About S.M.P

Scalp Micropigmentation. (Hair follicle replication procedure) By Machisimo Mike at Machisimo Wellness Centers. Scalp Micropigmentation –a procedure aim to create the illusion of real hair follicles by applying tiny pigment deposits to the scalp. Background: Cosmetic deformities, resulting from some dermatologic diseases or deformities caused by hair restoration surgeries, have had few, if any, good, permanent solutions. Most of these patients have learned to live with their problems. Objective: A cosmetic tattoo technique has been developed to address unsightly scalp and hair conditions. Materials and Methods: The technique that i have developed and upgraded to do scalp micropigmentation uses specialized techniques and Special cosmetic instruments and pigments in a stippling pattern on the scalp. Results: A variety of alopecia, refractory to treatment and hair transplant deformities, impact millions of men and women. Many of these deformities can be concealed with scalp micropigmentation, making the deformities minimally detectable. Patient satisfaction is very high. Conclusion: Scalp micropigmentation offers a good nonsurgical alternative treatment for hair and scalp deformities. In this article I’ll demonstrates scalp micropigmentation results and discusses the histology, physiology, and pathology of pigments in the skin. The regulation of the process by the United States Food and Drug Administration and state governments is summarized. Unlike medical devices, scalp micropigmentation offers a non-medical “cover-up” that effectively hides unsightly conditions on the scalp and creates the illusion of thicker hair. I believe that scalp micropigmentation is destined to become a standardized offering for physicians specializing in cosmetic office procedures. There are millions of men and women who have cosmetic problems with their scalps and hair resulting from dermatologic and/or genetic conditions, such as intractable alopecia aerate or female genetic balding. There are also iatrogenic deformities in millions of men from hair restoration procedures done between the 1950s and 1990s, reflecting crude techniques of that period and scars from strip harvesting. Since hair loss is frequently a progressive process, genetic and iatrogenic conditions often become more pronounced over time. Scalp micropigmentation (SMP) uses pigments in a stippling pattern that mimics hair follicles that are cut close to the scalp. This relatively new technique can significantly address the cosmetic problems derived from the conditions noted above. S.M.P is becoming more socially acceptable as a cosmetic solution for covering appropriate scalp and hair problems. I want to explain how the SMP process is used, demonstrates a variety of clinical applications, identifies challenges created by the technique, discusses the anatomy and histology of the pigment interactions with human physiology, and identifies some of the safety issues known today. I will show how S.M.P will have a great impact on people who, heretofore, have had no acceptable long-term solutions for hiding deformities created by a broad variety of diseases and traumas. SCALP MICROPIGMENTATION, A PERMANENT HAIR CONCEALER Scalp concealers are products used by men and women and constitute a multimillion dollar industry. A concealer includes pastes or fibers that are frequently applied to the scalp that approximates hair color and lessens the contrast between hair and scalp color. Scalp tattoos have been used in the past to darken the scalp in Caucasians with alopecia; however, the art has not been aesthetically pleasing and, therefore, has not been routinely accepted by doctors or cosmetologists. My recent refinement of the S.M.P process for scalp applications blends the technical components of OUR SPECIELY DEVELOPED instrument and carefully selected pigments. When this is combined with the artistic and technical skills of My 13 year’s experience, it can address coverage of many scalp and hair cosmetic conditions. S.M.P can be utilized in a variety of ways, greatly expanding cosmetic treatment options for various forms of alopecia. It has great value as part of any effort to make a person’s hair appear more plentiful. It is very effective in camouflaging scars. Alopecia (e.g., alopecia areata or female genetic unpatterned alopecia) generally reflects reduced hair densities, but varies by degree and distribution. For early thinning or balding, styling manipulations are the first step taken by people (e.g., comb-over, or bouffant). These styling options evolve over long periods of time as hair loss progresses. Many Caucasians with chronic alopecia may change their hair color from dark to light (blonde or light brown), effectively reducing the contrast between a dark hair color and a lighter skin color. Such changes can camouflage diffuse or regional areas of localized alopecia. The use of concealers can match scalp color and, when combined with styling modifications, can be effective in areas of the scalp where balding or thinning is occurring. Many temporary concealers, however, interact with the person’s environment, including shedding on clothing or bedspreads and becoming runny in the rain or with perspiration. These topical concealers often require modifications of a user’s activities and lifestyle witch can be very uncomfortable and that is why S.M.P IS AN ULTIMATE SOLUTION. THE SCALP MICROPIGMENTATION PROCESS The skin of the scalp has an intricate anatomy. The normal thickness of the scalp has a significant supporting infrastructure for hair (i.e., glands, blood vessels, nerves, muscles, and