Hair Extensions Hair Loss

Traction Alopecia associated with Hair Extensions, Braids, Cornrows 

The ‘hair extensions’ procedure can involve the attachment of donor tails containing large numbers of human hair shafts to numerically lesser  groups of naturally growing hair-shafts.  The attachment process utilises metal rings, or methods of ‘welding’ at any given point along the shaft, but more usually at just above scalp level. The objective being to provide extra hair length or volume instantly.  Of concern is that some fine delicate naturally growing hair shafts may be intolerant of thicker more numerous donor tails especially those that have been exposed to oxidative tints and thereby become heavier due to water infiltration.
Whereas the procedure can instantly augment hair density and length it can also deliver disastrous consequences.
With hair extensions  the points of attachment usually manifest as hard lumps sited close to the scalp. Any involuntary movement of these lumps during pillow contact can cause the epilation of some hair shafts. This is verifiable by the presence of a usually light coloured epithelial tissue (the Henle and Huxley layers) – which would have connected the hair shaft to the wall of its host follicle and has been ripped out.

Symptoms of intolerance include:
Real discomfort and pain especially during pillow contact, headaches, sleep deprivation and hair shaft epilation causing balding areas of scalp (traction alopecia). As there is no guarantee that hair will regrow.

Braids & Cornrows
Braiding and Cornrowing are procedures in which hair-shafts are plaited together into rows. Tractional forces created may and often do cause the development of traction alopecia. This hair may or may not re-grow.

Hair follicles were not designed to withstand such processes or support the weight of added natural or artificial hair shafts – especially when wet.
Each of the procedures should therefore be regarded as potentially damaging to hair-follicles. 

The author has seen many cases of permanent baldness resulting from Traction Alopecia associated with hair extensions.

If long hair is a necessity and extensions are seen as the only option, clip  in / out units are the safe option as they are easily removable for sleep.
During sleep, involuntary body movements can alter  the position of any near scalp level glue or metal lumps. The tractional forces created can cause the potentially harmful epilation of growing hair shafts.  Hair follicles suffering such tractional damage are not guaranteed to regenerate and sustain new hair shaft growth.

Braids, Cornrows & Weaves are procedures in which hair-shafts are plaited into rows at close proximity to the scalp. Tractional forces on these during pillow contact have the potential (either immediately or eventually) to cause actual pain / discomfort, scalp distress / damage (occasionally with bleeding) and the more frequently witnessed traction alopecia from which the follicle may or may not recover to reproduce hairs.

Hair shafts and their individual host follicles were not designed to withstand such processes or support the weight of added natural or artificial hair-shafts – especially when wet or during the sometimes traumatic ritual of routine grooming.
Each of the said procedures can therefore initiate the potentially damaging traction alopecia which can render hair follicles incapable of generating hair shafts.  Traction alopecia can therefore create permanently bald areas.

Many ethnic women have permanent traction alopecia as the direct result of corn-rowing, braiding, weaving or plaiting.

Damage limitation  (with no guarantee of success) include:
i)   to attend a hairdresser who is aware of the risks caused by permanent fixings at close proximity to the scalp.
ii)  attaching extension tails which are significantly heavier and much greater (numerically) than the naturally growing hairs to which they are         attached.
iii) attaching extension tails composed of poor quality hair-shafts which have been structurally compromised by:
a)  the malnutrition of the donor.
b)  excess solar exposure.
c)  oxidative recolouring products.
d)  lack of cuticle matching (cuticle cells form the hardened protective outer layer of the hair-shaft. The cells (up to 6 layers deep) overlap and are seen under scanning electron microscopy to be imbricated (like the tiles on a roof) with the free margin of the overlap pointing toward the distal end. It is important during the assembly of groups of donor hair-shafts that the cuticle cell imbrications of each donor hair shaft lay in the same direction.

© The Trichological Society