Hair Loss

Cancer Center New Mexico

Hair Loss during chemotherapy:

Not all chemotherapy drugs cause hair loss, but the ones that do are fairly predictable. If your doctor has told you to expect hair loss, this is what usually happens:

One and a half weeks after your first treatment, your scalp may become tender. Some people don’t feel this at all, and for others their scalp is quite sore. This is normal and goes away after the hair loss is complete.

With most chemotherapy drugs, hair loss begins about two weeks to the day after your first treatment, and takes 3-7 days. Occasionally, hair loss doesn’t begin until three weeks, but be prepared for two, just to be on the safe side.

I promise you, you will not lose your hair before two weeks, and you will not wake up one morning bald without warning. You can generally wear your hair normally for the first few days, but by the third or fourth day, you’ll be ready to brush out what’s left and cut it short, if you haven’t already.

Whether or not to cut your hair before you begin treatment is a matter of personal preference. For some women, having their hair cut into a shorter style helps them get used to it, and it’s less traumatic when the hair begins to fall. For others, particularly if they love their hair, cutting it any sooner than they have to is more traumatic. Either way, you’ll definitely want to have it cut short once hair loss begins. 100 hairs that are two inches long are much easier to deal with than 100 hairs that are 6 or 10 inches long.

Something to consider, particularly if you have long hair, is to go wig shopping before you begin chemotherapy. Pick out a shorter style that you are comfortable with and have your hair cut like the wig. When friends, co-workers and the cashier at the grocery store see you, they’ll notice your new hair cut. Later, when you transition into wearing the wig, they won’t notice the change and make a big deal about it. This approach has been very helpful for many of my clients.

If you have long hair, and wish to donate it, Contact Locks of Love for more information.

Though some women shave their head when hair loss begins, keep in mind that all of your hair doesn’t come out on the first treatment. You’ll lose 90-95% of your hair, and if you shave it down to the scalp, what’s left will feel rough and whiskery. Instead, have it cut down to an inch or so. If you do use a clipper, use one of the attachments (most patients prefer #2) so that your hair and scalp will still feel soft to the touch.

Continue to wash your scalp with a mild shampoo (not bar soap) every day, even after you’ve lost your hair. Your oil glands will put out the same amount of oil whether you have hair or not, and this will keep your wig, hats and scarves cleaner.


Lashes usually go rather quickly, but brows tend to hang in there longer. I found that I wore my eye makeup exactly the same way, sans mascara. False eyelashes do not work well because you don’t have a base to set them on. Soft black or brown eyeliner pencil makes the best substitute for lashes.

If you have thick, deeply rooted eyebrows, you may get by without having to do anything, so don’t rush out and buy eyebrow cosmetics until you see if you’re going to need them. If you are skilled with an eyebrow pencil, you can use it to fill in your eyebrows by sharpening the tip and using tiny flicks to draw individual eyebrow hairs. However, an easier solution is to use an eyebrow brush–a short, stiff angled brush, and an eyebrow cake, similar to an eye shadow cake, to create a soft arch along your natural brow line. Under no circumstances may you draw a solid line over each eye!

Even if you don’t wear eye makeup or eyeliner now, you may want to wear a small amount during treatment. I prefer eyeliner pencil, rather than liquid. If you need help, visit your local Aveda salon or the cosmetics counter at any major department store. The American Cancer Society has a program called, Look Good Feel Better, that offers free classes for women undergoing chemotherapy. Call 1-800-395-LOOK or your local American Cancer Society for a time and location near you.


The straight scoop on wigs

The most exciting advancement in wig design is the monofilament top. It’s a transparent mesh top with individually tied hairs, so that wherever the hair parts, you actually see your own scalp. This allows the designer to use less hair, because they are not trying to cover up the wefting. Monofilament wigs are lighter, more comfortable, cooler, and stay in place better than conventional wigs. They range in price from $220-$320 compared to $120-$150 for a high-quality, conventional synthetic wig.