fat) in much greater abundance than other areas of body skin because of the higher hair densities of terminal hairs. In androgenetic alopecia (AGA), the large terminal hairs become miniaturized over time, as the hair cycles between catagen and anagen phases. When hair bulk is lost through miniaturization or apoptosis, the supporting infrastructure is reduced in proportion to the loss of the hair. Diseases and scalp surgeries also alter scalp anatomy, resulting in regional microscopic variations in the manner that each individual reacts to SMP. The atrophic scalp of a bald man, with its reduction of blood flow and dermal fat, will respond differently to the introduction and retention of scalp pigments than would a normal hair-bearing scalp. Many incurable scalp diseases produce skin deformities that persist despite treatment. The S.M.P process offers a good, creative, cosmetic solution to these deformities. The use of small follicular units was introduced in the early 1990 and, when these smaller follicular units were artistically blended to camouflage large grafts, many of the surgical deformities from prior procedures were corrected. These “surgically corrected patients” frequently became donor hair depleted as the number of surgical corrective procedures increased, creating problems of coverage and scarring in the back and side of the head. I estimate that patients living with a see- through donor area, donor area hair depletion, and/or severe donor area scarring number in the hundreds of thousands. The medical and surgical problems that can be addressed by SMP concealment include: -Patient with scar from multiple surgeries with significant donor area depletion with a shaved scalp. -People with autoimmune diseases such as refractory alopecia areata or alopecia totalis -Scalp scars from scarring alopecias -Women who are balding or thinning who are not responsive to minoxidil or other medical treatments and do not qualify for hair transplantation -Neurosurgery scars and scars from head trauma, surgeries, and/or hair restoration procedures -Chemotherapy patients, who do not grow back significant amounts of their hair after treatment -Deformities in hair restoration patients resulting from unplanned progressive hair loss in men, whose hair transplants have failed to achieve the amount of “fullness” they expected -People with wide or obvious scars from donor strip harvesting techniques -People who have open donor scars, as a complication of hair transplant surgery from harvesting techniques between the 1950s and the early 1990s, from strip harvesting surgeries, or from the more modern follicular unit extraction techniques that create punctate scars. -Patients who have the old pluggy or corn-row look with or without donor site depletion and a see-through donor area -People who dislike using topical concealers or wigs -Hair thinning or regional balding, where the patient desires to appear to have a fuller head of hair, with or without a shaved scalp. HOW SCALP MICROPIGMENTATION IS PERFORMED SMP functions as a permanent concealer, and the targeted artistic effect is similar to the visual effect of a stippled painting as dots are created between the pores of a balding scalp. This can be done with the hair remaining long or on a shaved scalp. The density of the stippling does not necessarily match the number of pores that contain the hair in the average adult. The average Caucasian has 50,000 pores (i.e., 50,000 follicular units), Asians have an average of 40,000 pores (i.e., 40,000 follicular units), and Africans have an average of 30,000 pores (i.e., 30,000 follicular units). The density of the stippling created in the S.M.P process can be designed to produce shading and create the illusion of texture and fullness to address the desired results worked out between Me and the patient. The establishment of a realistic expectation is a critical goal in the first consultation. What the patient sees and what the provider does must be designed to meet the patient’s initial objectives; however, if the patient wants to change his or her goal after the procedure is complete i can create a more full look or a haircut style look on the scalp by adding more fullness in certain areas to create an illusion of a stylish haircut like a military cut or a design, this technique took me few years to develop and bring to a perfection and as of today i am the only one who master this technique .the patients should be brought to the understanding that seeing through the hair with some visible scalp, is the norm. The pigments of different hues in a variety of formulas and viscosities and instruments employing needle groupings from 1 to 12 needles packaged together, in various sizes and shapes. The requirements for each targeted area varies based upon numerous aesthetic factors, including the presence of blemishes or scars on the scalp, skin color, hair color, the amount of hair that is present, and the color and viscosity of the pigments used. My S.M.P process begins by improving the skin condition on the scalp and treating it to create a better ‘’working surface’’ to guarantee better long lasting results. then i move to the next phase of inserting a micro droplet of pigment (which was color corrected to match your skin tone and minimize color change with time) through the skin and into the upper dermis, using a Special instrument witch i have developed and is nothing like any other instruments out there it works different and minimize human mistakes (if pressing to hard by mistake my machine stopes.), my instruments supports between 1 and 5 