for hair transplant surgery or who do not want it.
However, scalp micro-pigmentation is increasingly being used as a complementary treatment to hair restoration surgery, either to add
the illusion of additional density and enhance the overall result of thepatient’s surgical procedure, or to camouflage existing scarring from older transplant surgeries where the patient has declined the option of a scar revision procedure.
One specific technique, Hair microPigmentation Treatment (HPT), involves the use of a digitally controlled needle that applies medical grade hypoallergenic colour pigment into the scalp. Unlike a traditional tattoo that would use ink, HPT is performed using specially designed pigments that will not have the colour change or migration that is commonly seen with a body art tattoo. The pigments used for HPT are of a pharmaceutical quality and fulfil the most demanding quality and security regulations, complying with category 1 of EU Cosmetics Directive and European Directive ResAp 2008(1). The pigments are dermatologically and microbiologically tested and contain high
quality mineral pigments. Additionally, they are sterile, hypoallergenic and do not contain any kind of artificial preservatives, aromatic
amines or heavy metals. Although it may appear to be a similar technique to body art tattooing, tattoo inks are not subject to the same stringent testing and regulations as the pigments used in HPT. In addition tattoo needles and treatment depth into the skin are very different. Both techniques use needles to implant colour, but that is where the similarity ends. Traditional body art tattoos have the tendency to change colour. If it was black to start with, very often they will turn blue as a result of migration due to the type of ink used and the tissue level at which the tattoo was implanted. HPT is not implanted at a deep level on the scalp; the simulated hair follicles are implanted in the very top layers of the epidermis.
For general scalp micro-pigmentation treatments, we would expect HPT to last between one and three years. After this, the patient will require some minor maintenance or touch ups to ensure their treatment is kept looking its best. However, it is impossible to predict the exact length of time the treatment will last, as each patient’s biology is different and lifestyle choices and other variables can affect the longevity of the treatment. The pigments used for HPT are designed to fade over time. This makes it possible to adjust the tone and colour of the implanted ‘hair follicles’ and change the hairline, if applicable, to be more ‘age appropriate’ for patients as they
mature. HPT is a multi-treatment procedure that usually requires two to three sessions to complete. Depending on the size of the area to be treated and the extent of a patient’s hair loss or scarring, each session will take two to four hours. The treatment in itself is not painful, as the pigment is implanted only in the epidermis.
However, no longer than four-hour sessions are recommended as there is a residual build up of ‘irritation’ that can eventually make the patient’s scalp feel sore. We have used HPT effectively to help a number of patients camouflage their transplant scarring, which is either strip scarring, or hole punch or plug marks left after older hair transplant surgery techniques. For successful scar camouflage procedures it is important to understand how to assess the scar. The first step is to examine the scar and decide whether micro-pigmentation is suitable, or if another treatment such as excision or laser is more appropriate. It is of paramount importance to understand the different types of scars and how they have been created in order to decide the best HPT technique to treat them.Depending on the age or severity of
the scar(s) we may need to improve the texture and flatten these scars with microneedling, mesotherapy or PRP prior to referring the patient to a micro-pigmentation specialist. HPT is only appropriate for the treatment of scars that are more than a year old and are fully healed. Hypertrophic scars present as raised scars within the border of the trauma or incision. Hypertrophic scarring will almost always need a medical treatment prior to HPT. Keloid scarring presents as raised scar tissue outside the border of the trauma site or incision and is a contraindication to HPT as there is a high risk of precipitating further scarring. The aim of re-pigmenting a scar is to blend
in the damaged skin and reduce the contrast between the scar and the healthy scalp and surrounding hair. However, as highlighted
previously, scars by their very nature are unpredictable to work on. Unlike healthy undamaged skin, the scar area may grab the pigment resulting in possible migration or occasionally it may reject the pigment and push the colour out.
Reference: Dr Sotirios Foutsizoglou (Aesthetics – Monthly Journal for Medical Aesthetic Professionals)
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