Q: Is it ill-advised to comb one’s hair more than twice a day, especially hair that has been transplanted? Will frequent combing induce hair loss? — G.K. ~ Paramus, N.J.
A: Combing or brushing one’s hair does not cause hair loss – no matter how many times a day you do it. However, constant traction with braids or hair extensions can cause hair loss and this loss can be permanent.
Dr. Bernstein was quoted in an article on NYCityWoman.com, where he spoke about the risks associated with popular hair extensions, such as weaves, wefts, and similar clip-in or add-on pieces. Extensions are a stylistic choice that allow women to dramatically change their appearance. However, their frequent use can contribute to a type of hair loss in women called traction alopecia – hair loss around the frontal hairline and temples caused by tight hairstyles pulling on the follicles.
Dr. Bernstein is quoted:
“Hair extensions can create a problem over a long period of time, as constant tugging on the hair follicles compromises their blood supply and may cause permanent thinning,” explains Robert M. Bernstein, M.D., a dermatologist in midtown Manhattan who specializes in hair loss.
Traction alopecia often causes thinning that reverses itself when the hair is worn loose, but if tugging on the hair follicles continues for an extended period of time, the hair loss can be permanent. In patients with permanent hair loss from traction alopecia, a hair transplant can typically restore the hair that is lost from sustained traction. See before and after photos of Patient BOI, Patient NBN, and Patient KAR for examples of women who had their edges restored by hair transplant surgery.
NYCitywoman.com is a website dedicated to lifestyle issues for “women on the right side of 40” — women who are smart, stylish, and eager to embrace new challenges and opportunities.
Read about Traction Alopecia
Read about the Causes of Hair Loss in Women
Before and after photos of women who had surgical hair restoration to repair thin edges:
Patient BOI
Patient NBN
Patient KAR
Dr. Schweiger lends his expertise on hair loss in women and cosmetic hair extensions in a segment on PIX 11 television. The interview with Dr. Steve Salvatore focused on the pitfalls of using some types of hair extensions, or using them improperly.
Hair extensions can result in undesirable bald patches caused by traction alopecia, which is hair loss due to a constant tugging on hair follicles.
Read the transcript of the interview below:
Posted byDr. Steve: Dr. Schweiger, there are two types of hair extensions, tell me about those. The permanent and temporary type.
Dr. Schweiger: There are permanent and temporary. The temporary are just that. They are clip-on hair extensions, they’re meant to be used for weddings, special occasions, to test out a new hair style. And they are generally the safer of the hair extensions.
Then there are permanent hair extensions, and there are different types. One permanent type you actually sew into the hair.
Dr. Steve: So you sew it into the existing hair, not the scalp, but the existing hair.
Dr. Schweiger: Exactly, into the hair.
And the other types are either glued or they use metal clamps to put it into the hair and they stay in for anywhere from 1 month to 3 months at a time.
Dr. Steve: So what are the problems that you have with the… I mean, obviously the clip-on ones are probably fine, right? But these other ones, the more permanent ones, what are the problems you run into.
Dr. Schweiger: The main problem that we’re seeing in patients is what’s called traction alopecia. And traction alopecia can come from tight braids or tight hair extensions and it leads to hair loss. Alopecia is just the medical term for hair loss. We’re seeing young patients who are using these products to look better, actually ending up with bald patches and looking worse.
[……]
Dr. Steve: So, obviously you think that the temporary ones are better. What’s the treatment for something like that.
Dr. Schweiger: The first thing, [which] is obvious, is take out the hair extensions. And then go see your doctor to assess the damage. Oftentimes, time will grow back the hair, if not, we can use injections of cortisone. The last line is hair transplant surgery, which a lot of people don’t know is an option. With a hair transplant, we take out a long strip of hair in the back of the scalp, and we dissect it into slivers, then into individual hairs. Then, actually, place them in the balding area to bring back the hair.
Dr. Steve: And the good thing about that is it’s not the old transplants of the past that look like little cornrows. It really does look great. Dr. Schweiger and Chioma, thanks so much for coming. Really appreciate it.
Dr. Schweiger, our resident expert on hair loss in women, was featured in a segment about hair extensions on “Good Morning America” and ABC News online.
While many women extoll the cosmetic virtues of hair extensions — they are designed to add to the length and fullness of one’s hair — many others have realized the potential for extensions to cause hair loss.
Dr. Schweiger:
“We have patients who are in their early 20s come in after wearing hair extensions for six months or one year, and they actually have bald spots,” Dr. Eric Schweiger, a New York City dermatologist, told “Good Morning America.”
Some of the hair loss can be attributed to traction alopecia, which is localized hair loss that occurs with constant tugging on the follicles. However some of the problems occur due to underlying medical conditions, like anemia. Regardless the underlying cause, when someone is exposed to prolonged tension and weight from cosmetic enhancements, temporary or permanent areas of balding can occur. In some cases hair may grow back in those areas, but for individuals with permanent hair loss from extensions, hair transplantation may be the best treatment. In those cases, a visit to a hair restoration physician is the first step towards treating or repairing your hair loss.
This risk of damage to the hair is why it is important to use caution and care with extensions, as well as to have an understanding of potential issues the extensions might cause.
Dr. Schweiger on understanding these risks:
Posted by“It’s very important that people out there know the risks of hair extensions before they get them done,” said Dr. Schweiger. “If you’re going to do any extensions, just use them for a few hours and take them out. That’s the safest way.”
Q: Over the years, I have worn my hair in braids and extensions. My hair is not growing at my hairline and temples. Can the braids be the cause and can this be treated with a hair transplant? — Williamsburg, Brooklyn, NYC
A: The name for hair loss is this area is called alopecia marginalis. It is almost invariably caused by continued traction from braids or hair extensions. When this is the case, the condition is also called traction alopecia. If the problem is long-standing, the hair will rarely come back, even if the braiding is stopped, and a hair transplant would be indicated.
If there is enough hair loss on the sides of the scalp that the donor supply is significantly reduced, surgical hair transplantation may not be possible.
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