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18. Camouflage, Extensions, and Electrical Devices to Improve Hair Volume
Keywords
WigHair prosthesisHairpieceHair extensionsScalp camouflageHair fibersMicropigmentationMicrobladingArtificial hair implantsBlow dryerHair ironHair Prosthesis
The most complete camouflaging of a patient’s scalp involves hair prosthesis. Many patients may feel uncomfortable talking about hair prosthesis due to the emotional reality of substantial hair loss, so the subject should be approached delicately. But, it is beneficial to discuss the variety of options, ranging from complete scalp coverage using a wig to partial coverage using hairpieces and extensions. The decision of which option to use can be made based on the patient’s preference and degree of hair loss.
Wigs
Wigs, also referred to as cranial/scalp prosthesis, typically provide complete scalp coverage. Patients who desire a wig may benefit by enlisting the help of a professional hair stylist with experience using wigs. There are five key features to consider when choosing a wig: cut, cap size, composition, cap, and color [1].
Cut
Wigs of various length, texture, and hairstyles are available. When wearing a wig for the first time, patients may decide to wear a style they are familiar with. But, the availability of many styles allows for limitless experimentation with different looks.
Cap Size
Wigs come in assorted sizes to fit many different head shapes. Most people will fit into average-sized wigs, and many wigs included adjustable straps to make small adjustments in size for comfort and a secure fit. Caps may also use adhesives, which give the risk of developing allergic contact dermatitis.
Wig size based on head circumference
Wig size | Head circumference |
|---|---|
Child | 19” |
Petite | 21” |
Average | 22” |
Large | 23” |
Composition
Human hair versus synthetic hair
Natural human hair | Synthetic hair | |
|---|---|---|
Pros | Most natural look and feel Most styling versatility – can be styled as natural hair More durable – can last over 1 year with proper maintenance Can be colored or permed | High-quality synthetic hair can look and feel very similar to human hair Requires little maintenance Less expensive Less susceptible to sunlight fading Typically lighter in weight Less odor absorption |
Cons | Requires more styling, particularly after wash Requires more maintenance and care More susceptible to environmental and sunlight damage Typically more expensive Typically heavier than synthetic wigs | Limited ability to style – cannot use hot tools Less durable, lasts 4–6 months with proper care Unable to be colored or permed May appear and feel less natural |
Cap
There are two main types of caps: hand-tied and machine-wefted. Wefted caps are more common and less expensive than net caps and involve rows of wig hair. Wefted caps usually have hair lifted at the root to create more volume in order to hide the cap below. Net caps have a mesh base and are typically more expensive. These two basic types of caps can be combined with premium features such as monofilament, hand-tied, and lace fronts.
Monofilament caps involve a sheer base made of a nylon lace that composes part of the cap. This feature creates an appearance of natural hair growth where the hair is parted.
Another premium option is 100% hand-tied caps, where each hair is individually hand tied to the base. This is usually considered the most comfortable cap and allows for the most style flexibility. They exhibit the appearance of natural hair movement due to each hair moving freely.
Patients who desire a natural looking frontal hairline may opt for the lace front feature. This involves sheer lace at the front of the cap with hairs sewn in, which gives the appearance of hair growing directly from the scalp at the frontal hairline.
Custom-made caps are also available, which can include any of the premium features previously described. These custom-made caps can be constructed with a silicone or polyurethane vacuum base, which is then secured by pushing down on the cap against the scalp. This creates a tight seal allowing for physical activity including swimming. The wig is removed by inserting fingers under the cap, breaking the seal. To create the tight seal, the patient must either be completely bald or be willing to keep a shaved head. These wigs are expensive and may take months to be manufactured [3].
A wig by CRLab mimics a natural scalp appearance
(a, b) CNC® Hair Prosthesis designed for frontal fibrosing alopecia
(a–c) Hairs of different colors are manually selected in order to obtain a final color that matches patient’s original hair. (Courtesy of CRLab)
The choice of which type of wig to use should depend on the expected duration of hair loss. For example, a patient with temporary chemotherapy-induced alopecia may be best served by a synthetic hair wig with a wefted net due to its low cost and minimal maintenance. Conversely, a patient with a long-expected duration of hair loss such as with alopecia totalis may benefit most from a natural hair wig with a custom cap due to its durability and natural appearance.
Color
Wigs made with human hair give a more natural appearance because there is natural variation in color and fiber diameter. For custom-made hairpieces, the manufacturers mix hairs of different colors in order to obtain a final color that matches the patient’s original hair.
Wig Care
Wigs should be washed approximately every 4–14 days depending on the use of styling products, frequency of use, and amount of perspiration [3]. Human hair products must be styled, whereas synthetic hairpieces are ready to wear after drying. Wigs should always be stored on a wig stand or Styrofoam head to extend wig life.
