This question, from a member of our hair loss social community and discussion forums, was answered by a staff physician from Coalition hair transplant clinic Shapiro Medical:

Is permanent scalp micropigmentation better than temporary ?

tempermThe biggest factor in determining whether to use permanent vs semi-permanent SMP is future hair loss. Many younger patients with early hair loss come to our clinic not wanting to do hair transplant surgery but want a solution nonetheless. They may or not be on medical hair loss treatments for prevention. These patients, in my opinion, are better served by going the semi permanent route.

The reason that this is a better option is as follows. As these patients lose more hair they will need additional SMP. It is not as simple as just adding more pigment into the areas that have faded. The problem with patients who lose more hair is that they need a different pattern and level of density of SMP. If one only adds to the pattern that was originally made, the SMP will only become more obvious (relatively darker looking) instead of less obvious. The magic of SMP is that it is subtle and natural looking. The beauty of semi permanent is that as one loses more hair, the pattern, density and area of SMP coverage can be modified. This cannot be done if one has a permanent pigment already in place.

This question, answered by Coalition hair transplant surgeon Dr. Scott Alexander, was asked by a member of our Hair Loss Social Community and Discussion Forums:

What do you think about putting some sunscreen on my scalp and then putting some Toppik hair loss concealer on top? Will that be okay?

I do have pre-existing hair,and applying only sunscreen, even the ones that claim are non-greasy, makes my hairs stick together and look real bad. It’s also difficult to apply on your scalp when you have some hair.

Dr_Alexander_photoI would try using aerosol sunscreen instead of the lotion, which should help with the greasiness.

Yes, it is fine to use Toppik hair loss concealer in addition to the sunscreen.

I hope this helps.

Dr. Scott Alexander
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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This below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by Nicole, the SMP and Micro-Pigmentation Specialist for Coalition hair restoration surgeons Dr. Ron Shapiro and Dr. Paul Shapiro.

Are there any changes made to the scalp micropigmentation (SMP) procedure since inception? For example, any changes to the ink? I’m just curious if the temporary ink lasts any longer than it used to or if anyone has found a way to make the permanent ink not fade or change colors?

SMPNo changes have been made with the ink itself since inception. We have better needles and a better machine now. This makes a big difference because it implants the pigment in such a way that causes less trauma to the tissue which should create a bit of extended longevity. The best thing to come out of the time between inception and today is that we are better able to predict what it will do exactly and have tailored our protocols in a way that it should get our patients some more time between maintenance visits.

I don’t think there will ever be a time that a pigment that doesn’t fade will exist without changing color. The law of color won’t allow that. With time the body is always going to be able to break down implanted pigment in some way. When that happens, instead of it disappearing it starts fading to the most dominant primary color that created it. For instance, black is made of many levels of the color blue and brown is made with more red and yellow. That is why when permanent black SMP fades you see blueish tones and when permanent brown fades you see orange. I’m talking permanent like tattoo pigments and permanent make-up pigments. Those are designed to be life long.

This question, from a member of our hair loss social community and discussion forums, was answered by a staff physician from Coalition hair transplant clinic Feller Medical:

One of my apprehensions about any sort of hair transplant surgery is having to go through the ugly duckling phase. So I wondered, assuming I get follicular unit extraction (FUE) and shave everything down, what would be the disadvantages of getting temporary scalp micropigmentation SMP before a procedure, so that afterwards I can maintain the shaved down look when the transplanted grafts start to fall out and my scalp looks red raw.

Does it make FUE more difficult, or even impossible for the hair transplant surgeon to implant into a tattooed area? Any other reasons why it makes it more difficult/inadvisable/a non starter?

Thoughts welcome, especially from any docs or other professionals.

smpThe only problem coming to mind at the moment — from the HT doc perspective — is the fact that we would really goof up your new SMP making slits into it. Especially because the SMP is done at a more superficial level, so the blade would really move through all of it.

I’m not sure if this would create a smudged or smeared kind of appearance or if the ink would be pushed deeper, or if it would simply just mess up the work and it would look like you didn’t have any SMP done after.

Has anyone tried saw palmetto to treat thinning hair? I am a woman of 69 years. Also, which oil is best to treat scalp dryness? I eat a very healthy diet, take vitamins and use the laser cap. I had a recent hair transplant. I have androgenic thinning in the front that is not terrible.

I read that the above supplement blocks the production of DHT. I plan on asking my hair restoration physician, Dr. Glenn Charles about it but I wonder if others have experience with this herb. Thanks and be gentle with yourself. We are more than our hair.

Saw_Palmetto_ExtractSaw Palmetto is an active ingredient in a number of alternative hair loss treatments and allegedly stops the effects of DHT from destroying hair follicles. That said, it is not clinically proven and it is not FDA approved. However, many of the hair loss treatments that include this ingredient have allegedly run internal tests that have shown positive results.

Since women, for the most part, should not use finasteride products like Propecia, it may be worth trying saw palmetto products to see if they have any benefit. Having said that, I do strongly suggest considering the use of Rogaine Foam, the strongest and most effective version of Rogaine that is FDA approved for treating hair loss in both men and women.