Most women who continue to work during their treatment prefer to wear a wig, and wear one every day. The only reason to have more than one wig is if you want a different style or color, or if you want the reassurance of having a spare. If a monofilament wig is within your budget, they are definitely worth the extra money. If not, one regular, high-quality synthetic wig will be just fine.

Synthetic wigs have come a long way in terms of improved texture, color, style and most importantly, the amount of hair they have. They wash up easily, just like washing a sweater, and styling requires just a quick fluff with your fingers. They are very light weight and most styles come in highlighted colors, just like today’s foil-weave techniques.

The drawbacks are heat and friction. You very likely would not be wearing your wig while cooking, but if you do and you open the oven door and look in, the blast of heat is enough to singe the front of your wig. Ditto with fireplaces, woodstoves, barbeques and dishwashers. No curling irons, blow dryers or hot rollers.

A short wig is going to look more natural than a long wig, and be easier to care for.

If you do want a longer wig, I recommend that you get one that clears your shoulders. Long wigs are okay for occasional wear, but if you wear a long wig all day every day, the friction from your shoulders and collar will tangle and in a few months the ends will frizz. There’s no getting around it, even with the best brands. If you do get a longer wig, be sure to spray the ends with wig conditioner and use a pick to remove the tangles after every wearing.

Only use products made for synthetic hair–it does make a difference. Regular hairspray and mousse are not compatible with synthetic fibers and will gum up the hair.

The pluses for synthetic wigs are: they are less expensive than human hair, lightweight, easy to care for, they come in a large variety of styles and colors, and they look great. The life expectancy for a synthetic wig, worn all day, every day and cared for properly is 9-12 months.

The general guidelines for washing are every 7-10 wearings. Obviously, if you live in a warm climate or perspire a lot you may need to wash it more frequently. You can tell when it needs to be washed because it loses it “oomph”. It picks up dust from the air, just like your own hair, and will lose its shine and body. If you use good products, COLD water, and conditioner, they wash up beautifully. If you wear your wig all day every day, wash it once a week.

Human hair wigs are slightly heavier than synthetic wigs because human hair weighs more than synthetic fiber. They feel great to the touch and lay more naturally, especially longer styles, because of the weight of the hair. They can be styled a variety of ways with rollers, blow dryers and curling irons. However, unless you like the wash-and-wear look, you have to do some styling. They can be colored or permed, though use extreme caution and have it done professionally by a stylist who is experienced with human hair wigs. Human hair wigs with a monofilament top run $450-700 and up. The life expectancy for a good human hair wig is about 5 years.

The wig bottom line:
Never has the adage “you get what you pay for” been truer than it is with wigs. You may wonder why you should go to a salon and pay $125 for a wig when you can order one out of a catalog for $40-50?

Well, there is a huge difference in the quality of the fiber, workmanship and style. A $50 wig will be dense and thick and dull. Even if you try to thin it out, it’ll still be thick at the scalp and the fibers will not have a natural feel, color or shine. If you look really close at the pictures in the catalog, you can see how thick and unnatural they look.

Every woman wants to look and feel beautiful, and it’s especially important when you’re experiencing hair loss. If you buy a cheap wig that you hate, you’re not going to wear it or feel good about it and it’ll just be a waste of money. If you can afford a nice wig, please treat yourself. If you do find that an inexpensive wig from a catalog is your only choice, take the catalog to your hairdresser and ask her advice. Also, most oncology offices and hospitals have free wigs that have been donated either by wig companies (new) or patients who no longer need them. Some of them are pretty scary looking but you may get lucky. If it’s a used wig, be sure to wash it before wearing.

Raquel Welch wigs are the very best wigs available today. Whenever possible, you should go to a salon that specializes in wigs. It’s nice to try on several, to touch them and actually see the color up close, to have a professional guide you in what style and color are best for you, and trim it up for you.

You can buy high-quality wigs, such as Raquel Welch, on the Internet, but read the return policy very carefully. For some sites, if you so much as comb through the wig it is not returnable, and how are you going to know what it looks like if you can’t comb through it?

