Chemotherapy

To wig or not to wig: hair loss

Posted by Sara Liyanage on 03 October 2017

The big question for a lot of women embarking on breast cancer chemotherapy is “will my hair fall out?”. And (depending upon your chemo regime) the answer is often “probably”. Hair loss can be the most distressing thing for some women going through breast cancer. It just adds to the general crappiness that is breast cancer. Not only do we have to deal with all the emotional stress and worry that cancer brings; endure the physical trauma of chemotherapy and radiotherapy; now you are telling me that I have to do all of this with a bald head, no eyelashes and no eyebrows? Mmmmm ….yes.

Although it may seem impossible, do try to come to terms with the fact that your hair will fall out. There are lots of ways to look good during treatment despite the hair loss. And remember that it will grow back.

Here are our top ten things to know about hair loss, followed by a list of link to some very helpful information about hair loss, wigs and cold capping:

1. WHEN AND HOW

The timing of the hair falling out depends upon the chemo drugs you are having. Your hair falls out by thinning first. You notice more than usual in your brush or on the floor of the shower. Quite soon after that, it starts to come out even when you just run your fingers through your hair – it comes out in handfuls. This is the most distressing part. And it is not just the hair on your head which falls out. It is all over your body. Yes, everywhere.

2. LONG, SHORT OR SHAVED?

As soon as your hair starts to fall out is the time to make your decision – leave it to fall out, cut it shorter or shave it? You can leave it to fall out but you risk having bald patches showing up. You can cut it short which will temporarily camouflage the thinning hair. Or you can bite the bullet and get it shaved. There are salons which provide very kind, discreet services for ladies going through chemo: they may have a private area where you can go to have your head shaved (phone up your local salons to ask if they’d do this for you).

If you do this, remember to take a hat or scarf with you for when you go home. Some people shave their hair off with friends and family at home. Or they do it themselves alone. If you do it yourself be very careful you don’t cut yourself because you don’t want to get an infection (remember your low immunity).

3. SCALP CARE

When your hair falls out your scalp can feel tingly and itchy. There are waves of this itchiness. All you want to do it rub and scratch your head. And as you rub and scratch your head, more hair falls out. And even after having your head shaved (if you chose that route) you will have some stubble on your head which will fall out, and as it does you will still get these irritating waves of itchy, tingly, prickly, tickly, crawling ants over your scalp. To help with this:

  • Shampoo your scalp with a very gentle shampoo (consider ph neutral, paraben free or organic).
  • Use a very natural oil or moisturiser on your scalp – olive oil or something like aveeno moisturiser.
  • Cover your head whilst outside so keep the sun off your skin and also in cold weather to protect it.
  • Wear a soft scarf or hat.

4. HAIRCARE

Special hair care is necessary in the days before your hair falls out, during the thinning stage, and throughout treatment if you are using the cold cap. Advice includes:

  • Use gentle shampoo and conditioner – ph neutral are good.
  • Don’t wash it every day.
  • Don’t use harsh styling products like mousse, gel and hairspray.
  • Don’t rub your hair with a towel: blot it dry.
  • Don’t use a hairdryer, straighteners or heated curlers.
  • Don’t have your hair treated or coloured.

5. COLD CAP?

You can try the cold cap. This is a cap that you wear whilst you are having your chemo, which gets incredibly cold and it stops some of the chemo drugs getting to your hair follicles. There is no guarantee that this will stop you losing your hair: your hair can still fall out or thin.

It is like a long tube of car antifreeze which is wound round and round into the shape of a head, covered by a horse riding hat. You have to wet your hair and slather it in conditioner before you put the hat on your head, and then the nurse spends a while making sure that there are no gaps between the cap and your head. Then the cap is switched on and the liquid in the tube gets very cold. Your chemo session is longer when you use the cold cap because you have to sit with the cap on your head for a while before the chemo is administered (to ensure your hair follicles are frozen) and then you keep the cap on for a little while after the chemo has finished.

