Toupee or not Toupee : Revealing the illustrious history of hair systems, Getting to know today’s hair systems, Considering all the different ways of attaching your new hair, Looking at special considerations for hair systems for women, Estimating (and planning for) the cost of your hair system and Attending to the business of system maintenance

Toupee or not Toupee?

In This Chapter

• Revealing the illustrious history of hair systems
• Getting to know today’s hair systems
• Considering all the different ways of attaching your new hair
• Looking at special considerations for hair systems for women
• Estimating (and planning for) the cost of your hair system
• Attending to the business of system maintenance

The practice of using toupees and wigs to cover hair loss goes back to the beginning of recorded history, and the jokes about

toupees blowing away and wigs going askew have been around almost as long. A toupee is a small piece of hair (real or synthetic) on a mesh or fabric foundation that’s worn to cover a bald or thinning area of scalp. Wigs cover more area than toupees and are known by many interchangeable names — hairpieces, rugs, units, hair systems, systems, or just pieces. For simplicity, we refer to both wigs and toupees as hair replacement systems, both in this chapter and throughout the book.

People turn to hair replacement systems for many reasons. For some, hair restoration surgery isn’t an option due to cost or other factors; other people need a wig just for a short time because of hair loss from chemotherapy or another health-related temporary hair loss situation (see Chapter 5 for disorders that cause temporary hair loss).

In this chapter, we introduce you to the different types of hair replacement systems, addressing both their pros and cons as well as the care and maintenance they require. We also talk about methods for attaching these systems and the best ways to keep your hair in place while you live an active lifestyle.

A Brief History of “Rugs”

The earliest known example of a hair system was found in a tomb near Hierakonpolis, an ancient city in Egypt. The tomb and its contents date to 3200–3100 BC. As necessity is the mother of invention, and to address the balding problem, the hair system more resembling what’s available today was later invented in the form of toupees or wigs.

Powerful men throughout history were self conscious about balding. It’s known that Julius Caesar, who felt that his bald head had to be addressed, was known to have tried wearing a hair system, and King Louis XIII began wearing wigs to camouflage his balding condition in the 17th century. Due to King Louis XIII’s tremendous influence, wigs soon became the fashion throughout France.

In England, King Charles II was restored to the throne after his exile in Versailles, where he was exposed to the French wig craze. The English, not to be outdone by the French, followed the fashion. The use of hair systems grew in the United States in the 19th century as well.

By the 1950s, it’s estimated that over 350,000 American men wore hair systems, out of a potential 15 million wearers. With only about one percent of the market captured, the opportunities for hair systems seemed limitless. Hair system manufacturers helped to build credibility for their products starting in 1954, when several wig makers advertised hair systems in major magazines and newspapers. This opened the wig market to the men who knew they had a problem but didn’t know what to do about it.

With advertising came acceptance of hair systems, and improvements in craftsmanship, pioneered by Max Factor, advanced the wig-making art of the time. Since that time, some national organizations like Hair Club for Men, sprung up to offer hair systems to a wide variety of men through heavy television promotion. For those of you old enough to remember the famous line Sy Sperling uttered in his commercials: “I’m not only the Hair Club president, I’m also a client.” This was one of the more successful ads that helped make this industry, and it quickly became a phenomenon.

The heavy promotion on television gave rise to a new industry where hair salons all over the world started to exploit the market for hair systems. Almost every city had some specialty shop selling hair systems, and as a result of the heavy promotion, the quality of the hair systems got better and better.

Today’s Hair Replacement Systems

Today’s hair systems are quite an improvement over the powdered wigs of the 1700s. Many are made from human hair, resulting in a

more natural feel and appearance. This section weighs the advantages and disadvantages of hairpieces, explains the attachment systems available, and prepares you for the care and upkeep of your hair replacement system.

Weighing the pros and cons of hair systems

Hair systems were the only option for balding prior to the late 1950s, when doctors developed hair transplantation. Today, for men whose baldness is very extensive and who don’t have enough hair for a hair transplant, a hair system may be the only alternative to simply shaving the scalp. The cost and the final appearance of a hair system varies with the materials used and the expertise of the maker. Cost for a system also varies based on the total costs for marketing and commission sales. Most clients have two hair systems so that they can wear one while the other is in the shop.

The major advantages of wearing a hair system are that

• The initial cost can be relatively low.
• You get a fast and easy result (within a few hours) without a surgical procedure.

Some major disadvantages to hair systems include:

• A rapid change in appearance when the hair system is first used
• Lack of durability
• Need for frequent cleaning and repairs
• Need for duplicates for when one is “under repair”
• Potentially unnatural frontal hairline
• Unpleasant smell from scalp sebum (natural oil) buildup
• Accelerated hair loss caused by the hair system

All hair systems are fragile and must be returned to the maker regularly for cleaning and upkeep; even with this attention, they usually last only a year or two. Sun, salt water, human sweat, chlorine in swimming pools, and harsh shampoos all shorten the life of a hair system.

