Scalp micropigmentation (SMP) is an innovative type of tattooing that mimics the appearance of natural hair – and for those experiencing hair loss, it can be truly transformative.
SoGlos sits down with acclaimed SMP artist and founder of Cheltenham's HeadStrong Clinic, Russ Nicholson, to discover how this innovative treatment can help men and women experiencing hair loss regain their self-confidence in just three to four sessions.
How does SMP differ from other types of tattooing?
In many ways, it's more similar than people think. All forms of tattooing are aiming for that same upper layer of the dermis – the second layer of the skin. That's where pigment is held most effectively, and those fundamentals don't change.
Where SMP differs is the artistry. When it comes to the scalp, you’re creating something incredibly subtle, the illusion of thousands of individual hair follicles which, together, create the illusion of a shaved head of hair, or much greater density for areas of thinning. It requires skill to blend in with the natural hair colour and existing follicle density. Precision is everything. When it's done well, it looks completely natural.
The pigment I use is also made specifically for the scalp. It is organic and thinner than traditional inks, and preferred for its hypoallergenic nature, minimising the risk of allergic reactions and irritation.
How does SMP replicate the look of hair?
The magic is in the detail, and the detail is tiny. We're talking about microdots, incredibly small deposits of pigment placed individually into the scalp to mimic the appearance of hair follicles. When you look closely at natural hair follicles, they're not uniform. They vary in size, shape, depth, colour, and that's exactly what I replicate. I use different needle sizes and multiple shades of pigment to create that same natural variation.
What makes SMP so versatile is that it can be used for almost every hair type and skin tone. Whether someone has very fine, fair hair or thick, dark hair, whether they've got olive skin or pale skin, SMP is tailored to your natural appearance.
I also adapt the density and distribution of the dots to suit someone at the very earliest stages of thinning all the way through to complete hair loss. No two heads are the same, and no two treatments should be either. I spend a lot of time at consultation stage really understanding what each person wants from the treatment, what feels right for them, and what's going to look completely natural for their age and their face.
How many sessions are there in a typical course of SMP?
A full course is typically three to four sessions. The first session is about building the base foundations of the treatment. In that session I establish the hairline, the shape, and lay down the initial framework. This is a really important stage because getting the hairline right is everything. A hairline that's too sharp or too low will look artificial immediately, so we take real time here to get it right.
The second session is where we build density by adding, blending and working across the whole scalp or area to create that consistent, natural look. Then the third session is where it all comes together, where we increase density, refine the colour and really dial in the detail – and where you get to see the finished result.
In the fourth session, about four weeks post treatment, once the skin has settled, I review with the client and add any finishing touches I feel are necessary, to make sure both me and the client are 100 per cent happy. After that, clients walk away absolutely delighted.
I always say, don't judge it on session one which can be quite underwhelming. Trust the process, because by the end, it genuinely transforms how someone looks and feels.
Is SMP a permanent solution?
SMP is a long-term solution, but not a 'do it once and forget forever'.
Over time, the pigment can soften and settle into the skin, causing some fading. External factors such as UV should also be considered – for example, if you over-expose yourself to the sun, it will inevitably have an impact. Most clients find that a maintenance session every three to five years keeps everything looking fresh and sharp.
Honestly though, for most people that's a really minor consideration compared to the daily impact hair loss is likely having on their lives. The way I look at it, that gentle fading is actually a positive thing — it means if you ever want to make a subtle adjustment as you age or your hairline naturally changes, we can do that. It's not set in stone forever. It evolves with you.
Is SMP suitable for everyone?
The truthful answer is not always, and I'll always tell someone that, even if it's not what they want to hear. I won't advise a treatment if I don't think SMP is the right solution for them at that moment.
That said, SMP has an incredible range of applications. It works across all stages of hair loss — from someone who's just starting to notice thinning through to complete pattern baldness. It works brilliantly for people with alopecia, where we can disguise areas of patchy baldness in the same way we would on wider areas. I also work with people who have scarring, whether from surgery, accidents or previous hair transplants, where SMP can disguise and blend those areas seamlessly.
