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Scalp Hair Follicle Simulation Tattooing™

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Andrea Darby International Master Trainer

Andrea Darby - Master Trainer at Permanent International Congress Berlin 2012

ParaMedical & Medical tattooists have been providing scalp camouflage tattooing services for clients/patients for at least the last 20 years and this includes attempts to obscure small patches of hair loss and transplant scars with pointillism's or etching strokes in an effort to mimic the appearance of hair, sometimes the results were aesthetically pleasing to the client other times they were not.

In the last few years there has been a lot of interest, in particular by men with Androgenic Alopecia, who have been actively seeking this service and as a result supply has met demand with an increasing number of technicians offering this type of service.

Who provides this type of service?

The quality of outcome for the clients from the range of service providers is quite diverse I have seen some very good outcomes and I have also seen some outcomes that have been devastating for their clients. Some technicians may think this is an easy service to provide  believing “its just putting a few dots of pigment on someone's head” nothing could be further from the truth.

During that past few years I have observed with dismay as technicians with inadequate training have begun offering scalp tattooing with virtually no understanding of when or how this service should be provided and even worse no comprehension of when it should not be provided. Its important to note that most respected Medical Tattooists had many years of prior experience in providing Cosmetic Tattoo services before they undergo training in Medical tattooing.

I have been cautiously perfecting and improving scalp tattoo services in Melbourne for several years for clients with suitable forms of alopecia or for the camouflage of hair transplant scars. I have also had several requests from the clients of other service providers to correct the outcomes of poor quality tattooing, with this in mind we undertook detailed research involving the review of over 200 scientific and clinical publications and have created the first comprehensive course in Scalp Hair Follicle Simulation Tattooing™ (SHFST™) the acronym is pronounced 'shift' for simplicity.

What about dedicated scalp tattoo services?

A: Some would not even meet our prerequisites for enrolment in our SHFST™ course, we decline more applications than we accept.

For example SHFST™ is module 16 within our training curriculum and we only accept enrolments from those with adequate prior qualifications, but some of the dedicated scalp tattoo services out there have jumped straight from little or no prior medical tattooing experience into offering one of the most difficult types of Expert Medical Tattoo services.

Who are the most appropriate providers of this service?

A: In my opinion the most appropriate providers of this service are skilled Medical Tattooists and Health Professionals who have undergone our comprehensive training program in
Scalp Hair Follicle Simulation Tattooing™

Remember to ask your chosen service provider the following questions:

  • Are you a qualified Medical Tattooist or have you just undergone a quickie course in tattooing?

  • What is your background in the field of Medical Tattooing?

  • How long have you been a Medical Tattooist?

  • What other Medical Tattoo services have you been trained to provide?

  • Have you completed the CT-AIVEP SHFST™ course?

  • How many Scalp Hair Follicle Simulation Tattooing™ services have you provided?

  • How long do I need to wait for an appointment (if you can obtain treatment on very short notice that should ring alarm bells)

"I do not condone technicians taking an aggressive commercial approach to the provision of this service nor do I agree with them applying pressure to clients to undergo a treatment. But if technicians are going to offer this service surely it is better that they are trained properly?"


Before Undergoing this type of treatment I recommend that you read the article on the link below;
Scalp MicroPigmentation - More Than Just Ugly Scars


My Approach To This Service Is Quite Different to Anyone Else In The Industry

Before & After
 (3 x SHFST™)

This procedure has been given many names in recent years, in our view none of those terms are accurate enough for it to be clear to client or patient precisely what the service actually is, and some terms in use are downright misleading. I have adopted the trademark term;
Scalp Hair Follicle Simulation Tattooing™,
I believe this is the most accurate description of the service being provided, I am tattooing pigment into the skin of the scalp in an attempt to simulate/mimic the appearance of a hair follicle.

I claim both Copyright and Trade Mark over the use of this term and acronym primarily because I do not want the term being being used by untrained providers to describe lower quality untrained services.

Privacy: My client photographs are not routinely placed on our website to ensure client privacy but numerous photographs can be viewed during a consultation.


Surgical Loupes are an essential part of the examination process when performing SHFST™ services as they provide high quality magnification of the treatment area.