If you are interested in trying it take a look at this brilliant Q&A with Paxman which answers all the FAQs about cold capping and take a look at their website www.paxmanscalpcooling.com.

6. WIGS

Before you start your chemo treatment have a think about whether you are going to get a wig. You can get fantastic wigs which are so realistic and close to your original hair style that you don’t look as if you are wearing a wig. Or you can have some fun and get some fun wigs and wigs with the hair style you’ve always wanted.  Take a look at the My New Hair website which is a super website all about wigs. They have a really helpful patient booklet giving loads of information about hair loss, different types of wigs, choosing and caring for a wig, hair re-growth and aftercare. It lists nationwide salons who provide wig services.

Wigs vary in cost from around £30 for a synthetic wig, up to around £600 for a real hair wig. Some health insurance companies pay for, or contribute towards, the cost of a wig so check with them. Or you may be entitled to an NHS wig or a NHS wig voucher. Research your options. Wigbank is an online shop selling pre-loved wigs (washed, conditioned and disinfected) and can be a more reasonable cost option. Macmillan has lots of helpful information about getting a wig including how to apply for a free NHS wig.

If you want your wig to look like your original hair then the salon can often find a good match and then style it. They can really work wonders. A big tip is to take a few photos of your hair before it begins to fall out so that the salon catch match a wig to your natural style and colour. Take a friend. A friend sees your hair from all angles and can give honest advice about how much a wig looks like your original hair. Do get a wig liner made from a soft fabric because the underside of the wig can be uncomfortable.

THINGS TO BEAR IN MIND ABOUT GETTING A WIG:

  • If you wear glasses (bear in mind contact lenses are difficult to wear during chemo because of dry eyes) the thick part of the wig comes over the ears and can make the wig uncomfortable.
  • Some treatments can cause hot flushes which makes wearing a wig very uncomfortable – you may want to bear this in mind when considering how much to spend on a wig.
  • Wigs are expensive – think about how much you are likely to wear the wig.

7. HEAD WEAR 

Scarves. You don’t need to buy special scarves to wear on your head. You may have some already that you can use. Tying scarves on your head can be tricky (so they don’t come unravelled in public) but there are a lot of online tutorials to help you. Pinterest and YouTube are good places to start, and there are more listed in the helpful link section below.

Hats. There are also a lot of places which sell hats which look like scarves but which are already tied. If you choose to buy some of these then looking online is a minefield. There is a lot to choose from online and a lot of them are, quite frankly, horrific. The best thing is to set aside an afternoon, pop the kettle on, make a cup of tea and search online for what you like.

Whether you plan to wear scarves or hats or both, make sure you have a couple so that you always have one to wear if one is in the wash. And look for natural, soft fabrics because your scalp will be sensitive.

Night caps. Definitely get a couple of night caps. Having a bald head at night is chilly. Plus your scalp can feel very sensitive against a pillow. A lovely friend bought me two bamboo night caps, says Sara, which were the best present ever and I cannot recommend them enough.

8. HENNA TATTOOS

If you google “chemo hair loss henna tattoos” and look at the images you will see some absolutely beautiful bald heads. 

9. EYEBROWS AND EYELASHES

For some people all their eyebrow hairs fall out and all their eye lashes fall out. For others they may just thin and some lucky ladies keep them.

