Has anyone tried FUE + SMP?

[tuna123]

Hey guys,

I'm a 29yo, who is progressing towards NW5-6.

I've contacted all surgeons on the IAHRS website with the intention of getting FUE and to see if I was eligible or not. All of them came back positive except one.

I don't have high expectations and don't expect any sort of full set of hair. All I want is something like Fredrik Ljungberg:

https://s-media-cache-ak0.pinimg.com/originals/b7/70/25/b77025f94e5b0e435c5dc1215e151463.jpg

So I thought maybe restoring the hairline with FUE + a bit covering the top and scalp. And then getting some density from SMP.

What do you guys think? Is it possible?

One thing I'm worried about is scars from FUE. How small punches do you need for it to not be visible on a bald head?

[mwolfe]

would it possible to cover up the fue scars with SMP?

[delhihairclinic]

FUE is a traditional and outdated method and yes you are concerned there might be scars on the scalp after the treatment why don't you go for a FUT hair transplant surgery check this URL for more detailed information http://delhihairclinics.com/fut/

[Hairo]

FUE is a traditional and outdated method and yes you are concerned there might be scars on the scalp after the treatment why don't you go for a FUT hair transplant surgery check this URL for more detailed information http://delhihairclinics.com/fut/

FUT is the older technology and will leave more of a scar then FUE

[JoeTillman]

FUT is the older technology and will leave more of a scar then FUE

Technically, FUE leaves more scar tissue. It's just that the human eye is attracted to patterns thus why a linear scar is infinitely more identifiable than properly spread out and random dot scars. If we assume a 25cm long strip scar at 2mm wide, you've got 5cm 2 of total scar tissue. That would be the typical length of a donor scar if 1cm wide strip were taken for 2000 grafts, assuming an average of 80 FU per cm2 in the donor area. With 2000 FUE, assuming a .8mm punch, the total scar tissue is 1600 mm or 16 cm2. That is three times the total amount of scar tissue from FUE when compared to FUT for the same # of grafts. That does not take into account the "spread" that typically occurs before the visual surface tissue.

Tuna, what you ask for is possible and I've seen it done. It can look good but the problem is that to go as short as the example you presented, you run the risk of having the dot scars revealed in the donor area, along the sides and the back of your scalp. SMP does not always work well in scar tissue as it is a different type of tissue than skin tissue. Sometimes it works, sometimes it doesn't in that it can disappear quickly, or even worse, it can spread. I've seen both scenarios unfold in scar tissue.

I think the safest way to move forward to try and achieve what you want is to maybe have tricopigmentation first to create this look that you seek and then see how you like it and go from there.

[tuna123]

Hi Joe,

Thanks for getting back to me. Can you tell me if there's always going to be dot scars? Or is it possible to use lower punches? Like .4mm or similar? All up it seems like a big risk to take if I have no way of covering the scars.

[JoeTillman]

Hi Joe,

Thanks for getting back to me. Can you tell me if there's always going to be dot scars? Or is it possible to use lower punches? Like .4mm or similar? All up it seems like a big risk to take if I have no way of covering the scars.

Hi Tuna,

I'm glad to help. Never forget, once you're cut, you're cut and every time there will be a scar. The size of the scar depends on three factors:

1. Your physiology, how you heal. Do you generally heal well when you get cut?

2. The size of the punch being used. As far as I know, .4mm medical punches are not made and the smallest I'm aware of is .5mm but I'm also not aware of any clinic using such small punches except for possibly Dr. Gho, which is a completely separate story. The punch size will depend on not only the doctor skill but also your graft bundle size. No amount of skill can get around the fact that certain size grafts require slightly larger than equal sized punch diameters.

3. The angle of the punch. An angle more flight to the plane of the scalp, usually which matches the exit angle of a graft, makes any round punch leave an elliptical scar. The ellipse will be larger than the punch itself so the scar as well will have a higher chance of being visible.

The idea of getting a hair transplant in order to shave your head is a long held dream by many and while FUE in seasoned hands has made this possible for many patients there are many more that were not so fortunate and regretted the attempt in it's entirety. My advice is to not have a hair transplant unless you understand not just the benefits, which can be intoxicating to think about, but also the consequences which can be equally devastating. If you do wind up having a hair transplant I believe you should be doing so with the goal of having hair to style, not to shave, because if you shoot for that goal it has a higher probability of success. With your goal you have two potential failure points, the growth and the donor scarring.

[mwolfe]

Joe,

Thanks so much for your insight about the scarring. Is there really no way to consistently and effectively conceal the FUE scars with SMP? That's a major worry of mine, because I could definitely see myself thinning more late in life post-transplant and just wanting to go shaved.

[JoeTillman]

No way that is guaranteed to work. If there were, there would be a lot more of these procedures going on. Don't misunderstand, they can work and work really well but it's just a gamble. The odds are in your favor but not completely.

[mwolfe]

Ahh, that's disappointing. Hopefully, in the next few years surgical techniques and SMP will improve more to address this issue.

[tuna123]

Hi again,

Thanks for your feedback. It's good to have a 3rd party that knows the industry in and out on this forum.

What would be the best thing to do as a NW5-6 with average or below donor density? Have you seen any procedures work out well? Do you have any photos?

[Sean]

That's a great question. It be interesting to know the long term effects of smp on the skin. Does it create scarring on recipient zones in scalp? If there was FUE performed later would it be detrimental to the area? Seems like some folks that used smp with their transplant had good results as it seems to act like a filler.

