Scalp micropigmentation (SMP) is a highly sophisticated medical tattoo process for balding or thinning hair. SMP looks amazingly simple, but this novel technique must be customized for each patient because the skin in each patient differs with regard to how the scalp reacts as it holds on to the tattoo dye. There are many variables involved with performing SMP that makes this process more of an art form than a science. SMP is a very labor-intensive process that could require multiple sessions and up to 20 hours of procedural time to satisfy the patient. This review discusses applications and technical considerations of the SMP process.