This question, from a member of our hair loss social community and discussion forums, was answered by a staff physician from Coalition hair transplant clinic Shapiro Medical:

It’s been 7 days since I had my hair transplant surgery. I just rubbed my scab with my fingernail and I can see the scab in my nail. Since it is 7 days post-op, would I still bleed if I dislodge my hair. How much blood should I have? Also, should there be any pain? If yes, how much pain?

questionSeven days post-op is a fairly safe time for the follicular unit grafts. At Shapiro Medical this is when we actually encourage patients to begin to use their fingertips to gently massage away any of the remaining scabs.

At this point, any scabs that fall are perfectly normal. Also, some hair may fall along with the scabs. This too is to be expected. The follicle remains in the scalp but the external hair typically does break off. At about a month’s time, most patients should see the vast majority of the transplanted hair has fallen off.

Usually the only window of time that a graft can fall out and cause bleeding is in the first 1-3 days. During this time, the graft can be bumped out or fall out if there is any rough handling of the scalp. There is not typically any pain associated with this.

The following response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “MrGio”, Online Representative for Coalition Hair Transplant Surgeon Dr. Patrick Mwamba:

I had a follicular unit extraction (FUE) hair transplant in my front/top area 2.5 months ago. So far I’ve been very careful following all post-op instructions. I always wear a hat outside.

I was told sunlight is very bad for the scalp after hair restoration surgery and can result in permanent skin discoloration and, even worse, can damage newly transplanted grafts. My post op instruction says avoid sunlight for 6 months post hair transplant.

Now I live in the UK and normally we don’t have much sunshine at all but this time of year it can get sunny. I don’t plan on sunbathing, etc, but I find it very difficult to wear a hat for 6 months, especially since I have existing hair and they can be styled with Toppik. It’s already been 2.5 months that I’m wearing a hat outside.

how do people cope with this issue?

my main question is,if I use Toppik or similar fibre based concealers , do they block the sunlight as well so I can go out without wearing hat?

sun-clipart-12You want to protect your scalp from extended sun exposure while the hair growth occurs. The growth is affected by ultra-violet rays. If you do tanning beds or sunbathe, keep the grafts covered with a thick material to prevent any sunburning.

The following response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

I have Norwood Scale 6 hair loss may become a 7. I used to think I wouldn’t loose that much more hair, but now I realize that I will most certainly loose more, maybe a lot more than I think.

One thing I’ve wished for is to just accept the baldness, shave it all off and live my life. I’ve tried it but it became the start of 10 years with stress, anxiety and major depression. I know it’s all in my mind, I wish that I could face it better but I can’t.

I’m wondering how using a hair restoration system affects the hairs that are under and close to the system. I use glue, and the scalp is getting pretty dry.

IMG_0891.JPGI know exactly what you are experiencing as I wore a full hair system for 11 years and hated it. Had my first hair transplant in 1996 in the frontal core and finally pitched my systems. To date I had roughly 6900 grafts in four separate hair restoration procedures.

So here’s the deal. in my opinion, you have a lot of potential to restore your frontal third zone with a nice hairline and then transitioning the level of density as you reach the mid-scalp. I also agree that you leave the crown alone for now. You don’t have to go above say 60 square centimeters in the frontal core to get a nice result. It won’t be superb density but enough to attain nice coverage.

The following response, posted on our Hair Loss Social Community and Discussion Forums was written by recommended hair restoration surgeon Dr. Tejinder Bhatti:

IMG_0895.JPGI’m 34 years old and a 6 on the Norwood Scale for hair loss. I started losing hair when I was 20. I’ve worn hairpieces for the last 3 years but I’m not really happy about it, it feels fake and a lot of work.

I miss the feeling of my own hair. Before I lost too much hair (I was maybe 24-25) I had a pretty bald crown and a little bit of thinning hairline but I was happy with it. I’m not looking to cover my whole head with high density. I would be happy with a bald crown, but some coverage on the first half of the head.

I’ve measured the area I would like to cover, it is about 100 square centimeters. Is it possible to think I could get some decent coverage for that area if I leave the crown bald? How many grafts would you think would be needed?

Dr-Bhatti-photoYou have a lot to think about. It is imperative to first address the idea that you are young at 34 years of age and you have obviously had a lot of hair loss. The progression has not ended as you will lose more. Propecia (finasteride) is a consideration or else your future loss is a guarantee. The crown will enlarge and the sides might recede downward.

I’m in my late 20s and I am a 3 on the Norwood Scale for hair loss. I’ve been losing hair since I was 21. It accelerated during grad school (I had a ton of hair coming in). I went to a highly respected hair transplant surgeon in LA who told me it would take about a 1000 grafts to conservatively restore my hairline. However, he mentioned that another physician would be doing the surgery. It was unsettling to have my consult done by someone who would not even be performing/supervising the techs.

I came across a number of recommended hair restoration surgeons with great results on this site. I am currently in grad school on the East Coast and have to do an online consult. Is there any downside to an online consult? Will the doctor follow up day of the surgery prior to the work being done?

online_consultationOnline consultations can provide a prospective hair transplant patient with a general idea of his or her needs and also what may be realistic given their degree of hair loss, apparent donor supply, etc. However, it’s important to note that things can change upon meeting in person. For this reason, it’s always a good idea to be evaluated in person by a local hair restoration clinic if possible, even if you are strongly considering traveling long-distance for your procedure.

Personally, I would not be concerned about being evaluated in person by a skilled and very experienced surgeon even if he were not performing the surgery.

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