needles Vibrating between 10 to 50 vibrates per second. My needle(s) are laser pointed sharp, long thread to perforate the epidermis to get to the upper dermis better and with less irritation making sure the pigment stays better in the scalp. I do not use tattoo machines or tattoo needles as they hit to hard making the pigment spared in the skin taking away from the realistic look of a hair follicle. The depth of needle insertion varies by “feel” and visual judgments made by the technician that reflect the undulating thickness of the epidermis at the point of introduction. The thicker scalp, with more fat and supporting infrastructure, will produce a different skin turgor than an atrophic or scarred scalp, impacting what the technician feel and see as the S.M.P process is performed and this is one of the reasons i am considered to be the best in the world , my experience the tools that i have developed and the technique i use all come together to bring my clients the best results, I create a constant mental feedback loop as he/she constantly adjusts to the effects that are felt and seen. There are additional factors that become important to place the correct amount of pigment, at the correct level, into the scalp for the desired effect. These can be summed in a proportional mathematical “relationship” as shown below: Ideal pigment deposit correlates to: – R [ (Po) x (Pr) x (Vr) / (Co) ] x Cc x Di Po= Position of needle against the scalp (operator variable factor) Pr= Pressure of needle into the scalp (operator variable factor) Vr= Vibration length of the needle on the scalp (operator variable factor) Co= Condition of the scalp (atrophic vs. normal scalp is an intrinsic factor that varies locally in the scalp of the individual) Cc= Color correction of the pigment (choice of the best color and correction against color change) Di= Dilution of pigment thickness (extraneous factor) T= Tools – Machine, Needle size, type, number, vibration speeds R= the approximate mathematical relationship between the variables. Because every patient is different, every area of the scalp is different, and every point of insertion is different from the prior and subsequent points, My experience and knowledge helps me to make the right technical and artistic judgments as the process advances millimeter by millimeter. Scars retain pigment very differently than the skin of an atrophic or normal scalp. It is not unusual to have both normal and abnormal scalp conditions proximate to each other in the same patient. My artistic judgments in managing this often extend into the normal scalp since a scar that is white will have to blend into the tan or dark skin that surrounds the scar. If the scar is to thick or really noticeable i use a technique of scar removal before working on the scar and it is in the beginning of the process where i make the skin condition on the scalp better, at that point i also address scar issues and correct them. The stippling will vary in dot size based upon artistic judgments needed once the process starts. If the pigment is placed only in the epidermis, the process will fail because the pigment will leak out within a few days after the procedure is done (i do have clients from 10 years ago that are still holding the pigment i inserted when they got the smp from me). If the pigment is placed too deep into the dermis, it will fail as it diffuses outside the confines of its original area of placement (if you got the procedure done somewhere else and have this problem i can fix it). The observable size of the stippling may change into a noticeable confluent visual amalgam (bleeding) of ink, I recommend multiple sessions for SMP. The number of “dots” may be higher than 40,000 points in each session. The sessions are often long, extending up to eight hours per session. Pigment bleeding, in any one session, will have to be addressed, before the next phase of the treatment is undertaken. All of my patients will have two to four sessions before the process is complete since they want to have good assurance that only the upper layer of the dermis is penetrated. Pigment bleeding will be minimized with a cautious, slow, and judicious approach in each session and thickening of the skin on the scalp in the preparation phase of the procedure. This process is very important to me, as i take it very seriously to make sure my clients are 100% satisfied and confident with their new and improved look, my clients smiling in the end of the procedure is what keeps me on the edge and always looking to make it better. I treat my clients like if it was me getting the procedure. Since I first started S.M.P in the summer of 2003, physicians seem enthusiastic to offer this service. I have formalized a training programs with doctors and Dermatologist’s and it is available to anyone who wants to be an S.M.P technician or is already doing S.M.P and wants to improve their skill level to really give the best in the industry to THERE CLIENTS, it’s called the MACHISIMO ACADEMY. (More details are available at www.machisimo.com) tattooists or go on Youtube and watch the process people are not properly trained. They try to replicate what they see. What they see, however, does not address all of the variables discussed above. Professional tattooists have no experience dealing with the many variables of the human disease or scarred scalp (they lack the knowledge and experience).I have seen an increasing number of problems caused by the novices that reflect poor judgments in the technical and artistic delivery of S.M.P. Pigment bleeding is common, as are color changes from