You’ve probably already searched the healing photos, read the horror stories about botched hairlines, and wondered whether SMP will actually look like hair on your specific pattern of loss. This article walks through exactly what happens at each stage of treatment, from the first consultation to the healed result twelve months later. By the end, you’ll know what to expect at every appointment and how the process changes depending on your type of alopecia.
Scalp micropigmentation for alopecia is a three-session process in which a practitioner uses a fine needle device to deposit pigment into the upper layers of the scalp, creating the visual impression of closely shaved hair follicles. It doesn’t regrow hair or change the biology of hair loss. What it does is rebuild the appearance of density and camouflage the contrast between skin and remaining hair, which for most alopecia clients is the thing that actually bothers them day to day.
At Foli Sim, every alopecia client goes through the same structured three-session course, regardless of how mild or advanced the hair loss is. Kate Dawes, Founding Director and Senior Practitioner with 42 years in the hair industry, has built this into a fixed rule rather than a guideline: “Three sessions isn’t a sales figure, it’s what the skin needs. You cannot build convincing depth and correct tone in one or two sittings. I’ve seen what rushed work looks like on other people’s scalps, and it always shows.”
The consultation: working out what your alopecia actually needs
Before any pigment goes near your scalp, the first appointment is entirely diagnostic. The practitioner examines your scalp under strong lighting, checks skin condition for anything that might affect healing, such as active psoriasis, eczema flares or scalp acne, and discusses your history of hair loss.
This is where alopecia areata and diffuse or total hair loss patterns start to diverge in approach. Alopecia areata typically presents as one or more distinct bald patches on an otherwise full head of hair, which means the pigment work has to match tone and density precisely at the borders of each patch. Diffuse thinning or alopecia totalis, by contrast, usually means treating the whole scalp, which allows for more even, uniform density planning from the outset.
The consultation also covers realistic expectations. If you’ve got long hair around a patch of alopecia areata, the practitioner will talk you through how pigment sits differently under longer hair versus a fully shaved look. Photos are taken for reference, and a treatment plan is mapped out for all three sessions before the first needle touches your skin.
Session one: building the base pattern
The first replication session is the longest and most foundational. Using a single-point needle around 0.2mm for border areas and a triple-point needle around 0.25mm for broader zones, the practitioner begins placing pigment dots at a shallow depth, generally starting at a lower dot density and building outward.
For alopecia areata patches, this session focuses on establishing a soft transition between the patch and surrounding hair, avoiding anything that reads as a hard edge. For diffuse or total hair loss, the first session lays down an even base pattern across the whole treatment area, which will be built up in subsequent visits.
Sessions typically run between one and five hours depending on the size of the area. You’ll see redness and some pinkness immediately afterwards, similar to a fresh tattoo. This is normal and expected to settle within a few days.
- Days 1 to 4: no water on the scalp, no shampoo, no sweating, no shaving.
- Days 5 to 10: gentle washing permitted, avoid direct sun exposure.
- Day 10 onwards: SPF on the scalp, normal grooming can resume.
- Swimming pools and saunas should be avoided for a full 28 days.
Some clients ask about pain relief. Oral painkillers available over the counter in Australia can be taken beforehand if you find the sensation uncomfortable, but you should check with your doctor first rather than relying on advice from the clinic itself.
Sessions two and three: depth, blending and refinement
The second session usually happens one to two weeks after the first, once initial healing has settled and the practitioner can see how the pigment has taken. This is where density increases, moving from an initial lighter dot pattern toward something closer to 80 to 100 dots per square centimetre in the areas that need it most.
For alopecia areata clients, session two is largely about blending: matching the pigment tone to natural hair colour and softening any patch borders that still look too defined against surrounding hair. For diffuse and total hair loss clients, this session adds meaningful depth across the whole scalp, which is usually when the result starts looking convincingly like a close crop of hair rather than isolated dots.
The third and final session refines everything. Small corrections are made, any spots where pigment has healed lighter than expected are topped up, and the practitioner checks the whole scalp under different lighting conditions to make sure the density reads naturally from every angle. Kate Dawes puts it plainly: “The third session is where the work actually finishes. Skin doesn’t hold pigment perfectly evenly after healing, so this session exists to fix exactly that.”
How the healed result differs for patchy versus total hair loss
Once the full 30-day healing period has passed after the final session, the differences between alopecia types become clearer in the finished result.
| Alopecia pattern | Typical treatment focus | Healed appearance |
|---|---|---|
| Alopecia areata (patchy) | Blending patch borders into surrounding natural hair | Patches read as shaved scalp rather than bald skin; borders soften into existing hair |
| Diffuse thinning | Even density built across the whole scalp | Reduced scalp show-through, fuller appearance under normal lighting |
| Alopecia totalis | Full scalp coverage with graduated density | Complete buzzed-hair appearance across the entire scalp |
Results from SMP typically last four to eight years before touch-ups are needed, though this varies with skin type, sun exposure and how quickly your skin naturally turns over pigment. Regular SPF 30 to 50 on the scalp after healing helps slow fading considerably. Most clients return for a touch-up every four to six years, which is a far smaller commitment than ongoing management of other hair loss treatments.
SMP is not suitable for everyone. Active scalp conditions such as psoriasis flares, eczema or keloid-prone skin need to settle or be assessed carefully before treatment begins. If you’re weighing SMP against a hair transplant, it’s worth knowing SMP involves no surgery, no donor site, and considerably less cost and recovery time, though it doesn’t regrow a single hair. It simply changes how existing hair loss looks.
If you’re considering SMP for alopecia, the clearest next step is a face-to-face look at your scalp rather than guessing from photos of other people’s results. Foli Sim offers a free, no-obligation consultation at the Perth studio, as well as at the Melbourne and Sydney locations, where a practitioner can assess your specific pattern of hair loss and map out exactly what your three sessions would involve.
Frequently Asked Questions
What does SMP look like for alopecia areata patches specifically?
For alopecia areata, SMP focuses on blending pigment into the borders of each bald patch so it reads as closely shaved scalp rather than isolated bald skin. The goal is a soft transition into surrounding natural hair, built up gradually across three sessions rather than one heavy application.
How many sessions does SMP require for alopecia?
Three sessions are required for SMP regardless of how mild or advanced the alopecia is. Each session builds on the last, adding density and refining tone, and skipping sessions or compressing the process typically produces a less convincing, patchier result.
Does SMP work differently for total hair loss compared to patchy alopecia?
Yes. Total hair loss, such as alopecia totalis, is treated with even density across the entire scalp from the first session, while patchy alopecia areata requires careful blending at patch borders to match surrounding natural hair. Both still follow the same three-session structure.
How long does it take to heal after each SMP session?
Initial redness settles within two to three days, but full healing after the final session takes around 30 days. Water, shampoo, sweating and shaving should be avoided for the first four days, with gentle washing allowed from day five and sun protection needed from day ten onwards.
Will SMP results fade, and how often do alopecia clients need touch-ups?
SMP results typically last four to eight years before noticeable fading occurs, with most clients returning for a touch-up every four to six years. Sun exposure, skin type and aftercare all affect how long the pigment holds its depth and tone.
Ready to talk it through?
Foli Sim in Perth offers a personal consultation to answer your questions and recommend the right approach for you. Get in touch with Foli Sim to book your consultation.
