SMP for alopecia areata and diffuse thinning: is it suitable?

Scalp micropigmentation, or SMP, deposits tiny dots of pigment in the scalp using cosmetic tattoo instruments in a stippling pattern ¹. It is often linked with a closely shaved "buzz cut" look, but it is also used for other kinds of hair loss. One review describes SMP as widely used to camouflage various scalp scars and types of alopecia ².

If you have alopecia areata (patchy, immune-related hair loss) or diffuse thinning (hair that is thinner all over the top), you may wonder whether SMP is a sensible option. The honest answer is: sometimes, with important caveats.

What SMP can and cannot do

SMP does not grow hair. It is a tattoo-based, non-medical cover-up that hides scalp conditions and creates the illusion of thicker hair ¹. In longer hair, the pigment dots sit under the remaining hair and reduce the contrast between hair and scalp, so thinning looks less obvious.

SMP for diffuse thinning

Diffuse thinning, including female pattern hair loss, is one of the more common reasons people consider SMP. In one series of 22 patients treated between 2017 and 2020, all six women had female pattern hair loss ³. Fading over a mean of 20 months' follow-up was described as minimal, one person had an allergic reaction, and most patients reported being very satisfied ³. This was a small series from one team, so results elsewhere may differ.

A retrospective study of 40 women with female pattern hair loss who had either a transplant or SMP found that hair density was the most important factor in choosing between them ⁴. In that study, SMP was favoured when density was still relatively high, and a transplant was favoured when density was lower ⁴. In plain terms, SMP may work best when there is still enough hair on top for the pigment to blend under.

Points to consider for diffuse thinning:

• The cause should be diagnosed first. Thinning can come from shedding, iron or thyroid problems, or pattern hair loss. See the Ludwig scale and first steps.
• Treatment can still continue. SMP does not stop pattern hair loss progressing. Many people combine it with medical treatment.
• Your hairstyle matters. SMP blends under hair, but the effect depends on hair colour, length and how you style it.

SMP for alopecia areata

Alopecia areata is harder. Its course is unpredictable: in most people hair grows back, but it can come back later ⁵. When hair grows back, it may at first be white or grey ⁵.

That unpredictability raises specific questions:

• Active patches may still grow back. If you tattoo a patch that later fills in, the pigment stays under the new hair. If new hair is white at first, the contrast may look odd for a time.
• New patches may appear elsewhere. SMP done on one area will not cover patches that appear later.
• Extensive or long-standing loss. For people with large areas of loss that have not responded to treatment, SMP is one of several camouflage options. A review notes that a variety of alopecias that do not respond to treatment can be concealed with SMP ¹.

Many clinicians would suggest waiting until alopecia areata has been stable for some time before considering any lasting cosmetic procedure. A dermatologist can advise on activity and treatment first. See also alopecia areata and whether it goes away on its own.

The risk of poor work

SMP is hard to undo. One study of 120 people who needed correction after unsatisfactory SMP found that 89.2% had first been treated at a tattoo or cosmetic facility at a beauty salon ⁶. The authors noted that badly performed SMP is very difficult to correct and can cause considerable distress; revisions included laser tattoo removal, repeat SMP and hair transplant surgery ⁶.

Before booking, ask:

• Who will do the procedure, and how much experience do they have with alopecia areata or diffuse thinning?
• Can I see photos of similar cases, taken over time?
• What happens if my hair grows back or my hair loss spreads?
• What pigment is used, and how is fading handled?
• What would removal involve if I change my mind?

Other options

SMP is one of many camouflage choices. Others include wigs, hair pieces, concealing powders and sprays, and transplants ⁷. For a broad comparison, see hair loss camouflage compared. To understand how SMP differs from a regular tattoo, see is SMP a tattoo?.

Frequently asked questions

Is SMP suitable for alopecia areata?

Sometimes, but alopecia areata is unpredictable and hair often grows back ⁵, so many people wait until it is stable before considering SMP.

Can SMP help diffuse thinning in women?

It may reduce the contrast between hair and scalp. One study found hair density was the key factor in choosing SMP over a transplant ⁴.

Does SMP make hair grow?

No. It is a tattoo-based cover-up that creates the illusion of thicker hair ¹.

What if SMP goes wrong?

Correcting poor SMP is difficult and may involve laser removal, repeat SMP or surgery ⁶.

Educational content. Not medical advice.