The highest quality and most natural-looking hair systems are custom-made and may cost thousands of dollars. They’re made of high-quality human hair carefully matched to the original hair of the client. The hairs, singly or in a few bundles, are skillfully tied around the threads of the foundation netting and knotted so that they may follow the pattern of natural hair growth or lie in a direction that maximizes layering. Hair layered from side to side tends to cover better and, like a thatched roof, blocks light from penetrating the wig (which is important because one doesn’t want the hair system to be seen through). Good cover is important for the users and a secure fit is critical because the new wearer will be most concerned about the feel of the hair system on their head and their concern that the hair system might just fall off.

Considering manufacture, upkeep, and replacement, even the aver- age hair system isn’t cheap, and you must expect continued expense throughout your life as long as you wear a system.

The hairs of less expensive hair systems may be made of artificial fibers or animal hair; cheap hair systems made from artificial fibers are less durable and begin to look fuzzy very quickly, so you must replace them at frequent intervals. Human hair has the most natural appearance and behavior, and the most common and affordable hair systems are traditionally made from Asian hair that’s dyed or bleached to approximate Caucasian coloring. Asian hairs are used because they’re generally coarse, straight, and strong, making them easier to work with. The costs of hair supplies from salons in developing Asian countries was far lower than from traditional European sources. However, the texture may be so different from a person’s natural hair that the final result doesn’t look convincing. Also, although Asian hair is very strong, the bleaching and toning processes make it brittle and dry, making it vulnerable to breakage.

Keeping your hair from falling apart

Hair systems start with a section of netting called the foundation. The netting is cut and molded to approximate the size and shape of the bald scalp area in a custom-made hair system; it also can be more extensive in design, covering not only the bald area but also covering the existing hair around it to make the transition from hair system to normal hair more transparent.

Human hair is fragile and the oils, wax, and sebum that is meant to protect your living hair, becomes a liability for the hair system. The hair in a hairpiece can’t replace itself as growing hair does and oils, wax, and sebum can’t flow to the hair shaft because the foundation stands between your scalp and the artificial hair. With a lessened ability to clean the scalp from sebum and oil buildup, the hair systems accumulate this buildup. This means that you need to wash the hair system to get rid of the oil and sebum buildup or replace the hair system at intervals that depend upon the quality of the system and your requirements for keeping your hair looking perfect — or just good enough becomes a problem.

Synthetic hair fibers aren’t as susceptible to injury unless you wash the hair system too frequently, heat them (or perm them) to a temperature that melts or chemically alters the fibers, or use products on the system that aren’t easily removed.

Some people choose to style their hair system with perming equipment, rollers, hot irons, and hair dryers. This styling opens up the hair system to damage just as the same processes do on a normal head of hair (see Chapter 3 for more information on these processes in normal hair).

Setting up a cleaning schedule

Some types of hair systems are designed to be removed at night to allow you to wash your scalp and then reapply the hair system in the morning. When your scalp is cleared of the day’s buildup of sebum and oils, the hair system will stay cleaner longer. Simple washing of the hair system doesn’t remove skin cells, skin oils, shed hair, and other debris that accumulates in the foundation and in the hair fibers of your hair system. Either you learn to clean your own hair system on a regular basis or you bring it in for serv- ice and cleaning to keep it clean and odor free. A spare is an absolute necessity, possibly two. For those people who use hair systems that are made to stay on the head for weeks at a time, there is no real viable option for keeping down the odor and removing the oils and sebum that builds up every day. Cleaning/washing the hair system while it is still on your head is not a viable option for most people for two important reasons including:

1. The sebum and oils will stay below the foundation even if it is washed. Only the hair is really subject to washing.

2. The hair system that stays on your head after washing will remain wet for some time. Wearing a wet hair system is like

wearing your wet towel without giving it the opportunity to dry. We all know the musty odor of a wet cloth that is confined to a closed space.

Cleaning your hair system with it off your head will allow you to get to the foundation and remove the oils and sebum, but if you scrub it too vigorously, you can destroy the hair system relatively easily. There is clearly some balance between washing and pre- serving the integrity of the hair system. Drying it with a lukewarm hair dryer setting deals with that musty smell discussed earlier.

The attachment mechanism for the hair system is critical. It is always best to be able to get the hair system off so attachments with tape may work well for this purpose (see attachment mechanisms later in this chapter).

For most wearers, the initial expense of owning more than one hair system is justified by the increased lifespan of the hair systems because they can be switched while being washed.

