Yesterday, we did SMP (Scalp Micpigmentation) on a patient whose hair transplant didn’t quite achieve the desired FULLNESS he nor I wanted to achieve. He reached his limit of grafts at about 4000 grafts but still wanted a full head of hair. He had a very large head and a poor donor density. I subsidized his 4000 donor area grafts with 500 beard grafts to the crown in the second of two procedures. This gave him just about enough hair to lightly cover the crown. With SMP, his situation has changed radically, as you can see with the before and after photos taken 4 hours into the SMP, which was still going as this post was written. This is a beautiful approach when hair fullness (notice I didn’t use the term density) is not achieved. Density is just one element that contributes to the LOOK OF FULLNESS. Other aspects contributing to fullness include the color/contrast between hair and skin color (SMP addresses this very nicely as shown in this photo), the thickness of each hair follicle (this man had fine hair reflecting poor hair bulk), and the needs of the balding area (can be expressed in square inches of balding area compared to the donor supply). This man has a Class 7 balding pattern. There is clearly a limit when the graft limit is reached. This patient and I discussed this before the very first procedure, and he went into this with his eyes open because I developed a Personalized Master Plan for him as I started his reconstruction. I did his last procedure 1 year ago, including some beard hair for his bald crown. I published an article in 2018 in the Journal of Plastic and Reconstructive Surgery on this philosophy. As it is read more often, more and more surgeons are adopting this approach in planning a hair reconstruction on men with lower-than-ideal donor densities, fine hair, and advanced balding patterns. This approach requires an excellent team to back up the surgery, including perfection on the SMP side of the equation, as shown in the photo below.
