Between self-confidence and insecurity, sometimes there is a fine hairline.

People fed up with living under a hat are instead going to hair clinics to receive a treatment for baldness known as scalp micropigmentation, or hair tattoos. The procedure involves having thousands of tiny dots inked onto the client’s scalp with a needle to mimic a freshly shaved head.

Typical customers at HIS Hair Clinic downtown and 14 other cities around the world are men in their 30s and 40s and occasionally women with thinning hair, said the clinic’s co-founder Ian Watson.

Watson went under the needle himself in 2002, after alopecia caused him to lose patches of hair.

“When as a man you start to lose your hair, you do start to lose your confidence and you think women don’t find you attractive,” he said in an interview at the clinic on Toronto St. “You feel as though you’re getting old before your time.”

He rediscovered his mojo after his sister-in-law and business partner, Ranbir Rai-Watson, gave him an inky buzz cut.

“You feel a bit more enthused about life,” he said. “You want to start going to pubs and clubs, and you have a bit more confidence talking to women.”

After experimenting with different inks and needles, and fine-tuning the process, he and Rai-Watson opened their first clinic in Birmingham, England about 10 years ago.

He vaunts the treatment as cheaper and easier than the alternatives. A full head of tattooed hair costs about $3,500, compared to sometimes more than $10,000 for a hair transplant. A hair tattoo is more expensive than a toupee, but will never fly off.

The procedure takes two or three sessions of about three hours each. Clients can choose from 100 shades of ink to match their natural hair colour and skin tone. Like a normal tattoo, the ink can fade and need retouching (HIS Hair Clinic offers this service free in the first year). The tattoo is meant to be permanent but can be removed with laser treatment.

Still, it’s not for everyone.

In a post entitled “Micropigmentation, Regrets!” on the online forum BaldTruthTalk.com, one user who went to an unnamed clinic was disappointed with the results. “My right temple has almost no hair and you can really see the tatoo (sic),” the user wrote.

“Really think what you are doing before deciding … I wish I could go back in time …”

In Toronto, scalp micropigmentation seems in high demand. The wait-list at HIS Hair Clinic is four to six weeks, Watson said.

One poster on the clinic’s wall shows Daniel Johnson, a celebrity hairdresser whose clientele includes soccer superstars Gareth Bale and Mario Balotelli. “This treatment is the next big male grooming must-have,” Johnson raves in a YouTube promo for the clinic.

Other clinics in the area also offer the treatment, including Quick Hair, at three locations in the GTA, and Scalp Esthetica, on Eglinton Ave.

“Be Bold, Not Bald!” says Scalp Esthetica’s website. And: “Finally, a tattoo you’ll never regret getting!”

Demand for scalp micropigmentation “has grown steadily over the last 6-7 months,” said Scalp Esthetica’s CEO Tino Barbone in a recent email.

“Right now there are companies vying to be the global leaders in (the treatment) as they know how fast this market is growing and how big it is going to be, so there are a lot of sharks out there looking for prey and to crush the competition,” he added.

The fad isn’t exclusive to Toronto. Watson said HIS Hair Clinics are fully booked in London, New York, Houston and Seattle.

In L.A., the most popular hairline shapes at the New Hair Institute are those of Vin Diesel and Jamie Foxx, a technician at the clinic told The Hollywood Reporter in 2013.

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But at HIS Hair Clinic, each client gets a unique inked-in do.

Critics who say getting the treatment is vain don’t know how it feels to lose their hair, Watson said.

“Imagine you lost all your teeth. Would you feel fairly conscious about it, perhaps not smile as much and go to a dentist to fix your teeth?

“When you lose your hair, you’ve lost something that other people take for granted.”