Creating a natural-looking frontal hairline

It’s not enough to just plop a toupee or wig — even a good one — on your head and forget about it. One of the problems with hair replacement systems is the appearance of the frontal hairline. Unless you have natural hair remaining in your frontal hairline, the foundation of the hair system may be highly visible, separating it visually from the scalp and leaving an artificial-looking hairline. Making this space appear normal is maybe the most challenging part of the manufacturer’s job. Most hair systems utilize a style where the hair is actually combed forward over the hairline to hide it from direct observation. When there is bright light, the leading edge of almost all hair systems can be seen, so a forward combing styling may be critical to the disguise.

The best frontal meshes that extend from the hair system are cus- tomized to match your skin color and may be see through. The hair fibers at the hairline should be thinner than the hair used in the rest of the hair system. This is particularly important when the system uses coarse hair. As an alternative, the front hairs of the system can be cut short so that they fall forward, camouflaging the seam at the front edge of the hair system. Multiple hair thicknesses on the front of a hair system tend to increase the costs.

The time investment to manage the fine mesh is considerable and may be difficult for you to do yourself if you have anything but a completely bald front. If you still have natural hair growing at your hairline, shaving it for such attachments is ideal because any natural hair present (it grows at a rate of about 1⁄ inch per month) causes significant problems in the ability to maintain the attachment beyond a week or so, but shaving the head and using tapes or glues will eventually cause traction alopecia and a loss of what- ever hair you had there before you started wearing the hair system.

Many high-end hair system suppliers offer weekly services to reattach these hair systems and recreate the delicate frontal transition zone. The flipside is that this care makes the process more time- consuming than a monthly hair cut would be.

Attaching Your Hair

The greatest worry for anyone who wears a hair system is that it will unexpectedly come off in public. This fear can dictate your daily activities and keep you from doing things you like to do — you may avoid going outside on a windy or rainy day or pass on a day of water-skiing. But rest assured that manufacturers have put a great deal of effort into devising methods to attach hair systems securely. Each method has advantages and disadvantages, which is why this section helps you assess your options for keeping your hair where it belongs.

In general, the following methods are used for attaching a hair system.

•  Glue: The area that the hair system covers is shaved or the hair is clipped very short, and you use glue around the outer edge of the hair system to hold it in place.
•  Clips: You apply the clips attached to your hair system to the surrounding fringe of normal hair.
•  Double-sided tape: The tape is attached to your hair system, and you stick it to your shaved scalp.
•  Weaves: The weave is a different beast. It sews hair that you have into the foundation mesh. The hair anchors the hair system to your scalp, but the hair continues to grow so the hair system become looser over time (1⁄2 inch of growth per month can be expected). Most weaves need to be tightened every 7–10 days. Traction alopecia results from chronic use of weaves.

Loose glue changes a life

Joey loved baseball and played every weekend. At age 22, he got a hair system attached professionally with glue. When he was 26 years old and playing baseball every weekend, an accident on the field changed Joey’s life. After hitting a double, Joey saw the pitcher hesitate and, seeing his opening, Joey ran for third base. He slid to the base but left his hair system some 10 feet behind him. It came off with his hat, exposing the front of his shaven bald head where the glue had been.

The crowd was in hysterics, and in the dugout, Joey’s teammates were not kind about his hair loss. That was the last time Joey ever played baseball. He also lost contact with all his teammates who had such a good time at his expense. Loose glue changed the course of Joey’s life.

Gluing it in place

A properly glued hair system is secure and comfortable for the wearer (some say it’s the most comfortable attachment method available). You must redo the glue every 10 to 14 days because your scalp skin sheds under the hair system and eventually the system will loosen and come off. The opportunity to wash the hair system when it is re-glued is available to each user. Some people take enough command of their hair systems to wash them while others just use their spare while the hair system is being serviced and washed. During servicing, repairs on the hair system can also be made and these include: replacing hair that has come out, reattaching the hair to the foundation, and styling or color alterations to account for the exposure to the environment of the wearer.

Glued hair systems don’t breathe easily (meaning they don’t allow much air to circulate). Combine that with the fact that you remove it less often than other hair systems to clean both your head and the system, and you can understand why you should wash your hair system frequently enough to minimize any odor from the body’s sweat and bacterial buildup underneath.

Every person who uses glue as an attachment mechanism develops a comfortable routine for removal and reattachment. Wearers often turn to those who sell and service the hair systems to handle this process.

Getting a professional to remove, reattach, and wash your glued hair system must be calculated into the total cost of the system.

Glues and clips are used frequently to attach weaves and wefts, two types of hair systems that we cover later in this chapter. When these systems are removed, normal hair may be pulled out because the bonding is often very secure and almost permanent. Great care should be taken not to put too much glue on the point of bonding the weave or weft to your natural hair. Some of the bonding mechanisms that glue the wefts to your scalp can last for as long as a few months, although this would be unusual.

Snapping and clipping

You may choose to attach your hair system with metal snaps or clips sewn to the foundation netting that fasten directly to your natural hair.

