Scalp Micropigmentation Is an Effective Treatment for Localized Alopecia: Technical Analysis and a Series of Ten Case Reports

ABSTRACT Background Scalp micropigmentation (SMP) is emerging for camouflaging localized alopecia, yet standardized protocols and long‐term efficacy data remain limited. Aims To evaluate technical parameters, clinical outcomes, and safety of SMP in diverse alopecia subtypes. Methods Ten patients (androgenetic alopecia: n = 6; scarring alopecia: n = 4) underwent a standardized three‐session SMP protocol. Technical refinements included zone‐specific needle selection (single/triple point), hierarchical pigment deposition (prioritizing thick‐haired regions), and randomized distribution to avoid uniformity. Pigment density was incrementally adjusted (30%→70%→100% of natural follicular spacing). Adherence to a zero‐bleeding protocol ensured epidermal–upper dermal depth. Outcomes were assessed via visual density score (VDS, 0~10) and patient satisfaction score (PSS, 0~3). Results All patients achieved significant cosmetic improvement. Immediate posttreatment VDS averaged 8.7 ± 1.1, with androgenetic cases scoring higher (9.1 ± 0.5). At 6‐month follow‐up, VDS declined modestly (7.7 ± 1.4), though scarring alopecia showed greater fading (Δ = 1.6 vs. Δ = 0.9 in androgenetic, p = 0.03). Patient satisfaction was high (mean PSS = 2.7/3), with 85.7% of androgenetic cases “very satisfied.” Strong correlation existed between VDS and PSS ( ρ = 0.91, p < 0.001). No adverse events occurred. Conclusions SMP is a safe, minimally invasive solution for localized alopecia, providing sustained cosmetic improvement. Technical refinements in needle selection, pigment layering, and depth control optimize outcomes. Future studies should focus on long‐term pigment retention and expanded cohorts.