Integration Wigs
Integration wigs may be appropriate for patients with diffuse hair thinning but not complete hair loss. These wigs are designed to allow a patient to pull their natural hair through the cap to be blended with the wig hair [3].
Before (top row) and after (bottom row) use of MicroLines hair integration system. (Photo courtesy of Chuck Alfieri Thin Hair Solutions, Fort Lauderdale, Florida)
Hairpieces
Hairpieces , also called toppers, come in many different forms for both men and women. They are typically held in place by combs, clips, or adhesive. They can be used with intentions of camouflaging thinning hair and for those who desire more length or volume . For women with frontal hair loss, bangs or fringe hairpieces may be appropriate. Ponytail or bun hairpieces can be used in those desiring added fullness and length. Falls and half wigs can be used to add length and volume to existing hair [7]. In men, due to pattern of male pattern baldness, a type of hairpiece designed to cover baldness on the top of the head can be used, called a toupee [8]. A hairpiece can be adjusted by a hair stylist or barber in order to blend with existing hair.
Extensions
Most common types of hair extensions
General info | Extension care | Duration of use | Advantages/disadvantages | |
|---|---|---|---|---|
Tape-in | Extensions come in pretaped wefts and then taped to patient’s hair with the aid of a heated tool Typically applied by a hairdresser in 40 minutes to 1 hour | Caution when washing hair or using hair products -May dislodge tape May require a special shampoo/conditioner to protect glue | Semipermanent 4–8 weeks, can be reapplied after removal | Advantages Less traction on hair because weight is distributed over a larger area Fast application time No heat required for application Disadvantages Must be reapplied frequently than other methods Removal can pull out hairs Allergic reactions to adhesive are possible |
Glue-in | Glue is applied to wefted hair extensions and then attached to hair Removed by an oil-based solvent Suitable only for short duration of use | Extensions must be reapplied every few days | Temporary Few days | Advantages Best for those desiring temporary extensions without having to remove before bedtime Relatively inexpensive Disadvantages Glue can damage hair Heavy wefts can cause hair loss Glue placed on scalp can clog follicles and cause infection |
Sew-in/weaves | Natural hair is first braided into corn rows Works best with thicker hair, used primarily by African Americans Extensions are sewn into corn rows using needle and thread, application takes several hours Professionally applied Caution: Increased risk of central centrifugal cicatricial alopecia (CCCA) and traction alopecia [11, 12]. Patients experiencing signs of disease must stop use of extensions | Moisturize scalp at least once/week with deep conditioning products | Semipermanent 6–8 weeks recommended Maximum of 4 months | Advantages: Suitable for thick, coarse hair No heat or glue required Disadvantages: Uncomfortable due to strain on scalp Risk of hair loss from traction alopecia |
Fusion/pre-bonded/keratin bond | Bonded to hair via strand-by-strand method using adhesives such as glue, typically using hot glue. Premium bonding methods use plastic polymer and laser Applied by hairdresser in 3–4 hours Some bonding methods, especially ones using hot glue, can be damaging to existing natural hair and can cause hair loss, breakage, and scalp irritation. Patients experiencing these symptoms should have extensions promptly removed by a professional | Cared for as natural hair May require repositioning due to growth of natural hair | Semipermanent Up to 4 months Premium bonding methods can last 6–8 months | Advantages Best used in thick, coarse hair Highly durable Premium bonding methods blend seamlessly with existing hair Disadvantages Longer use can cause hair breakage or loss Expensive and time-intensive Some bonding methods involve hard glue attachment points in hair which can be uncomfortable Hot glue method can cause heat damage to hair Extensions may appear obvious if not properly cared for |
Micro-link, also called micro-bead, micro-loop | Extensions are applied by looping around natural hair and then clamped down using clamp, heat, and a metal bead or ring Applied by hairdresser in approximately 3 hours Damaging to existing hair. Patients experiencing hair loss, breakage, or scalp irritation should have extensions promptly removed by a professional | Cared for as natural hair May require repositioning due to growth of natural hair | Semipermanent Up to 4 months | Advantages More natural hair movement Application does not use heat or glue Extension hair is reusable Disadvantages Time-intensive application Metal bonding points can be visible through thin hair, can damage hair, and can be uncomfortable to the wearer |
Clip-in | Extension hair is pre-sewn into clips and then is clipped onto patient’s natural hair Can be done by patient in 5–15 minutes Can be easily removed and replaced at patient’s discretion Least damaging to patient’s existing hair | Wash every 15–20 wears by using shampoo and conditioner, and then allow to air-dry | Temporary Can be removed at patient’s discretion | Advantages High versatility, can be applied and removed as desired Can be used without professional help Disadvantages Not for those desiring more permanent option Clips used repeatedly in the same place can cause hair loss |
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