Some technicians may simply purchase a cheap set of jewellers loupes or a poor quality (toy) set of imitation surgical loupes but they simply do not provide the quality magnification required.

I use plastic surgeon grade surgical loupes and lighting which cost several thousand dollars but they are worth every cent to improve magnification in the field of vision and ultimately the quality of work.

Tip: Ask your technician what kinds of magnification devices they use and if they are plastic surgery grade.

Pigment depth is crucial with SHFST™ for this reason I use a variety of Medical/Clinical grade equipment to assist me in determining the correct depth of pigment implantation including the use of a Multi-Spectral device.

I am unaware of any other Cosmetic Tattooist who is skilled in the use of this type of equipment.

To have a large area of scalp tattooed you may be seated for several hours, therefore it is important for both the client and the technician to be seated comfortably with easy adjustment of position, I consider an electric adjustable couch essential equipment.

Some technicians may expect you to sit in a cheap uncomfortable chairs or massage tables, this will result in you moving around a lot trying to get comfortable and that will ultimately affect the outcome of your tattooing.

Tip: Ask your technician if they have a comfortable electric chair for you to sit in during the procedure.


Many technicians offering this service simply guess what needle size and ratio to use and what pointillism density (pigment dots) to provide. As a result they might make completely the wrong choice of needle size and pointillism density.

After extensive research I now routinely perform a SHFST™ Tricho-Exam to ascertain the average diameter of the hair follicles for the client and a target density that relates to the clients surrounding hair density.

Tip: Ask your technician how they determine the relationship between needle size and the size of your hair follicles.

Readings taken from the client during the examination are then fed into our own proprietary software the SHFST Tricho-Analyser™ this software is the result of 5 years of extensive research and the review of over 200 clinical and scientific publications.

The SHFST Tricho-Analyser™ takes the guess work out of needle selection it automatically calculates;

  • Calculation of the treatment area in square centimetres

  • Estimated number of treatments required

  • Estimated duration of each treatment in hours based on my individual workflow rate

  • Suggested needle sizes

  • Ratio of use of different needle sizes

  • Suggested needle depth based on average epidermal and dermal depth for age and sex of my client

  • Suggested pigment colours

  • Expert comments based on my clients metrics

This information assists me with my treatment plan for the client.

Tip: Ask your technician if they use the SHFST Tricho-Analyser™ to guide them on the treatment plan.


Many technicians providing scalp tattoo services give little thought to their clients mental state.

There is a higher rate of depression among people with alopecia than is present in the general population, for this reason if I believe a client is exhibiting significant signs of depression I may ask them to complete a short 60 second self rating questionnaire which helps identify those clients who should be reviewed again by their doctor before making this kind of cosmetic treatment choice.

We have integrated a widely accepted standard clinical self rating questionnaire into our own proprietary software that automatically calculates the raw score and severity index.

I consider this to be an ethical approach in circumstances where I believe a client may be vulnerable or their decision making may be compromised.

Tip: Ask if your technician is a trained Para/Medical Tattooist.


Selecting the correct machine, hand piece, and needle are essential steps required before commencing a SHFST™ treatment.

I use a Linelle Supreme and the new high precision 'Precise' hand piece, and I use needles that were specifically developed for hair simulation tattooing. Some technicians may be using needles obtained from dubious sources, we do not condone the use of under the counter needles.

Tip: Always ask your technician to provide full details about the type and source of their needles, ask to see the needle packet.


Wrong Choice of Equipment & Technique

Use of the wrong equipment and technique can result in a very aesthetically unpleasing result. This client approached me for correction of full scalp tattooing performed by a "Cosmetic Tattoo Trainer".

Wrong choice of equipment
Wrong choice of handpiece
Wrong choice of needle
Wrong needle depth
Wrong technique
Wrong choice of pigment


Some kinds of alopecia should not recieve scalp tattooing.

Both the SHFST™ Tricho-Exam and the clients medical questionnaire provide me with important information that helps to determine which clients have forms of alopecia that may not be suitable for scalp tattooing.

There are certain kinds of alopecia that need to be excluded before providing the service, many technicians providing scalp tattooing are unaware what forms of alopecia should not be provided a scalp tattoo service.

Crucial Tip: Ask if your technician has been instructed by a Registered Health Practitioner on which forms of alopecia should not receive scalp tattooing.


