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Photo: Scalp Micro USA

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Forget Toupees, Try Tattoos

Why are thousands of people getting dots tattooed on their scalps to give the illusion of hair?

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At the office of Scalp Micro USA in Manhattan, hair is not grown, it’s made. The flagship office feels more like a hip spa for dudes than a tattoo parlor — there’s pumping pop music, a cowhide rug on the hardwood floor, men’s interest magazines on the stylish coffee table. It gives the impression of being a little preoccupied with its masculinity.

Moses De Jesus drove seven hours from Massachusetts for his second appointment. He lost his hair young, at about 20 or 21, he thinks. He’s 30 now, and has always been interested in getting his hair back in a natural way. “This is the closest thing to that,” he says. He takes off his hat to reveal a dusting of dark dots. His family has noticed, he says — his daughter, age four, thinks his hair is growing back, but his son, 13, is privy to the truth behind his dad’s new ’do. De Jesus sits in a tall chair and tells technician (or “artist”) Matt Iulo about how he’d like to lower his hairline a bit this time. Iulo marks out the new hairline with something that looks like a white colored pencil.

Then they get started. Iulo starts at the hairline. He deftly and quickly moves the pen, which looks a lot like a tattoo machine, dotting De Jesus’ scalp in a pattern that is not too concentrated but not too sparse. It doesn’t hurt, De Jesus says, but he feels it, and the vibration from the tool makes his nose run. Iulo dabs away the excess ink with a tissue. From what I can see of the final result, it seems pretty convincing.

Matt Iulo treating a patient.
Photo: Scalp Micro USA

De Jesus is getting scalp micropigmentation, a procedure in which an artist dots the head with permanent ink to give the semblance of very short hair. De Jesus is one of thousands of people internationally to have chosen the procedure. Hair loss can negatively impact a person’s confidence, and as more affected men and women refuse to settle for the head they’ve been dealt, a growing number are turning to scalp micropigmentation. The procedure is cheaper and often less invasive than other hair-loss treatments.

Matt Iulo, who founded Scalp Micro USA in 2015 and runs the Manhattan clinic, says his clinic alone has done about 3,000 procedures over the past three years. In fact, in 2010, he got it himself, then worked in similar scalp micropigmentation clinics for a few years before starting his own.

Here’s how it works. The ink — a natural-based pigment without any metals, so it’s rare that anyone has a negative reaction to it — is diluted to match the client’s hair color. The machine used to dot the pigment on the scalp is a microneedle, so it stays shallow on the skin, more like permanent makeup than traditional tattooing.

A man’s hairline before and after the procedure.
Photo: Scalp Micro USA

“We don’t draw on the scalp — we shade,” Iulo says. It’s done in layers, which takes two to three sessions, each of which can last up to four hours depending on how much of the head they’re shading. There’s an art to doing the procedure, Iulo says, to knowing which hairline fits a person’s head shape. The basics are easy, but mastery takes a long time. Every five years or so, the pigment lightens, so clients often want a touch-up.

The effect is subtle. Most clients don’t have to explain to loved ones or coworkers why their hair has suddenly grown a little bit; instead, people around them say things like, “You look good, you look different, but I can’t put my finger on why.”

For clients who are almost completely bald, it makes it look like they have a shaved head. “I choose to wear my hair this way. I have a hairstyle, it’s a shaven head,” says Ian Watson, the CEO and co-founder of His Hair Clinic, which invented the procedure (Watson trained Iulo, along with many other people who operate similar clinics in the US).

Many of Iulo’s clients are men who are losing or have already lost their hair, like De Jesus, but he also works with women and people who don’t grow hair due to medical conditions like alopecia (they do eyebrows, too, with a “hairstroke technique” to make them look sufficiently bushy). Somewhere around 40 percent of his clients want to cover up scars from previous hair transplant procedures. Iulo offers a discount to veterans, firemen, and police, who he estimates make up about 10 percent of his client base.

The only real risk is of an allergic reaction to the ink, which is rare, Iulo says. Occasionally patients want to get some of their pigmentation removed or to change their hairline, which requires laser removal, much like a standard tattoo.

Eyebrows before and after the treatment.
Photo: Scalp Micro USA

Depending on the extent of hair loss, scalp micropigmentation can cost between $2,000 and $3,500 at Iulo’s clinic. Compared to other interventions, that’s a bargain. Hair transplantation is an invasive surgery and costs around $16,000 in New York City, says Nicole Rogers, a dermatologist who has been treating hair loss for a decade and recently started her own hair-loss practice in New Orleans (she doesn’t do scalp micropigmentation there). “Hair systems” or wigs can run $3,000 and have to be replaced every year, if not more often.

Rogers says scalp micropigmentation can be a great option for women with advanced hair loss, men who have had a lot of hair surgery, and people with alopecia. But she doesn’t recommend the procedure for men who have short hair with hairlines that are actively receding. “I’ve seen men who have had scalp micropigmentation done too soon,” she says. “The problem with men is that the whole hairline can move back. If they don’t have a stable hairline [and they get the procedure done,] they may have a funny-looking hairline sticking out.”

There are a few dozen clinics operating throughout the United States. Watson, who has been doing the procedure for 15 years and has trademarked the acronym SMP, has mixed feelings about its growing popularity. On the one hand, he’s grateful that more people are hearing about the technique and finding a solution that works for them. On the other hand, almost all the people starting these clinics were once employees or clients of Watson’s, and they’re taking business from him. “We set up our company to help people. They set up to make money,” he says. “Their motives aren’t as true as ours.” Watson is considering legal action against clinics advertising their services with the acronym SMP, which he trademarked in the US and the United Kingdom.

A Scalp Micro USA client.
Photo: Scalp Micro USA

But for most clients, these kinds of conflicts don’t matter much. For many, the final result is that their confidence is restored. “No one cares about your image more than you,” Iulo says.

Confidence was what De Jesus was looking for, too. When I left, about a half hour into his second session, he was well on his way. He was excited to see what the final outcome would be, and so was his wife.

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