SMP takes 2 to 4 sessions over 3 to 8 weeks to complete. Each session builds on the previous one, layering pigment dots at increasing density until the final result matches the appearance of a naturally full, closely shaved scalp or fills in thinning areas with realistic coverage.
This article is for informational purposes only and does not constitute medical advice.
Before Your First Session
Consultation and Design
Every SMP treatment starts with a consultation, either in-person or virtual. During this meeting, the practitioner:
- Assesses your hair loss pattern and Norwood stage
- Discusses your desired hairline position and density level
- Evaluates your skin tone to select the correct pigment shade
- Reviews your medical history for contraindications
- Photographs your scalp for before-and-after documentation
- Provides a treatment plan with session count and pricing
The hairline design is the single most important decision in SMP. A good practitioner will create a hairline that looks age-appropriate and matches your facial structure. Overly low or perfectly straight hairlines look unnatural. The best SMP hairlines have slight irregularity and a soft, feathered edge.
Pre-Session Preparation
| Task | Timing |
|---|---|
| Shave or buzz your head to desired length | Day of or day before session |
| Avoid alcohol | 24 hours before |
| Avoid blood thinners (aspirin, ibuprofen) | 3-5 days before (consult your doctor) |
| Wash and clean your scalp | Morning of session |
| Eat a full meal | 1-2 hours before (prevents lightheadedness) |
| Avoid caffeine | 2-3 hours before (reduces scalp sensitivity) |
Arrive with a clean, freshly shaved or buzzed scalp. The practitioner needs to see the scalp surface clearly to place pigment accurately.
Session 1: The Framework
Duration: 2 to 4 hours
The first session establishes the foundation of your SMP treatment. It is the most involved session because it includes hairline mapping and the initial pigment layer.
What Happens
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Numbing (30-45 minutes): Topical anesthetic cream is applied to the entire treatment area. Some practitioners use a combination of topical lidocaine and a nerve block for areas with higher sensitivity (temples, crown).
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Hairline mapping (15-30 minutes): The practitioner draws the proposed hairline using a cosmetic pencil or marker. You review and approve the design in a mirror before any pigment is applied. This step is collaborative. Speak up if the hairline is too high, too low, or does not match what you discussed during consultation.
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First layer of pigment (1.5-3 hours): Using a specialized SMP machine with single-point or 3-point needles, the practitioner begins depositing dots of pigment across the treatment area. The first layer is intentionally lighter and less dense than the final result. This layer creates the base pattern.
What It Looks Like After Session 1
The scalp will appear slightly reddish with visible dot patterns. The pigment will look darker than intended for the first 3 to 5 days, then lighten as the skin heals and the outer pigment layer sheds. By day 7 to 10, the remaining pigment settles into a lighter, more natural shade.
Expect session 1 to look incomplete. This is normal and by design. Layering pigment across multiple sessions produces a more realistic result than trying to achieve full density in a single appointment.
Session 2: Building Density
Duration: 2 to 3 hours Timing: 7 to 14 days after session 1
What Happens
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Assessment: The practitioner evaluates how the first layer healed. Some dots will have faded more than others. Areas where the skin absorbed less pigment are identified for additional attention.
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Pigment reinforcement: The second layer fills in gaps between first-session dots, creating a denser appearance. The practitioner works between existing dots rather than on top of them, building the three-dimensional illusion of real follicles at varying stages.
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Hairline refinement: The soft, feathered edge of the hairline is adjusted. The transition zone between the hairline and the bare forehead gets its characteristic gradient of decreasing dot density.
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Color adjustment: If the pigment from session 1 healed lighter or warmer than expected, the practitioner adjusts the shade for session 2.
What It Looks Like After Session 2
Density is noticeably increased. Most patients can see the intended final result starting to take shape. The scalp may again appear slightly red and darker than the final outcome, settling over the following week.
For patients with smaller treatment areas (scar camouflage, mild thinning), session 2 may be the final session.
Session 3: Refinement
Duration: 1 to 3 hours Timing: 7 to 14 days after session 2
What Happens
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Final assessment: The practitioner reviews the cumulative result under different lighting conditions (overhead, natural, side-lit) to identify any areas that need additional density or blending.
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Detail work: This session focuses on precision. Adjustments include evening out density in specific zones, perfecting the hairline edge, blending the transition areas at the temples and nape, and adding micro-details that increase realism.
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Final photography: Updated photos are taken for comparison with the pre-treatment baseline.
What It Looks Like After Session 3
The result is complete for the majority of patients. The scalp shows a uniform pattern of realistic follicle impressions with appropriate density gradients. The hairline looks natural with the characteristic soft, irregular edge.
Session 4 (If Needed)
Duration: 1 to 2 hours Timing: 7 to 14 days after session 3
A fourth session is recommended for:
- Full head treatments on Norwood 5 to 7 patients who want maximum density
- Patients whose skin absorbed less pigment than average
- Patients who want ultra-dense coverage that requires careful layering to avoid an artificial look
Not all patients need session 4. Many practitioners include it as an option within their package pricing at no extra charge.
Pain and Discomfort
SMP discomfort varies by person and by scalp location.
| Scalp Area | Sensitivity Level | Notes |
|---|---|---|
| Top of head | Low to moderate | Most tolerable area |
| Hairline and forehead | Moderate | More nerve endings |
| Temples | Moderate to high | Thinner skin |
| Crown/vertex | Moderate to high | More sensitive than top |
| Behind ears | Moderate | Can be tender |
| Scar tissue | Low | Often has reduced nerve sensation |
Most patients rate the overall experience at 3 to 5 out of 10 on a pain scale, with the numbing cream in effect. The sensation is commonly described as a light buzzing or scratching feeling. It is significantly less painful than a traditional body tattoo.
What to Expect Between Sessions
Between each session, the scalp goes through a healing cycle.
| Day | Healing Stage |
|---|---|
| Days 1-3 | Redness, slight swelling, pigment appears darker than final shade |
| Days 3-5 | Light flaking or peeling begins as outer pigment layer sheds |
| Days 5-7 | Flaking subsides, pigment lightens to closer to final shade |
| Days 7-10 | Pigment fully settled, true color visible |
| Days 10-14 | Scalp fully healed, ready for next session |
Do not pick or scratch flaking skin. Let it shed naturally. Premature removal can pull pigment out of the dermis and create uneven spots.
Next Steps
SMP is a structured process that rewards patience. Each session builds on the last, and the final result depends on completing the full course. To understand whether SMP is appropriate for your hair loss stage, read our SMP complete guide or check the Norwood scale. For a free personalized assessment, visit myhairline.ai/analyze.