•  Metal snaps are tied or sewn to the foundation and to your hair, which means they must be relocated as your natural hair grows out and the attachment loosens. Some of the advantages of clips and snaps are that
• They’re usually very secure once you get used to them.
• The hairpiece is easily removed so you can cleanse your scalp and wash your hair as frequently as desired.
•  Metal clips are ideal for affixing a hair system during the transition phase following a hair transplant when a client wants to cover his baldness while the new hair grows in.

One concern of clips is that the point of attachment to the existing hair may create localized balding from traction (called traction alopecia and explained in Chapter 5). Frequently relocating the clips to different areas of the hair system may postpone the appearance of traction alopecia, but sooner or later a bald area will develop at the point of attachment on the scalp.

Drilling it in: Don’t try this at home!

One “clever” surgeon invented a snap system for attaching hair systems in which the snaps are anchored to the skull with drill-holes made in the bone. Bone cement was used to seal the snap, with the edge of one snap brought through the skin. The surgeon found some neurosurgical friend to affix the clips to his skull. He was promoting this technique, using his own head as an example. Could he have had a screw loose himself? We’ll let you decide that for yourself.

Sticking it on with tape

Tape with adhesive on both sides is one of the simplest methods of attaching a hair system. It’s particularly handy for removing the hair system at night to wash your scalp thoroughly. This attachment method generally requires that the scalp is shaved under the taped section.

In spite of its good points, double-sided tape does have some dis- advantages, including the following:

• Tape can leave a sticky residue of adhesive on the skin and on the net foundation of your hair system.
• The tape often takes dead skin cells with it when you remove the hair system from your scalp. These skin flakes eventually build up on the tape, and as the skin flakes decay, they develop a pungent odor.
• With the skin buildup on the tape, the tape becomes less effective and must be changed and replaced.
• Tape tends to become unstuck when the hair system is pulled or when you sweat. For this reason, this type of attachment is especially unsuitable if you like to exercise or spend time in hot, humid, sunny climates.
• The stickiness of tape is vulnerable to swimming and diving, activities that tend to loosen the attachment of taped hairpieces.

Tips for keeping your hair tied down

As we mention earlier in this chapter, when you wear a hair system of any kind, one of your biggest concerns — and perhaps the root of your self-consciousness — is keeping it in place. No one wants to find themselves in the embarrassing situation of dealing with fly- away hair.

All attachment methods can be vulnerable under certain circumstances (which we address in the earlier sections on each method), but there are things you can do to ensure a tight connec- tion between your scalp and your hair system. Here are a few ideas:

• Change the glue or tape frequently. The fresher the glue or tape, the more secure the bond will be.
•  If you use clips, also use glue or tape. Combinations of attachment mechanisms add to attachment security.
•  Keep an open mind and experiment with the alternative attachment methods if you’re not happy with the one you usually use.

Attaching extensions: Weaves and wefts

If you have hair to work with, you can enhance it by using hair extensions in the form of weaves or wefts. Hair extensions come in various sizes and lengths and are groupings of synthetic or natural hair that are placed into your hair to add bulk to it.

Change isn’t always a good thing

Michael wore his hair system to work, taking it off after work and at some social activities around the house. His hair system stylist, Sylvia, called one day to report a new advance in the product line — a lace front — that would help make Michael’s hair system less detectable. That was a sticking point for Michael, so he headed to the hair system office. Sylvia recommended that Michael get the new lace front, which was a very fine nylon mesh with softer hair than the front of his existing hair system, which was made of a harsh, coarse hair and without transparent mesh. He enthusiastically agreed to give it a try.

Michael’s method of attachment was clips attached to the sides and back of his hair system, and he had a considerable amount of thin hair at his frontal hairline. When Sylvia offered to shave the front of his hairline in order to glue on the new lace front, Michael refused the shave, saying that he didn’t want to take such a drastic step until he was sure he liked it. So Sylvia glued the lace mesh in place, over Michael’s normal hair in front.

When Michael got home, he felt uncomfortable as the glue pulled on his forehead and his frontal hairs, so he decided to go back to his previous attachment, using the spare hair system he kept at home. Unfortunately, when he tried to take off the glued lace front, it would not come off. He panicked and immediately called Sylvia, but the office was closed. He didn’t sleep that night because the hair system tugged on his frontal hair, and he couldn’t remove it as he did every night with the clipped system. In the morning, Michael returned to the office and had Sylvia remove the lace front with acetone and alcohol, but the whole experiment pulled out most of the hair he had at his frontal hairline. The lesson of this story is that everything has its price, and your comfort level with whatever you choose, is critical to commanding your independence.

•  Synthetic hair extensions: Hairs are be attached to each other by putting heat to one end and fusing the hairs together.

The small groupings of 20 to 50 fibers (hairs) may be attached to the base of your own hair with heat fusion, adhesive, clamping, wax, or braids.

The use of synthetics reduces the cost of hair extensions because fibers of monofilament are less expensive than human hair.

