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Chapter 7: Cosmetic Treatments


Cosmetic treatments for hair loss only affect the user’s appearance, and not the structure or function of the living cells that make up the body. Cosmetic hair loss treatments are temporary solutions that need to be performed again and again on a regular basis. And cosmetic treatments are reversible, although some treatments such as cutting the hair or shaving the head will take some time to return to the original condition.

Hair Styling

A good haircut can go a long way towards improving the appearance of a person with hair loss. It is important to have the right cut for the shape of your head, and for the desired look you are trying to achieve. Hair styling for people with hair loss can either use the existing hair to more effectively camouflage the hair loss, or can involve cutting the hair shorter so that the thin hair is not as apparent.

Using existing hair to camouflage hair loss generally works only when the hair loss area is small, and when there is plenty of existing hair to work with. Comb-overs are not an effective solution, and usually draw more attention to the balding scalp.

Permanent waves, commonly called “perms,” are a method of increasing the curliness of existing hair by wrapping strands of hair around rods while treating the hair with chemicals. After a short period of time, the chemicals are rinsed out and the hair retains the shape of being wrapped around the rods. The increased curliness of the hair creates the appearance of greater hair density, and helps to hide the scalp under thinning hair. But perms need to done periodically as the hair grows out and the chemicals used can weaken the hairs and cause increased breakage, and sometimes may cause scalp irritation.

Cutting the hair short is a surprisingly effective solution for moderately thinning hair. Usually the hair on the top of the head gets thinner than the sides and back. When thin hair is allowed to grow long, it can get “stringy”, and draws attention to the scalp that is visible under the strands of hair in the thin area. But when all of the hair is worn short, the thin area on top is less apparent. This styling technique can be made even more effective by thinning out the hair on the sides and back adjacent to the thin area on top. Hair stylists have special scissors with comb-shaped blades for thinning hair; or an electric clipper can be used.

And then there is always the option of shaving the head completely. Shaving the head is a bold move, but it solves the hair loss problem completely. Athletes, chemotherapy patients, and people with moderate to severe alopecia areata commonly use this solution. A shaved head also allows for the occasional use of other temporary cosmetic solutions such wigs, hats, and scarves.

Another bold hair styling technique that men can use is to allow facial hair to grow out in order to draw attention away from a receding hairline or bald spot. Moustaches and beards can help to reshape your face, but they’re not for everybody. While facial hair can give some men a distinguished look, they can add years to the apparent age of others. And many men simply don’t look good with beards or moustaches.

Hair Care Products

The hair care product industry, like the perfume industry, sells “hope in a bottle.” There are countless products claiming to give the look of “fuller, thicker hair.” Shampoos and conditioners clean the hair and scalp, remove excess oils, and seal the hair shaft to maintain moisture and keep hair manageable. While some conditioners coat the hair shaft and make the hair more manageable, some people with thin hair find that conditioners flatten their hair making their hair loss even more noticeable. Shampoos without conditioners can result in hair that is “frizzy” and less manageable when worn long. However, when the hair is short this can be a desirable result that gives the appearance of greater hair density.

In addition to shampoos and conditioners, there are thousands of spray-on thickeners, foam mousse products, gels, and lotions that all promise to improve the look of people with thin hair. Many of these products coat the hair shaft, in a manner similar to how mascara thickens eyelashes.

Hair dye and bleaching products can give mixed results. Some feel that for those with light-colored skin, making dark hair lighter can reduce the contrast between the hair and the skin on the scalp, which can make thin hair less apparent. On the other hand, some feel that darkening thin hair can sometimes make what hair exists seem more prominent. In either case, once the hair is colored or bleached, the treatment must be repeated periodically to avoid having different colored roots become visible as the colored hairs grow out.