What Needle Depth?

Selecting the correct needle depth is an important part of every cosmetic tattoo procedure, we sometimes ask experienced cosmetic tattooists what needle depth they use for various procedures and we often find that either they don't measure the depth at all or they use objects such as the width of coins as a standard measurement for all their clients without any rational reason for selecting that particular depth.

Selecting the correct starting needle depth for the age and sex of the client for the initial test patch is more important for SHFST™ than with any other procedure but many technicians simply guess and can end up using the wrong needle depth.

Tip: Ask your technician to explain the rationale they use to choose the correct needle depth for a procedure.

Test Patch

The initial stage prior to a full SHFST™ treatment is a test patch, the results of the test patch are reviewed in 4-6 weeks time, the results of the test patch provide me with important information that I will use to fine tune a full scalp tattoo treatment.

Q: Will you perform a full scalp SHFST™ treatment without a test patch.

A: No, this is an important step.

Pigment chemists are the appropriate experts for compounding pigments, would you buy medications from someone who was making them in their garage?

Tip: Avoid technicians who are "experimenting" with pigment ingredients. This kind  of work should only be performed by a Pigment Chemist.

The choice of pigments is another challenging factor this is because previously pigments were not specifically manufactured for scalp tattooing, this has resulted in technicians experimenting with pigment blends in an attempt to provide a suitable pigment for scalp tattooing. Some technicians engaging in pigment experimentation have absolutely no idea about pigment chemistry, some may not even have a basic understanding of pigment colour theory.

We have been working with our pigment manufacturers senior chemist to fine tune a standard pigment range specifically for SHFST™.

Tip: Ask your technician to disclose the full details of the source of their pigments and ask to see the full ingredients list.

NB. This pigment range is only made available for purchase by technicians who have completed our SHFST™ course.


Shortcut services using pigment rollers - results do not look natural

Pigment implantation technique is also important, pointillism's need to be placed in a random pattern that mimics a natural hair distribution and consideration also needs to be given to hairline shape & position, temporal angles, and whorl.

Some technicians are actually advocating the use of needle rollers to provide scalp tattoo services.

I suppose it depends of you like the corn plantation look!





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Another trend I have noticed with the 'novice' services that are springing up around the globe is that due to lack of adequate prior medical tattooing experience the novice service providers are using body art techniques that achieve a 'pigment wash' type result.

The result can be that the skin just looks as if you have coated a dilute paint over the entire area. This just results in a general duskiness of the skin rather than the simulation of a hair follicle and that type of look will only give the appearance of hair coverage from a very long distance away (4-5 meters).

Novices services may try diluting unsuitable pigments with tap water or saline and may even coat the skin with a pigment wash at the end of the tattoo procedure in an effort to make treatment as quick as possible.

Tip: If this is the look you want you can achieve the same appearance with several cheap topical camouflage lotions.

Our Expert SHFST™ Documentation

We have produced our own copyrighted range of comprehensive client documentation including;

  • Alternative Options to SHFST™

  • Pre Treatment Advice

  • Post Treatment Aftercare Advice

  • Specialised Stationary for Technicians Use

  • Amiea-Vytal Technicians Manuals for scar pre treatments

The use of specialised documentation assists us to standardise the quality of service for clients to achieve more predictable outcomes.

Tip: Always ask for your client advice documentation before agreeing to proceed with a treatment.

NB. Our expert documentation is only supplied to technicians who have successfully completed our SHFST™ course.

It is also vitally important that clients follow our pre and after treatment advice to increase the chances of the best possible outcome, clients who ignore advice risk causing pigment migration and coalescence please ensure that you follow the advice provided.

See my hygiene page for details on the hygiene standard that you should demand for this procedure.

See my warnings page for warnings about dangerous industry practices.

See our forum for discussion about scalp tattooing.

See our eCommerce store for details about our comprehensive Scalp Tattooing course - SHFST™.

If you would like to receive your treatment at 25% of the regular cost you can register as a model for our supervised student training program.

If you have questions or would like further information about SHFST™ please contact me.

Kind Regards                       


Andrea Darby
International Master Trainer:
Cosmetic & Medical Tattooist
Medical Camouflage Makeup Specialist

For an Appointment Phone: 0423 230 740




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