  • If your eyes are irritated while your eyelashes are falling out, ask your chemo nurse to recommend a suitable eye wash or eye drops.
  • Treat eye lashes and eyebrows gently when cleansing and moisturising your face.
  • Treat them gently when applying make up. You may need to consider avoiding eyebrow pencils, mascara and eyelash curlers.
  • You can get your eyebrows temporarily tattooed. It is best to do this before your eyebrows start thinning so that the salon can follow the lines of your actual eyebrows. Search for a local reputable salon online, or ideally go with a personal recommendation because once on, they are there for the duration. Check with your chemo nurse/oncologist before getting this done because if you are in chemo then you will need to avoid any risk of infection and it may not be suitable. You might be best off getting this done even before you start chemo so that there is no risk of infection during chemo.
  • Fake eyebrows. You can get eyebrow wigs! They are little eyebrows which you can stick on your thinned or non-existent eyebrows. Do a little online search and you’ll see that there are plenty of stores online.
  • When it comes to eyelashes, the advice is not to use false eyelashes. False eyelashes need a little bit of existing eyelash to stick to and if yours have fallen out or thinned then the false one has nothing to hold on to. If you do decide to use falsies, then before using false eyebrows or eyelashes, check with your chemo nurse because the adhesive and remover may not be suitable for you. Also bear in mind that your newly sensitive skin may not like the adhesive and you may cause an allergic reaction or rash.
  • Eyelashes and eyebrows do grow back. It takes around 6-8 weeks for lashes and brows to re-grow after chemo. 
  • Take a look at the section on make up in the for tips on using makeup to disguise your lack of eyebrows and eyelashes.

10. HAIR RE-GROWTH

Yes your hair will grow back.

When? It depends on which chemo drugs you are on. And everyone’s hair regrowth is different. For some people it can grow back before chemo ends (yes that surprised me too, writes Sara, but half way through my taxol regime soft fluffy hair started to slowly poke its way through my scalp). For others it can start a few weeks after the end of chemo.

2. How? To start with the hair that comes through is a soft fuzzy hair, a bit like a baby’s new hair. Then after a few weeks/month the real hair comes through. It doesn’t grow evenly over your head and can be patchy to start with. And when your hair starts to properly grow, it may be different to your previous hair. You may have curly hair when you used to have straight hair. It may be a different colour. It may be thinner or coarser. Everyone is different.

3. Hair care. Look after your new hair carefully. Use gentle shampoos and conditioners (try ph neutral, paraben free or organic). If you want to colour your hair then the advice I was given, says Sara, was to wait 6 months after chemo to colour my hair, although it may be ok to use a vegetable dye – chat to your hairdresser for advice.

4. Assistance. There are plenty of shampoos on the market which claim to help your hair grow back. Whether these actually work or not is debatable and up to you to decide if you want to try them. Lush have a few shampoo bars which claim to help hair regrowth and they are know for being gentle products.

Wigbank. If you had a wig why not consider donating it to this charity Wigbank  which washes and disinfects pre-loved wigs for other people to buy at an affordable price.

HELPFUL RESOURCES AND MORE INFORMATION

Penny Brohn has a helpful article on their site about hair loss: Chemotherapy Hair Loss – What You Need To Know

Cancer Hair Care for information on every aspect of hair loss: hair loss, wigs, scarves, hats, scalp care, regrowth and so on. Read their guest blog here.

Headwrappers is a charity providing free support to anyone suffering hair loss as a result of cancer treatment.  They go around the country visiting cancer charities and putting on sessions for support groups. However, with the lockdown, they currently put on a regular online session for people to get together and chat about hairloss: “Tea, Topknots & Turbans”. It’s the first and third Thursdays of each month. And they have tied up with a number of charities to provide online support groups each month where they give advice on headscarf tying, practical scalp care, hair loss concerns and so on. These are done with Maggies, and Trekstock.

Wigs for Heroes is a small charity providing support for people who lose their hair. They put on a lot of support via Instagram such a video tutorials, tips, advice on caring for wigs and weekly “online coffee mornings”, plus more.

The major charities all provide support for hair loss:

Look around for a local support group or salon that provides support for women suffering hair loss. For example, Jennifer Bolton – situated in the south-west of the UK,  not only provides a wig service for women who lose their hair through chemotherapy, but also a support group.

There are a number of places where you can buy hats and scarves suitable for your bald head. Some suggestions are:

The information and content provided on this page is intended for information and educational purposes only and is not intended to substitute for professional medical advice.

Reviewed August 2021

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