Scalp coloring cosmetics are types of cosmetic products for treating hair loss that fall into in a category separate from other hair care products. These products color the skin on the scalp, reducing the contrast between the hair and scalp, which otherwise draws attention to thinning hair. Some of these products are heavily pigmented talcum powders in an aerosol spray can, and others are liquid scalp paints, and some are colored lotions that come in squeeze tubes. Scalp coloring products are selected to match the color of the existing hair, and are applied to the skin on the scalp, rather than to the hair itself. These products tend to work best for thinning areas, surrounded by dense hair growth. By covering the scalp with pigment, there is less contrast between the skin and the hair, and what hair exists looks fuller and thicker. Make-up artists use scalp coloring products to prepare actors and actresses for television and film performances. A major disadvantage of scalp cosmetics is that away from the camera, the painted-head look is apparent. Also, some versions of this product are not waterproof, so care must be taken if perspiration is a possibility, or if rain is anticipated. Most scalp paint products can be readily shampooed off in the evening.

Another type of cosmetic treatment for hair loss are dust and fiber products that are sprinkled into the hair, just as artificial snow flocking is sprayed onto Christmas trees. Like scalp paint, the color of the dust or fiber product is selected to match the existing hairs. Dust and fiber products are almost undetectable, even upon close visual inspection, and are ideal for use on camera, even under bright television lighting. Certain dust and fiber products can also be used immediately after hair restoration surgery to effectively camouflage newly-placed hair grafts until they have healed. Regular shampooing rinses the dust and powder away.


Hairpieces are artificial hair devices designed to cover the bald spot on the top or front of the head, and to blend in with a person’s existing hair along the sides and back. They can be constructed from natural human hair or synthetic fibers, which are usually placed into a transparent synthetic mesh base. Hairpieces go by many names, including hair appliances, hair extensions, hair weaves, hair systems, units, and non-surgical solutions. Today, hairpieces are usually attached to the scalp by adhesives, or by weaving the person’s existing hair through the clear mesh base at the edges of the hairpiece.

Artificial hair will work for just about anyone with hair loss. There is no concern about the degree of effectiveness, which is an issue with medications, or having adequate donor hair, which is a problem with surgical hair restoration.

Hairpieces made from human hair are more costly than synthetic hairpieces, and they require more maintenance. However, when they are constructed carefully and matched well to the individual’s existing hair, human hair hairpieces can look very natural. Synthetic hairpieces last longer; however, they generally look and feel less genuine.

Hairpieces have several advantages as a treatment for hair loss. They are relatively fast and easy solutions. There is no waiting for months for medication to work, or for surgically-relocated hair follicles to begin to grow new hair. A custom made hairpiece may take several weeks to complete, but after that you have instant hair.

And hairpieces and wigs can be constructed with whatever hair density is desired. Hairpieces and wigs actually add new hair, while transplant surgery just moves existing hair around. A hair unit that is too thick for the age of the user will look fake, so expertly designed custom hairpieces are made with only moderate hair density. But even these hairpieces are generally constructed with greater hair density than can be achieved with micrograft hair transplants. Artificial hair will work for just about anyone with hair loss. There is no concern about the degree of effectiveness, which is an issue with medications; or having adequate donor hair, which is a problem with surgical hair restoration.

Hair appliances will work even if you have no hair at all. A hairpiece that covers the entire scalp is called a “wig.” Hairpieces and wigs are also ideal for people with temporary hair loss, which may be caused by various diseases, or medical treatments such as chemotherapy or radiation therapy.

But hairpieces also have some distinct disadvantages. By far the most significant disadvantage is fear of detection. While cosmetics for the skin and even tanning bed tans are accepted, there continues to be a certain stigma against wearing artificial hair, regardless of whether it is synthetic or human hair. Wearing a hairpiece is fine, as long as it is not discovered. Despite the perfectly reasonable desire to look one’s best, wearing a hairpiece in particular can be embarrassing. It’s a “cover-up.” It’s fake. So artificial hair wearers expend considerable effort to avoid detection.

The first line of defense against detection is the visual appearance of the hairpiece. A hairpiece wearer must be ever vigilant to assure their hairpiece looks natural at all times and well groomed, but not too well groomed. It has to be cleaned and styled to look good…but not too good. The wearer’s real growing hair on the back and sides of the head must be trimmed as needed to match the length of the hair in the hairpiece, which obviously does not grow at all.

When the hairpiece wearer begins to develop gray hair, the hairpiece must be altered or replaced to blend in with the changes. And all hairpieces wear out eventually, and must be repaired or replaced periodically before they look too unnatural. Hairpiece users need to have at least two hairpieces, so that they can wear one while the other is being cleaned, modified, or repaired. Most hairpiece users own three or four “units.”