Wigs on the Internet run about $20-30 less than in a salon, but by the time you pay for shipping and pay a stylist to trim the wig for you, you haven’t really saved anything.

In my opinion, the only reason you should buy a wig on the Internet is if you live in an area with no wig salon available, not to save money. I realize a lot of women fall into this category, in which case I recommend that you take advantage of the free phone consultation offered by most online wig companies.


Hats, scarves, turbans & sleep caps

Even if you wear a wig for work or when you go out, you’ll want something soft and easy around the house. Turbans, berets, soft hats and scarves are perfect–kind of like jammies or sweats for your head.

Some women wear the same pair of sweats every night at home, others like to dress up a little, even when relaxing, and like to wear a variety of things. The same holds true for head wear. Some women will have 1 or 2 basic turbans and some will have dozens of hats and scarves.

My goal is to offer head coverings that “disappear” on your head–hats and scarves that look great and are so comfortable you’ll forget you’re wearing anything. Here are my top recommendations:


Small brimmed hats are great for around the house. Total comfort and great style are important. Our office has hats in the chemo room. You are welcome to take a hat for free. The hats have been made and donated by ladies in Albuquerque.

Chemotherapy drugs used to treat breast and other cancers makes your skin very sun sensitive. It is recommended that you use a 30+ sun block when outside. You might also want to consider a sun hat for added protection.


I love scarves and find them to be a nice alternative to hats and turbans. They’re colorful, light, easy and elegant. Tying scarves is easier than you might think. With a large square scarf, simply fold it into a triangle, then back again and tie at the nape. Avoid silk or polyester scarves, as they will slip right off a bald head. Just pop it on and enjoy.

A long narrow scarf works great for tying around a turban or hat to add color or completely change the look. (Silk or polyester is fine) You probably already have several that will work. Just sit down in front of a mirror and experiment.


Turbans are a great alternative for casual comfort. Even if your wig is very comfortable, the first thing you’ll want to do when you get home is take it off, rub your head and put on something comfy. They can be worn alone or dressed up with scarves and hatbands. If turbans are not your style, try a beret in either angora or cotton knit. They’re nice and roomy, with no seams or elastic, and come in lots of colors. They make great sleep hats-angora for winter and cotton for summer.

Sleep Caps

You’ll want a sleep cap, even in the summer. It’s true that you lose 80% of your body heat out the top of your head. The sleep cap made of fine combed cotton—is perfect for the summertime. For winter, the Furry Fleece sleep cap or Angora Beret are your best bets. I think a good basic headwear wardrobe would include 2-3 scarves, a couple turbans, 1 or 2 sleep caps and 2-3 hats. As your treatment progresses, you’ll discover what looks and feels best to you and you can expand your headwear wardrobe accordingly. The nice thing about our headwear in the chemo clinic is, most items are not “made for cancer patients.” They are fashionable hats and scarves that you’ll wear long after your treatment is over.


Your hair will start growing back right away, but it’s about three and a half months before you have enough hair to really cover your head. It usually comes back the same color, but you’ll be so happy to have hair again, you won’t care if it’s green with pink stripes. And it usually comes back curly-at least for a while. Sometimes women keep their curl for a year or so, but most often, once that first inch is cut off, it’s back to normal.

At first, it’s just like baby hair-thin, wispy, maybe even blonde or transparent at the tips. When you can comb your hair and hold it between your fingers, it’s a great time to get it trimmed. That may sound strange, since you’ll be loath to part with even a quarter inch of it, but trimming off those wispy ends will make it look like you have short hair on purpose, rather than post-chemo hair. It’ll give your hair more body and style and you’ll be well on your way to growing it back. For some reason, your bangs may grow slower than the rest, and it may be several haircuts before they reach your eyebrows, but hey-you’ve got hair!

Amy Gundelach RN, BSN, OCN

Hair loss due to chemotherapy treatments can be one of the biggest stressors of your treatment.

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