SMP is also absolutely not just for men. A significant number of my clients are women. Female hair loss is incredibly common, whether from hormonal changes, conditions like alopecia, thinning over time, or stress. The emotional impact is just as profound, sometimes moreso, because there's even less conversation about it.
For women experiencing thinning, SMP can add the appearance of density and fullness between existing hair, delivering a really natural result that gives confidence back. Anyone who's unsure whether it applies to them, come in, have a chat. That conversation costs nothing.
What sort of results could someone hope for after SMP?
The goal is always for someone to look in the mirror and feel confident in what they see. It should look like a deliberate style choice, not a response to hair loss. When it's done properly, even under close inspection it's genuinely difficult to tell the difference between the SMP and real hair follicles.
We create a soft, natural-looking hairline that frames the face properly, not a hard edge, not something geometric and artificial, but something that looks like it grew there. A lot of clients tell me afterwards that people around them can't quite put their finger on what's changed, they just know they look well, they look like themselves again. That, to me, is the ultimate result. Not that it's dramatic, but that it's seamless.
As well as physical appearance, how does SMP affect people's self-confidence?
This is the bit I can relate most to and care about for my clients. The physical transformation matters, but what happens underneath it is where the real change takes place.
Personally, I struggled with hair loss in my late twenties and the effect it had on my confidence was significant. It was something I thought about constantly, it affected how I carried myself, how I felt walking into a room. When I eventually had SMP myself, yes I looked different, but more importantly, I stopped thinking about it. That mental space coming back was huge. I wasn't fixating on it anymore. I felt like me again.
I hear versions of that story from almost every client. People talk about going back to the gym, being more present with their partner, their kids, feeling confident in meetings, wanting to be in photos again.
Hair loss, for men and women, touches identity in a way that's really hard to articulate until you've experienced it. There's still a tendency to dismiss it as vanity, and I think that's deeply unfair. At HeadStrong, I talk about that openly with my clients. I'm also a skincare advisor for Look Good Feel Better, supporting people going through cancer treatment, and I've seen first-hand just how powerful feeling comfortable in your own skin can be.
Why are more people opting for SMP over surgical procedures like hair transplants?
I think a few things have shifted. Firstly, awareness of SMP has grown enormously. Five years ago, a lot of people had simply never heard of it. Now there's much more visibility, more conversation online, and people are researching their options more thoroughly.
When they compare SMP to a hair transplant, the differences are pretty compelling. A transplant is a surgical procedure – there's downtime, there's recovery, there's a level of risk, and there's a significant cost, often running into thousands. Results can also vary, and it doesn't address ongoing hair loss, so many people end up needing further treatment or eventually considering SMP anyway, to fill in the gaps.
SMP, by contrast, is non-surgical, there's no recovery period, most clients are back to their normal routine within a day or two and the results are immediate. You leave your third session looking the way you want to look. It's also considerably more accessible in terms of cost. And critically, it works regardless of what stage of hair loss someone is at. There's no 'we need to wait and see how much you lose first.' We can treat someone effectively right now.
Do you think attitudes towards aesthetic treatments are changing — particularly for men?
Absolutely, and I think it's a positive shift. When I first started out, a lot of men would come in almost apologetically, like they needed to justify wanting to feel better about how they looked. There was this unspoken idea that caring about your appearance as a bloke was somehow a weakness. That attitude is changing, and changing fast.
Men are more open now to talking about how they look, how they feel, and what they can do about it. Social media has played a part, there's more visibility of men investing in grooming and aesthetics. But I also think men's mental health has become a much bigger part of the conversation, and the two things are connected. When people start talking more openly about how they feel inside, it becomes easier to admit that how you feel about your appearance matters too.
I've always been vocal about the mental health aspect of what I do at HeadStrong, because I genuinely believe in that connection. Confidence and wellbeing aren't separate things. For a lot of the men and women who come through my door, this isn't a vanity treatment, it's a step towards feeling like themselves again. And that's never something to be embarrassed about.
To book an SMP consultation with Russ at HeadStrong, visit headstrongclinic.co.uk.
