Cosmetic Cover-ups and Hairpieces

14 Cosmetic Cover-ups and Hairpieces

Sara Lea Salas Tovar

Summary

Hair loss is a common problem for both men and women, as it has the potential to impact negatively on self-esteem and psychosocial functioning, whether it is reversible or a permanent alopecia. There are a lot of camouflaging techniques for patients suffering from hair loss or hair thinning. Many patients frequently come seeking advice about additional options to hide or reduce the appearance of hair loss with hair camouflaging agents (hair fibers, powder cakes, lotions, and sprays) or hair prostheses (wigs, hairpieces, and extensions). In this chapter, we will discuss the most important options currently available to help patients camouflage hair loss or hair thinning. Also, we will evaluate the advantages and disadvantages of these options. At the end, the physician will be able to respond to the most common questions as well as give advice to the concerned patients toward improving their quality of life.

Keywords: hair loss hair thinning camouflaging techniques hair fibers hair prostheses hair systems

Key Points

•Hair loss is a very common problem for both men and woman. Knowing how we can help the patients from the first day of consultation can change their lives.

•Hair loss or hair thinning directly affects patients’ quality of life.

•Hair camouflaging agents (hair fibers, powder cakes, lotions, and sprays) or hair prostheses (wigs, hair systems and extensions) can be a form of concomitant treatment alongside medical or surgical approach.

14.1 Introduction

In addition to medical and surgical therapy, a number of cosmetic and cover-up options exist that offer effective and cost-effective help for patients suffering from hair loss.1^,²^,³ These options do not reverse alopecia, but rather camouflage or cover-up the hair loss, making the existing degree of thinning less noticeable. With these options, we not only improve the degree of benefits we get from surgical and medical therapy, but often times help patients who are not candidates for these therapies. Unfortunately, while most clinicians are readily equipped to discuss medical and surgical approaches to hair loss, knowledge in cosmetic and cover-up options is often lacking. Too often, clinicians have “tunnel vision” and only discuss the medical or surgical approaches. If a patient is currently not a great candidate for these options, little more may be offered, and he may feel frustrated and disappointed with a lack of treatment choices. In this chapter, we will discuss various camouflaging and cover-up options available to help our patients.

14.2 Shampoos and Conditioners

It is helpful to remember that as hair grows and ages, it degenerates or “weathers” to some degree, becoming friable, and subject to breakage.⁴ This can be worsened by physical and chemical procedures, such as bleaching, permanent waving, and hair straightening. The cumulative effect of this damage may be an increase appearance of thinness. Because patients suffering from hair loss also frequently exhibit hair damage, the use of products that strengthen the hair shaft can be useful.

Shampoos for hair loss should remove adequate sebum, but not overly dry the hair, causing it to become, harsh, subject to static electricity, and difficult to manage or style. Some shampoos contain biotin, panthenol, B-complex vitamins, tocopherol nicotinate, and other active ingredients that potentially strengthen hair and restores volume and vitality.

Conditioners mimic the role of sebum in making the hair manageable, glossy, and soft.

Some conditioners can also strengthen hair that has been damaged by chemical or mechanical trauma.⁵ Some work by coating the hair shaft, while others work by swelling the hair shaft. Protein-containing conditioners can temporarily increase the hair-shaft thickness and hair strength by up to 5%, leaving the hair with a better cosmetic appearance in the hair-loss patient.⁶

14.3 Hairstyling Products

For early thinning, simply changing ones hairstyle or color can improve the appearance of fullness. A change in hair color from dark to light effectively reduces the color contrast between a dark hair and lighter skin. A change in length can also affect the appearance of fullness. Sometimes longer hair is better because of the ability to cover more area. At other times, shorter hair is better because it has more lift without the added weight of longer hair. Experimentation at different lengths is useful.

Applying hair-styling products such as gels or mousses can also decrease the appearance of hair thinning by allowing the hair to stand away from the scalp and add volume. A small amount of gel or mousse is massaged into the base of the hair shafts followed by drying the hair with a blow dryer, while combing the hair away from the scalp, creating the illusion of volume.⁶^,⁷

14.4 Cosmetic Concealers and Cover-ups

There are four categories of scalp-concealing products that help reduce the appearance of hair loss: hair fibers, powder cakes, scalp lotions, and scalp sprays. Scalp concealers primarily work by eliminating the color contrast between hair and scalp, thereby increasing the appearance of fullness. Each product is available in a variety of colors to closely match an individual’s own hair color. When combined with styling modifications, they are an easy, inexpensive, and extremely effective method of creating an appearance of fullness in areas of the scalp where thinning has occurred.³ A disadvantage of concealers is that patients need to apply the product daily. Also, they may need to modify their activities around water and with exercise as some of the concealers will come off or run with water or sweat.