•  Natural hair extensions: Hairs are attached as groups of hair.

They can be affixed to a foundation (a weft) or they can be

affixed to each other. The extensions consisting of grouped hairs can also be glued to your hair. When these extensions are glued to your existing hair, your original hair can grow and the extensions will move further away from the scalp as your hair grows.

Weaving a system in place

People often refer to a weave as a hair system, but it’s really more of an attachment method. A weave involves a hair system on a mesh foundation; strands of your natural hair are woven through the edges of the foundation to secure the weave. This woven attachment method holds the hair system to your scalp very securely and naturally because of its many points of attachment.

Weaves can be used for hair systems as a mechanism of attachment. They can also be used to braid groups of hairs or individual hairs to the person’s own hair. In theory, a single hair woven or braided to a single hair may be best, but that may be impractical considering the shear number of braids needed.

Hair systems secured with weaves require adjustment as the hair grows in order to keep the system tight to your scalp. After two weeks, your natural hair will have grown out about 1⁄4 inch, and the hair system will move easily as an entire unit when touched.

With braided weaves to groups of hair, your natural hair is put into horizontal cornrows. Braids placed well behind the frontal edge of your hair can add bulk without detection. Your own hair can be weaved with the new hair (synthetic or natural hair), or threads or human hair or artificial hair may be used to enhance the fullness. The greater the number of attachment point, the more secure will be the impact. The greater the numbers of braids, the thicker the hair will appear.

Weaving braids of hair to your own hair can produce traction hair loss particularly because this attachment approach is left on for longer periods of time (a few months in some people). They only become problems when the attached hair moves too far away from

the scalp as your natural hair grows out. With braids, it’s also difficult to lubricate or wash your hair because it’s caught up in the braid. Hair that is braided is often more brittle.

Weaves almost always pull on existing hair, some of which already may be weakened by the balding process. But even if the hair isn’t already weakened, the constant pulling of the weave eventually produces traction alopecia at the points of attachment (this also happens with wefts, which we explain in the next section). For this reason, you should have weave attachment points relocated often to different areas of the scalp.

With good relocation, wefts can add substantial bulk to your exist- ing hair without causing any permanent damage to your natural hair. Wefts can also be moved to different locations frequently. Unfortunately, many technicians who apply these wefts don’t understand the importance of moving them, so it is incumbent on the wearer to direct the process as the wefts are reattached.

You also have the option of weaving artificial hair with the real hair without a mesh foundation. One company invented special clips to attach strands of artificial or human hair to the bottom of the shaft of growing hair (almost one for one). Attaching this hair system is a tedious process requiring a very hefty fee (in the $50,000 range) and expensive weekly adjustments to tighten the strands of hair and move them back toward the scalp as the hair grows out. The normal hair acts as the anchor that holds the attached hair as your normal hair grows out. Many similar services have been developed at different facilities for far less costs, but unfortunately, all these techniques cause traction alopecia.

Using wefts

As mentioned earlier in this chapter, a weft is a type of hair system. It’s usually a linear strip of human or synthetic hair that’s bonded to a latex or fabric strip. Wefts tend to be longer than the systems used in weaves (braids of hair to hair), and they generally contain more than 50 hairs or synthetic hair fibers. They may require more points of attachment. They also provide more hair bulk than weaves.

Wefts that are made with human hair woven into mesh are more expensive than those that are pressed together with a machine and glued to the mesh foundation. Regardless, the wefts should match your hair color and hair thickness. After they’re applied, they’re cut down to the length that fits with your hair style.

The wefts can be woven into place using your natural hair, which is passed through the mesh with appropriate sewing needles and then knotted. Another attachment method involves the use of

adhesive glue that holds the weft onto the parted hair or scalp. This bond creates a barrier for fingers getting down to the scalp when someone tries to run their fingers through your hair.

Attaching wefts with adhesive is fast and less expensive than other attachment methods, although it does usually require a professional to do it well. Clips allow flexibility for the user who wishes to apply the weft on their own.

There’s no telling how long wefts will stay in place. For some people, their wefts stay attached for many weeks. But for others, the wefts may loosen up with the first shampoo. Natural hair oils cause the bond to lose its adhesive properties if it is glued, and an edge of a weft may lift off of the attached hair. If you use glue attachments, in order to help your wefts stay in place as long as possible, we recommend that you comb the hair very carefully and avoid perming your hair unless you use a salon that has experi- ence combining hair styling with the advantages of the weft.

Attachment no-nos

Three attachment techniques require special attention because of the risks and serious consequences involved: sew-ons, tunnels, and the implantation of artificial fibers. We mention these techniques only to warn you against them. The damage of a scarred scalp is very difficult to hide or cover, and all three of these techniques will permanently scar your scalp. In our practices, we see patients seriously deformed by these techniques and always advise against them.

