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. Bernstein and Bernstein Medical – Center for Hair Restoration were featured in New You magazine’s article “My Hair Lady.” The main topic of the article is hair transplantation in women, however it also touches on hair loss in women, Follicular Unit Transplantation (FUT), medication and other products.
On Bernstein Medical – Center for Hair Restoration:
The Manhattan office of Bob Bernstein, just steps from Park Avenue, is the kind of space that makes successful men feel at home — a good thing for one of the country’s foremost specialists in hair restoration (and the co-author of Hair Loss for Dummies). The layout is part design statement, part science lab, slick with granite, slate, and glass and full of microscopes and high tech gizmos. Among the space’s most noteworthy gadgets is one of only twelve robots in the world programmed to help perform hair transplants, which has a home in Dr. Bernstein’s office.
A female patient of ours discussing the “taboo” of hair transplantation in women:
Sara Lyles, 62, whose hair loss was caused by a styling technique, said that when Dr. Bernstein performed her hair transplant 12 years ago, the subject was taboo. “Women never talked about it, and I was so embarrassed that I avoided all social functions,” she recalls. “I’m African American and I slept in large tight rollers to keep frizzing under control. The traction destroyed my frontal hairline.”
At the time, she would have been mortified if someone found out she had undergone a transplant. “Even my hairdresser had no clue,” she says. “Dr. Bernstein not only gave me my hair back, he gave me my life back.”
Dr. Bernstein on the amazing progress of the hair restoration industry:
Posted byAs Dr. Bernstein emerges from his operating room, sporting green scrubs and green Nikes that match the room’s tiles, he shakes his head and sighs. “When I went into practice back in the eighties, transplantation was almost barbaric and Rogaine was the only alternative,” he remembers. He marvels at the advances and choices he and others now have to over. “I never would have thought I would be working with robots, lasers, and cloning.”
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.”
Telemundo47 — a Spanish-language media outlet based in New York City — interviewed Dr. Bernstein for a segment on hair loss and how hair treatments and styles can lead to long-term damage.
Here is the lead in Spanish:
Consejos para los tratamientos del pelo
Los tratamientos para el cabello la pueden dejar muy bella, pero pueden traer consecuencias a largo plazo y podrían ser desastrozas.
Now, in English:
Advice for the treatment of hair
Treatments for hair can leave it very beautiful, but they can bring consequences for a long period of time and can be disastrous.
Dr. Bernstein discusses how strong chemical treatments for hair can lead to hair damage and hair loss (pérdida del cabello). He also speaks to the issue of traction alopecia (alopecia por tracción) and how you can prevent hair loss by choosing to style your hair so that it is not tightly pulled back.
You can watch the complete video segment on the Telemundo website. [Update: the video is no longer available.]
Dr. Bernstein’s expertise in hair restoration (restauración del cabello) is appreciated around the world and by people who speak a wide variety of languages. Indeed, patients have come from all around the world to seek his advice and treatment for their hair loss.
Visit our Spanish language page on hair transplantation, Cirugía de Trasplante Capilar
Posted byQ: What are the most common causes of hair loss in women other than genes?
A: The most common causes for localized hair loss in women are traction (due to tight braiding) and alopecia areata (an autoimmune disease that produces smooth round patches of hair loss).
Other than genetic (hereditary) thinning; generalized hair loss is most commonly caused by medications, anemia, and thyroid disease.
Posted byQ: I am a Caucasian female that has experienced hair loss on the sides of my head from the height of the eyebrow to the ear due to traction. The hair loss has been present since my teen years. My job requires me to wear my hair up most of the time. Although I don’t wear it nearly as tight, I seem to continue to lose my hair in the front and on the top of my head. My hair also used to be very thick as a child and is now quite thin. I’m not sure if this is normal or something else is going on, but I am definitely interested in a hair transplant. — M.H., Larchmont, NY
A: It sounds like you are experiencing continued traction alopecia. Unless the underlying cause is corrected (the traction), you can expect to continue to lose your hair. People that have traction alopecia can have thinning even from mild pulling that might not be a problem for others. Once you stop the pulling, it can take up to two years for the hair to return, although there may be permanent hair loss.
Surgical hair restoration is the treatment of choice for permanent hair loss from traction. If you have significant thinning on the sides, you may not be a candidate for hair transplantation since in this procedure we often need to harvest hair from the permanent area in the sides of the scalp as well as the back.
An additional problem (that you allude to) is that you may have underlying female pattern hair loss. This would further complicate the surgical treatment.
A careful examination (including densitometry) can sort these problems out and allow for more specific recommendations.
Posted byQ: I am a 34 year woman with a patch of hair loss by my temple. I went to the salon to have my hair done and to my surprise my hairdresser told me that I have Alopecia? First time I’d heard of it, my G.P is not very concerned about it but having read so much about it on this site I am becoming a bit concerned. The rest of my hair is healthy any suggestions and diagnosis? — M.V., Williamsburg, Brooklyn
A: “Alopecia” is just a generic term for any kind of hair loss.
It sounds like you have a specific condition called alopecia areata. Alopecia areata is an autoimmune disease that presents with the sudden appearance of well localized bald spot(s) on the scalp or other parts of the body. The underlying skin is always normal.
The treatment is injections with cortisone. Hair transplant surgery is not indicated for this condition.
You should see a dermatologist to confirm the diagnosis and treat.
Other diagnoses to consider are triangular alopecia (which would have been present since childhood) and traction alopecia (that is cased by constant tugging on the hair).
Posted byQ: What is your opinion on having a hair transplant to restore the hairline and then wearing a hair system behind it to regain the appearance of a full head of hair? K.Y. – Hackensack, New Jersey
A: It is my personal feeling that one should not use a hair transplant to supplement a hair system, especially at a young age. We have occasionally performed this procedure in older men and women.
In my view, a main purpose of a hair transplant is for it to be low maintenance. The combination of a hair transplant and a hairpiece is extremely fussy.
In addition, hair systems cause traction alopecia (hair loss from constant tugging) and the hair loss will become permanent over time, limiting the ability to have a hair transplant in the future. If one needs to have the high density of a system — i.e. for a career — then just use the system. It will give you more long-term options.
Posted byQ: 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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Hair loss has a variety of causes. Diagnosis and treatment is best determined by a board-certified dermatologist. We offer both in-person and online photo consults.
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