poor choices in pigments and poor post-procedure follow-through. COLOR CHANGES It is important to explain to the patient that there may be a blue or green tint to the pigment. The greenish color of the black or gray pigment is similar to how the red blood vessels appear green under the skin, where the increased absorption of the red spectrum of light gives rise to a phenomenon explained by the trichromatic theory of color vision. The actual color of some pigments may actually change as well, resulting from direct ultraviolet light exposure on the pigment through the skin and, as such, it can enhance the trichromatic process. Color Pigment correction is a must to match your skin tone to minimize this effect; pigment correction is not a technique that is known by over 99% of the s.m.p technicians. PHYSIOLOGY AND HISTOLOGY OF PIGMENTS IN THE SKIN Once the pigment is placed into the scalp, the amount of pigment that remains over the first few days reflects the quantity and depth of placement. The epidermis ranges in thickness between 0.5 to 1.5mm. Both the stratum corneum and stratum granulosum, constitute the primary barriers for the protection of the skin. The largest layer in the epidermis is the stratum spinosum, and this area fills with pigment in the track created by the needle(s). The deepest layer of the epidermis is the stratum basale, a row of columnar cells resting on the basal lamina that separates the epidermis from the dermis. These cells are mitotically active and they migrate upward toward the surface. The technician try to limit the depth of the needle(s) to the upper dermis , Significant amounts of pigment may be found in the basal cell layer immediately after the process is done. Pigment particles are found within the cytoplasm of both keratinocytes and phagocytic cells, including fibroblasts, macrophages, and mast cells. At one month, the basement membrane is reforming, and aggregates of pigment particles that are present within the stratum basale are starting to disappear, as these cells migrate upward toward the surface. In the dermis, phagocytic cells that contain pigment may concentrate along the epidermal-dermal border below a layer of granulation tissue that is closely surrounded by collagen. The cells of the stratum granulosum and the stratum spinosum contain particles of pigment, as they migrate upward. Eventually, all of the pigments found in the epidermis will be pushed upward with the exfoliation of the stratum corneum. The only pigment that will remain will be the pigment originally placed in the dermis. This represents a satisfactory outcome. The portion of pigment that washes away on the patient’s first hair wash (2-3 days) reflects the pigment on the surface of the scalp or from the needle track within the stratum corneum and stratum granulosum. With the normal stratum corneum turnover of ~27 days, it is likely that the pigment remains below the stratum corneum in the lower layers of the epidermis for a few months. How much of the pigment remains in the stratum basale and how long it stays there probably varies in different people, especially those with skin diseases that impact skin cycling, also if your skin on the scalp was treated before the smp procedure to make sure that the skin is at the best condition to absorb pigment and hold it for longer time. Scalp conditioning is one of the things i do different in my s.m.p procedure to guarantee long lasting & natural looking results. The depth of the stratum basale from the surface of the skin varies significantly along the skin, millimeter by millimeter, reflecting an undulating depth of the epidermis at the dermal border. This makes the depth control by the technician who manually controls the needle by the feel of the resistance a very difficult skill that takes considerable experience. The needles are worked into the superficial dermis and this is the portion of the pigment that remains long term. Black pigment granules vary in diameter from 0.5 to 4.0µm. At one month, transepidermal elimination of ink particles through the upward movement of cells in the stratum spinosum is still in process with ink particles present in keratinocytes, macrophages, and fibroblasts. This is what causes changes in the appearance the patient sees in the first few weeks/months. Touch-ups are an important part of the service in follow-up for these patients, as the initial uniformity in appearance, after the first procedure, changes. An active foreign body reaction is induced by the pigment and the speed of the reaction varies with individuals; the quality and quantity of pigments used; and the local anatomy, physiology, and pathology of the scalp, to overcome this obstacle that can reduce the pigment in the scalp i have developed a method of pigment introduction to the body (one more thing i do different in my s.m.p procedure for better results) that reduces the risk of the body rejecting the pigment. i only use the purest and highest quality of pigments and needles . Pigments are found both intracellularly and extracellularly, with mild fibrosis and occasional foreign-body giant cell reactions. Pigment particles are initially dispersed diffusely as fine granules in the upper dermis, as well as in the epidermis in the tract at the point of the injection. The ink particles normally aggregate to a more focal location in the upper dermis from Days 7 to 13. Some of the soluble components of the pigment may be absorbed initially and taken away by the lymphatic system, while the insoluble components are incorporated with the connective tissue that surrounds each of the