Sewing it on

With sew-ons, the hair system is stitched directly onto your scalp with an encircling, permanent surgical suture. This procedure is illegal in the U.S. and most European countries. Unfortunately, in New Jersey, a few companies have been able to use this dangerous technique for years despite attempts by the New Jersey attorney general to block them. They sidestep the law by employing retired doctors with a valid medical license to sew them into the scalp. The hair systems are attached to the stitch that is placed through the skin of the scalp. If this turns you off, we include it to dissuade anyone from considering this barbaric technique.

Skin is a more complex organ than most people realize. One of the skin’s essential functions is to prevent bacteria and viruses in the environment from entering the bloodstream and reaching the vital organs. A suture through the skin leaves a small hole that allows bacteria to migrate into the fatty tissue under the skin. Long-term

sutures through the skin often result in infection and abscesses (tender masses full of pus and bacteria).

Many sutures incite enough of a reaction to cause the suture to be rejected and extruded by the skin, tearing a large hole in the scalp. (Most sutures in the scalp are rejected by the person’s body.) Surgical sutures left in the skin for too long need to be replaced, which is part of the profit of the sew-on business. This process of expelling the sutures is hastened when any traction is applied.

Between the sutures, the scars that they cause, and the recurrent infections, a wall of scar tissue gradually builds up in a circle around the sutured wounds. This encircling scar may eventually cause blood supply problems to the central portion of the scalp, and a thin, parchment-like layer of scar tissue may replace the skin in the center of the scalp. Any permanent hair that was present in the area surrounded by the suture is killed off. The damage from this process is permanent and the pain from the complications of this approach can be unbearable.

Tunneling grafts into the scalp

With this technique, tunnels are created in the skin of your scalp. These tunnels are made from small skin flaps from your own scalp skin. To make them permanent, skin grafts are often taken from another area of the body. Usually you get three tunnels: one in the front and two in the back. Plastic or nylon hooks are sewn to your hair system, and the hooks are inserted into the tunnels. The attachment is quite secure, and you can easily remove and replace the hair system without a visit to a wigmaker’s salon. The best part of these tunnel grafts is that once they are in and secure, they are completely painless.

The obvious disadvantage of this procedure is that it involves minor surgery, and you must ask yourself if the punishment fits the crime. The tunnel grafts create a deformity that looks like handles to a suitcase. If the tunnels are removed later, permanent scars remain in the scalp. With enough donor hair, hair transplants may cover the scars on the back of the head left by the tunnels; how- ever, the scar in front may be more difficult to conceal. And if you may need a hair transplant in the future to cover the damage from tunnels, why not just have a hair transplant in the first place?

Planting artificial fibers

The manufacturer of a synthetic polymer claims that its products look and feel like human hair. The material comes in small bundles of fibers that are implanted directly into the scalp. It’s most widely used in Japan and elsewhere in Asia but not in the U.S. or many European countries.

Be careful about considering this option, as its safety is in question. The artificial fibers can cause many problems, not the least of which is scalp infection, which can be severe and difficult for the body to fight off because the fibers are embedded into the skin (similar to the sew-on sutures; refer to the earlier section, “Sewing it on”). Thousands of artificial fibers go through the scalp, and an average of 15 to 25 percent of the fibers are pushed out of the scalp each year. Initially, the results are quite remarkable and almost bald men look like they have a crew cut, but the price that one pays becomes more evident over time as infections occur, and the fibers are expelled. Scarring remains after all of the artificial fibers are expelled by the body.

It’s almost impossible to treat the infections from these artificial fibers without removing the foreign material. The artificial fibers are brittle and tend to break off at the skin level, leaving bits of for- eign debris under the skin that festers, swells, and produces pock- ets of pus. Infection caused by fiber implants also may cause premature loss of natural hair follicles adjacent to the artificial fibers. Over time, inflammation may destroy the scalp to the extent that further hair transplants of any kind are difficult or impossible.

Aside from potential scalp infection, the artificial fibers have an unnatural, stiff texture that doesn’t feel like real hair. Combing is difficult because traction can break the fibers or pull them out, and using a hair dryer on them causes the fibers to frizz. Damage to the fibers above the skin level is permanent.

With so many problems and the fact that the process is illegal in most countries, one wonders why companies that make artificial fiber implants are still in business. The answer is simply profits. Anyone in the U.S. who sells these systems should be immediately turned over to the state medical boards.

Women and Hair Systems

As we explain in Chapters 4 and 5, women suffer from genetic thinning more often than outright baldness. The exception is about 15 percent of women, who experience frontal balding, develop a pat- tern similar to the Norwood classifications Class IIIA or IVA pattern of balding seen in men. We discuss this classification system in Chapter 4. Essentially, this type of balding goes from front to back. When a woman has this pattern, she may or may not lose the frontal 1⁄3 inch of hair but the hair extending as far back as about 3 inches may become very bald or very thin.