The second line of defense against detection is secure attachment, and regular re-attachment. At some point, all hairpiece wearers worry about their hairpiece coming loose. Many methods for attaching hairpieces have been tried in the past, including suturing the unit directly to the scalp, clipping the hairpiece to loops of live skin surgically constructed on the scalp, and even snapping one to bolts screwed through the scalp and anchored into the skull. But the most popular methods today are double-sided tape, weaving, and liquid adhesives. Double-sided tape is fast and clean, and allows a hairpiece to be easily removed at night; however it is the least secure attachment method.

Attachment by weaving is more labor-intensive, but very secure. A hairpiece designed for weaving has very fine clear mesh along the edges, and the person’s own hair is pulled through the hairpiece and woven into the mesh to achieve a secure fit. A weave will last for a month or longer, before hair growth begins to loosen the fit of the hairpiece. Weaves require reattachment every four to six weeks, to compensate for the attachment hairs growing out at the rate of about one half inch each month.

Liquid adhesive attachment is also very secure, and allows the hairpiece to remain in place for a month or longer. With adhesive attachment, the scalp is cleaned, adhesive is applied, and the hairpiece is pressed into place. The adhesive is placed in a U-shaped pattern with an opening at the back to allow cleaning the scalp under the hairpiece by using shampoo and a jet of water.

With modern adhesives, the risk of a glued-on hairpiece coming loose prematurely is practically zero. However there is still a limit to how long a hairpiece can remain glued on. Over time the skin cells on the scalp are shed, and glands in the scalp secrete oils, which eventually loosen the adhesive. The dead skin cells and oils can also accumulate under the hairpiece. This can cause bad odors, and in extreme cases, skin irritation.

So a third line of defense against detection is regular hygiene to avoid bad smell and scalp problems. Most hairpiece attachment techniques are designed to allow the wearer to loosen one edge of the hairpiece to wash under it, and then reattach the edge. Those hairpiece users who choose to have their units glued on for a month or longer, must take care to wash under their hairpiece regularly to avoid odors and possible skin irritation and infection.

The final line of defense against detection involves touch. In intimate situations, most hairpiece wearers fear that their hairpiece will feel unnatural to anyone touching their hair, and that discovery during certain situations can be awkward, at best. Many hairpiece wearers avoid letting anyone touch their hair. Hairpieces constructed with human hair generally feel more natural to the touch than synthetics, but most hairpiece wearers agree that discovery by their partner is inevitable, and usually choose to explain their “appliance” at the right moment, before it is discovered.

Surprisingly, cost is another disadvantage of hairpieces. Over time they are the most expensive alternative of all the hair loss treatment methods. While hairpieces are often sold by mail-order and over the Internet for $500-$700, a good quality hairpiece can cost $1,000-$5,000, and usually one or more identical spares are purchased at the same time, so that one can be worn while the other can be cleaned or repaired as necessary.

Hairpieces wear out and need to be replaced every year or two. In addition to the cost of the units, there is also the ongoing cost of service, with periodic visits to the “hair club” for hairpiece removal, scalp and hairpiece cleaning, hair cutting, and hairpiece reattachment. Even for do-it-yourselfers, considerable time is required to maintain a hairpiece in top condition at all times. Over a lifetime, the cost of hairpieces and maintenance is more than the cost of the ongoing medications or the cost of several hair transplant surgery sessions.


Wigs cover the entire scalp, and are often preferred by women with overall diffuse hair loss, by people with unpredictable patchy hair loss, and by people with total hair loss. Wigs temporarily replace all the hair on the scalp. Wigs are an excellent cosmetic solution for those with alopecia areata or alopecia totalis, and autoimmune condition that results in partial or full hair loss. Wigs are also prescribed, just like a medication, for chemotherapy patients who are likely to lose their hair as a result of treatment. Wigs can be attached with tape or glue in the same manner as a hairpiece. However, there are also vacuum fit attachment devices designed especially for full-cap wigs that offer the benefit of a very secure and comfortable fit without chemical adhesives.


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