Women are typically more accepting of concealers than men for a few reasons. First, women are more accustomed to using cosmetic products in their daily life. Also, while hair loss can be devastating for both sexes, for men it is at least considered a “normal,” albeit unwanted, age-related process. For woman, hair loss is never viewed as “normal” and often sends a message that one is sick.8 Although men may initially be more resistant to concealers, the author has found that most men will accept these products if they are told about them, especially once they see how well they work.

14.4.1 Hair Fiber Powders

Several companies manufacture products best described as pigmented, concealing hair-building fibers. In addition to decreasing color contrast between hair and scalp, these fibers contain an electrostatic positive charge, and theoretically work by cross-linking with preexisting hairs to increase the appearance of fullness and density. To apply these products, an individual sprinkles fibers from the supplied canister onto a dried, balding area of the scalp. A conventional hairspray is applied to increase the binding of the fibers to the patient’s hairs (Fig. 14.1a, b).

Fig. 14.1 Effect achieved on a female patient’s hair (a) before and (b) after application of dark brown fibers.

These hair fibers are not effective on areas of complete alopecia because synthetic fibers require a minimal density of hair to bind. Hair fibers will maintain scalp coverage during periods of mild sweating or light moisture, but will not last in heavy rain or while swimming.⁹ A few examples are Toppik Hair Building Fibers (Spencer Forrest, Inc.) and Nanogen fibers (Pangaea Laboratories Ltd.). The method of applying hair fibers and concealers is demonstrated in the accompanying video (Video 14.1).

14.4.2 Pigmented Concealing Powder Cakes

One popular example of a powder cake is DermMatch (DermMatch, Inc.). It is applied to the scalp with a wet sponge applicator after an individual has showered and towel dried her hair. Once again, a color should be chosen to closely match the patient’s hair. Powder cakes not only coats the scalp but also coats thin hairs and helps them appear thicker. This product is more waterproof than fibers, and the patient is often able to swim, exercise, and sweat with the product on the scalp. It can only be easily removed with shampooing. When dry and in place, the powder is not easily detectable, nor does it come off, even when a hand is run through the hair. This gives patients an added level of security and comfort.

14.4.3 Concealing Lotions

Lotions work similar to the powder cakes. The main lotion marketed for scalp camouflage is COUVRé (Spencer Forrest, Inc.), but others exist. It essentially functions like a powder cake to eliminate the contrast between normal hair and scalp; however, unlike powder cakes, it does not coat the hair shaft as much. Some feel it is a little messier to use and not quite as water proof as powder cakes.

14.4.4 Camouflaging Sprays

Some may remember the Good Looking Hair (GLH) Spray infomercials produced by Ronco, Inc. back in the 1990s. They popularized the term “hair in a can” or “spray on hair.” This and a number of similar products still exist today. Some simply color the scalp (like powder cakes and lotions), while others also apply some fibers (like Toppik or Nanogen). As silly as the process of applying these sprays look in the commercials, they do work, and some patients are attracted to them because of their speed of application. A major disadvantage of these sprays, in the author’s opinion, is they do not feel normal to touch, having a stiff and caked on feel.

14.5 Scalp Micropigmentation: A Semipermanent Hair and Scalp Concealer

This subject is covered in Chapters 13A and 13B in great detail. It is briefly mentioned here because scalp micropigmentation (SMP) does share some properties similar to concealers. SMP is the application of medical grade pigments to the scalp in order to create the illusion of stubble or shaved hair on the patient’s scalp. If the pigment color is similar to the patient’s hair color, it will decrease the color contrast between scalp and hair, and, like concealers, increase the illusion of fullness in areas of thinning hair. The main advantage of SMP is that it may last 1 to 4 years. This means a patient is not tied to using a concealer on a daily basis. Sometimes concealers and SMP are used together because the presence of SMP enables the patient to achieve his or her desired effect with less concealer.

Although SMP can decrease color contrast similar to concealers, it is not simply a more permanent substitute for concealers. SMP has its own list of indications and contraindications that are distinct from simple concealers. As stated earlier, concealers need a minimal amount of preexisting hair to be effective. If a patient loses this preexisting hair due to hair loss progression, the concealer becomes less effective and begins to look abnormal, like paint on the skin. At this point, the patient has the simple option of stopping the concealer and considering other choices. A patient does have this same simple option if the same progression occurred with SMP. They would have to either wait for it to fade; remove the SMP with laser (which can be done); or, if the patient is a candidate, consider doing hair transplants, medical therapy, or PRP to add hair back. So, there are more potential serious consequences of using SMP without proper planning. However, with planning and good technique, it is a great adjunct for patients and gives them options they did not have before (Fig. 14.2a, b).¹⁰^,¹¹^,¹²