Women frequently treat genetic hair thinning themselves using hair systems that clip onto existing hair, but other attachment methods are possible as is discussed earlier in this chapter. The use of attachments is often a styling decision intended to thicken finer hair, because the holy grail for women is thick, luxurious hair — the type heavily promoted in magazine and television ads to the tune of billions of dollars annually.

As a woman, your options for attaching a hair system to your natural hair are

• Clips that attach close to the scalp.
• Weaves (discussed in the section, “Weaving a system in place,” earlier in this chapter), in which small hair systems are woven into your hair.
• Wefts (discussed in the section “Using wefts”), in which long strips of hair are glued into the base of your hair.

African American women in particular are prone to alopecia, the fancy, medical name for hair loss. The use of thermal or chemical hair straightening products and hair braiding or weaving are styling techniques that place African American women at higher risk for various forms of “traumatic” alopecia than their Caucasian counterparts.

For example, tight braids that have pulled back the hair since childhood cause a substantial amount of traction alopecia in African American women. And traction alopecia has pushed many African American women to wear full wigs because the hair on the sides (which is often lost from the traction alopecia) isn’t easily hidden with even a small wig or any other hair replacement systems.

Adding Up the Costs of Hair Systems

The cost of a hair system is highly variable because it depends on so many factors. This section looks into the practical financial costs as well as those costs that you may not think of right away — psychological effects and the possible lasting effect on your natural hair.

Starting with financial costs

Dollars-wise, the cost of a hair system depends on a number of fac- tors. And there’s no one-time-only cost when it comes to hair replacement systems, especially because you may want to purchase up to three hair systems: one to wear, one as a spare, and one to wear if the others need repair.

Here are the basic variables that affect how much of a hit your bank account takes thanks to your hair systems:

• The quality and durability of the system
• The manufacturer’s marketing costs
• Monthly maintenance costs for cleaning and repairing what hair has fallen out
• Purchasing new hair systems as the old ones wear out
• Changing your hair system to match your natural hair color as it changes due to aging (that is, as it turns gray)

In the end, there’s no set cost for a hair system, and as long as you choose to wear one, you’ll be paying something for it on a frequent or regular basis.

Assessing your psychological costs

You may wonder what psychological costs could possibly result from wearing a hair system. For some people, worrying constantly about their hair — Is it going to stay in place? Can other people tell they’re wearing hair systems? Are people secretly laughing behind their backs? — may outweigh any benefit of having a full head of hair.

The only one who knows how you react to such things is you. If you know you’re a worrier and are likely to spend much of your time reaching up to see if your hair’s still there, or constantly trying to read strangers’ expressions to catch their reactions to your system, you may be better off without a hair replacement system. Other options are available, after all; we cover them in Parts IV and V of this book.

Beware the wig salesman who wants to clip your hair!

Twenty-one-year-old Charlie was concerned about his frontal corner recession (the hair in the corners of his hairline meets the side hair of the temple), so he looked through the phone book and found a full page ad proclaiming a modern form of hair replacement and a medical breakthrough. Charlie got the courage to visit the company’s office, where he met a likeable salesman who looked at Charlie’s balding area and, with hardly a word, clipped the front of Charlie’s frontal hairline back 2 inches from the front! “Don’t worry about a thing,” said the salesman. “If you don’t like what I’ve got, there’s no charge and you can just walk away.”

Needless to say Charlie was freaked out with the frontal 2 inches of hair clipped close to the skin; his 3-inch-long hair behind it made for an embarrassing contrast. The salesman took out a small hair system with tape on the back and stuck it to the newly clipped area on Charlie’s scalp. Immediately, Charlie had a full head of hair, but he was left with no choice but to buy the hair system. When he walked out of the office, although he felt okay about his new ’do, he was uncomfortable at having been taken in by the sales process.

This was the beginning of Charlie’s 20-year relationship with hair systems. His hair system changed as his hair style changed, and as his hair grayed so did his hair system. As his balding progressed over time, his hair system became larger. The problem that Charlie didn’t notice initially was that his hair systems were slowly pulling out the rest of his frontal hair. His hair system became an addiction, costing him thousands of dollars every year. Unfortunately, at no time was Charlie given the opportunity to explore other hair loss treatment options — he was hooked.

Considering the possibility of accelerated hair loss

Some hair systems accelerate hair loss. This is generally due to the attachment method causing traction on the existing hair. Glues and tapes are notorious for accelerating hair loss. Some doctors also theorize that the psychological stress of wearing the hair system (refer to the previous section) can contribute to hair loss. This theory has been observed in identical twins when one has a hair- piece and the other doesn’t.

Dr. Rassman had a pair of identical twins in their late 20s. One had a hair system and the other did not. The one with the hair system used clips, but his hair loss had advanced far more than his identical twin brother who wore no hair system. Dr. Rassman has seen this in a number of identical twins.