fibroblasts containing ink particles. The changes that can often be seen in these early days after the process has taken place include washing out of the surface epidermal pigments and extravasation (bleeding) of the dermal pigment beyond the area it was placed. My experience to balance what is seen at the surface at the time the first procedure is performed with an anticipated loss of some of the more superficial epidermal pigments after a number of days pass helps me to choose the pigment correction for perfect end results. With the stratum corneum penetrated, some leakage of pigments can be seen in the first couple of days after the procedure is performed. Since the pigment in the dermis is not initially stable under the body’s foreign body reaction, some pigments may be absorbed or change color over time if were not pigment color corrected to match your tone and if your skin on the scalp was not treated prior to the s.m.p treatment. Exposure to ultraviolet light can accelerate changes in color. SAFETY AND REGULATORY PRACTICES Due to poor training and lack of knowledge I have seen an almost complete loss of pigment within a few weeks of the initial treatment at one extreme, which might reflect a needle insertion that was too superficial. Considerable extravasation (a bleeding amalgam) of the pigment outside the areas where it was placed in the dermis could also negatively impact the visual aesthetic process as early as in the first week The United States Food and Drug Administration (FDA) considers the pigments used in S.M.P to be cosmetics. When FDA identifies a safety problem associated with a cosmetic, including a pigment, it investigates and takes action, as appropriate, to prevent consumer illness or injury. The FDA states, “Consumers should be aware of the risks involved in order to make an informed decision.” The FDA has not traditionally regulated inks or the pigments used because of “competing public health priorities and a previous lack of evidence of safety problems specifically associated with these pigments”. The actual practice of s.m.p is regulated by local jurisdictions in the United States. The growth of the s.m.p industry has pushed some state or local governments to increase regulation in this industry and license those delivering s.m.p services. The primary regulatory actions are activities by the departments of health in most states, reacting to sanitary conditions by those offering these services. Some state governments require completion of a defined educational process and internships and will issue licenses based on examination results and a physical inspection of the facility. Most state governments allow tattooists to work under the general supervision of a medical doctor or dentist, with little regulation which causes a lot of poorly executed procedures and a lot of unsatisfied consumers. Make sure you only choose the best, do your research first. Not uncommon risks and complications include the following: a) infection, where reported outbreaks of non- tuberculous mycobacterial infections associated with contaminated inks have raised questions about the adequacy of packaging, sterilization, the use of dirty or reused needles, and faulty techniques at the tattoo-parlor level, b) mycobacterium chelonae infection, c) allergies to the component in the pigments producing scarring, granulomas from foreign body reactions, and d) magnetic resonance imaging (MRI) complications, such as swelling and pain from the metals in the pigments when exposed to the powerful MRI magnets. It has been reported that unsterile smp equipment and needles can transmit infectious diseases, such as human immunodeficiency virus, hepatitis, and skin infections caused by Staphylococcus aureus and other bacteria. Little is known about the chemical composition, adsorption, distribution, metabolism, and excretion (ADME) of inks. Little information is available on short-term and long- term safety of the pigments, their carcinogenic potential, how they affect the cells that take up the inks, and how the body responds to the interaction of ultraviolet light with the inks. We do know that some fade or turn color when they are exposed to light. Research has also shown that some pigments migrate from the site to the body’s lymph nodes. The long-term health significance of this is unclear. SMP is not used to diagnose, prevent, or treat diseases or other conditions, and does not achieve its purpose through chemical action within or on the body. instruments and pigments used for these purposes, is a cosmetic process that merely covers up the appearance of unsightly scars, deformities, and balding and thinning areas. CONCLUSION S.M.P is a relatively new modality for cosmetic dermatologists and hair transplant surgeons who wish to expand their practices. For this reason, I addressed the opportunities presented by the S.M.P process, its strengths and challenges, as well as a variety of medical and surgical scalp and hair complications that can result during its use. Since this is a cosmetic procedure, the elegance of the results reflects the technical and artistic skills of experienced providers. Gaining experience in this process can bring great happiness to millions of people who have, heretofore, had few options in treating their hair and scalp deformities. The S.M.P goal of concealing the condition cosmetically is in marked contrast in risk to medical alternatives that treat the conditions themselves. Machisimo Mike-Owner and creator of the Machisimo way of Scalp Micropigmentation. Machisimo Wellness Centers www.machisimo.com 1.844.805.9848