[JoeTillman]

Hi Tuna,

The best thing to do is to not do anything. The best thing to do is to accept the fact that roughly 40% of all men will experience some degree of hair loss so by losing your hair you're not a social outcast nor are you unusual. This is one of the first things I usually say to people asking what they should do and in many cases people will still have a surgery, which is fine. However, in your case I think because you stated you have (potentially) below average density you should probably just forget about surgery completely. You should visit an IAHRS member doctor to confirm this but if you're right then just don't bother investing in surgery especially since only a small # of grafts would be realistic to begin with. And by moving forward with a small FUE and then trying to add SMP to the mix you're just trying to game the system which rarely ever works out the way one intends.

If you MUST do something then consider tricopigmentation with a reputable clinic that offers it to see how you like it. If you like the look then maybe you can consider adding some FUE to key areas but it's something that you should really think through before committing. At least with trico, if you decide you don't like it, it will fade away in a couple of years and it won't be something you're stuck with.

Hi Sean,

You bring up some good questions.

It be interesting to know the long term effects of smp on the skin.

I'm kind of torn on the subject but I do find it interesting. Tattoo ink in general is just a wild west side show in that you don't know what to believe but SMP pigments are supposed to be different. For one, and I can only speak about trico pigments, there aren't any black pigments which are considered bad. In fact, because trico pigments are made in Europe they have to pass stringent guidelines that are far more restrictive than anything the FDA does to regulate pigments and nothing that is known to have health issues is allowed. It is also supposedly hypoallergenic as well, which cannot be said of standard tattoo pigments in general. In fact, roughly 10% of people that get traditional tattoos will have some sort of short term allergic reaction to the process. From what I was told by Milena Lardi, she's never once had anyone report an allergic reaction after a trico procedure with her.

Does it create scarring on recipient zones in scalp? If there was FUE performed later would it be detrimental to the area?

As I always say, when you cut the skin you scar. However, when we look at skin cuts or injuries similar to those caused by an SMP needle, such as those from dermal rolling, we get not so much scar tissue formation but instead we get an increase in collagen production. Traditional SMP needles may go as deep as 2mm but trico goes only .5mm which is as shallow as about the most mild dermal rollers available. Some rollers go 1.5mm deep but the point is that permanent scars do not form but new skin does so in the end there shouldn't be any hindrance or negative effects in that regard. When you also consider that the microneedles in a roller are much closer together than the pattern an SMP technician would make to achieve density I think the long term outcome is clear in that it won't hinder the growth of future graft growth should one wish to augment with FUE.

[losthair85]

This is a great thread, and Joe thanks for your honest answers that DO make a lot of sense.
I hate to piggy back onto Tuna's thread, but I would like to pose a similar question...that is FUE with intention of not shaving right down + SMP.

I am a norwood 4V and currently machine cut to a #2 on top and then use dermatch to conceal scalp and the thinnest region, the crown.

I am planning for a 2000 FUE with Dr. Konior in the fall. He thought I had coarse hair during consultation.

What do you think about concentrating on a frontal zone hair transplant to rebuild the hairline/frontal zone with intention to machine cut on top to a #4, and then some SMP/trico behind this area and especially into the crown region for added illusion of effect? Would the contrast between a #4 machine cut (which is quite short) and SMP/trico behind it be too obvious? It seems like this could work to me, have you seen it in practice?

Is there a significant difference between something like SMP/trico and dermatch (what I am using now)?

Thanks for this informative thread.

[JoeTillman]

This is a great thread, and Joe thanks for your honest answers that DO make a lot of sense.
I hate to piggy back onto Tuna's thread, but I would like to pose a similar question...that is FUE with intention of not shaving right down + SMP.

I am a norwood 4V and currently machine cut to a #2 on top and then use dermatch to conceal scalp and the thinnest region, the crown.

I am planning for a 2000 FUE with Dr. Konior in the fall. He thought I had coarse hair during consultation.

What do you think about concentrating on a frontal zone hair transplant to rebuild the hairline/frontal zone with intention to machine cut on top to a #4, and then some SMP/trico behind this area and especially into the crown region for added illusion of effect? Would the contrast between a #4 machine cut (which is quite short) and SMP/trico behind it be too obvious? It seems like this could work to me, have you seen it in practice?

Is there a significant difference between something like SMP/trico and dermatch (what I am using now)?

Thanks for this informative thread.

Hi Losthair85,

No worries. I think that what you're asking for, and the chances of it looking good, are relative and depend on a list of factors, including the contrast between your hair color and scalp color and how much loss you have in the crown. Obviously it's enough to have a need for concealers but if it has only peach fuzz that it clings to then SMP won't work well. If it's just a moderate overall thinning it can work quite well but you have to understand a key difference. Concealers are called concealers because they're concealing your scalp and when they do this they do so in a manner that basically makes your scalp disappear. SMP only provided dots that mimic the exit point of hair and reduces the amount of visible scalp but with visible scalp in between the dots, if that makes sense. So you won't have the same effect and you won't have the same degree of coverage.

There is also a sweet spot for length when you're having SMP for a thickening effect as opposed to a shaved effect. To be honest, I don't know what that sweet spot is in this regard and I'm sure it is different for everyone. I had it done on my own scalp five years ago and it worked very well but my crown hair was longer than a #4 guard. My advice is to not count on SMP to do what you want and just incorporate concealers into your plan, if you want to incorporate anything. Once you have your FUE with Dr. Konior then you can try SMP and if it doesn't give you the result you want then you've got concealers as the planned backup.

I hope that helps.