Maintaining Your New Hair

Using a hair replacement system is much more complicated than simply buying something and sticking it on your head. (That only works if you’re using your new hair to block the sun and not as a way to improve your appearance!) You’ve probably seen people with hair replacement systems that are so obvious — and so badly in need of TLC — that they turn you off the idea of a hair system. But you need to remember that a well-maintained and well-fitted system isn’t noticeable. In order to help you achieve the best, unnoticeable results, this section covers some dos and don’ts for keeping your hair looking as good as the rest of you.

Staying active — and keeping your hair on!

If you’re very active or participate in sports, one of your main concerns may be how difficult it will be to keep your hair in place while you’re in the water or running down the soccer field, for example. Most people with hair systems try not to push them to the limits, at least not when other people are around!

Most wearers restrict many activities like water-skiing, yet many hair replacement advertisements show men wearing their products while water-skiing! We’ve heard reports from some people who have done just what the ads suggest and had their systems come off in the most embarrassing social situations. Our recommendation is that you use common sense, and if you think your hair system may not hold up to your activity, consider changing your plans.

Everyone is different, so what works for one person may not work for another. Generally, hair systems hold up to gentler sports (such as running, golf, tennis, most aerobic exercises and gym activities, and skiing the bunny slopes, for example), but if you’re into more aggressive athletics, you may be better off taking off your hair system and wearing a hat instead. For example, direct contact sports are clearly risky for detachment.

Two other problems plague many hair system users:

• What to do when your system gets wet in the rain
• How to manage sweating underneath the hair system

Unfortunately, these problems aren’t easily solved. Our best recommendation is that you carry a spare hair system with you and make a switch when such problems occur.

Keeping up with regular care and maintenance

Many women — and men — have standing appointments at the hair or nail salon. Think of maintenance for your hair system in the same way — as just part of your normal routine. Following are some handy guidelines for the care of your hair system:

 Set up a schedule for having your hair system washed — whether you do it yourself or take it to a professional. Don’t wait until it starts to smell.

• If you use a hair system that attaches with either clips or tapes, smell the system when you remove it at night. You should wash it frequently enough to keep any odor neu- tral and to avoid the “What’s that smell?” look from your closest friends.

• If your hair system is attached with glue, and you’re not an expert on the application of the glue, you may not be aware of a developing odor because you don’t remove the hair system nightly. Therefore, your maintenance schedule should take into account the timing of develop- ing odors. Ask someone near and dear to you to give it a sniff and judge if your hair system needs to be washed. If you’re too embarrassed to involve another person, just arrange a standing appointment with your system maintenance service people.

• If you have a weave, the weave will loosen as your hair grows, so you should have it professionally adjusted two or three times a month. The longer you wait between adjusting the weave, the looser it will become. And the looser is becomes, the greater the risk of traction alopecia (refer to Chapter 5). A wig that moves around your head is not only uncomfortable, but you also have to worry that others may detect it because most people’s hair doesn’t shift around!
•  If your hair system involves wefts, you should have it serviced before the wefts come loose from the base of the hair that they’re attached to. It’s relatively easy to feel the point of attachment, and when the wefts start to come off, you’ll feel them peeling away. Servicing a weft requires expertise, and it’s usually done by salons that specialize in this type of hair system. It’s best to be proactive in servicing your weft and not

wait for it to peel off; there’s almost nothing more obvious than a weft that hangs apart from your hair and scalp.

•  Think of your hair system maintenance like you do car maintenance: Attend to it regularly, and have the whole system looked over for potential problems. Your service experts will tell you when your hair system is wearing out, and if that’s detected early, the repairs hopefully won’t break the bank.
•  Don’t forget to maintain your spare hair system(s). It’s always smart to be prepared for the unexpected, and you never know when you’ll need your backup plan.

As you can see, the timing of your maintenance program depends largely on the type of hair system you have, but you’ll always benefit from being proactive. For example, servicing your system before you take a vacation is a good move. With some experience under your belt, you’ll figure out just how much preventive maintenance is required. Setting up a schedule is critical.

Recognizing when it’s time to replace

Even the most expensive hair system won’t last forever. On aver- age, you can expect your system to last for a year or two with proper care. The more expensive hair systems made of human hair will last longer. As we mention earlier in this chapter, you’ll need to replace your hair system as your natural hair color changes in order to keep the transition as seamless as possible. And if you work in sandy or dusty environments, it will become dirty, picking up dirt and grime between the hair filaments and in the foundation. The more dirt and grime on the hair system, the harder it is to clean (which may mean gentle washing isn’t very effective) and the more frequently it requires washing.

Consider wearing a hat instead of your hair system when you’re working in a dusty environment. It makes no difference if you’re an executive who only occasionally visits construction sites — the hair system will pick up elements of the environments you visit, and that can either accelerate damage or be a tip-off to others that your hair’s not really yours.