The dangers of hair extensions

The beauty trend can cause headaches, baldness, and allergic reactions

Published: February 2013

A 46-year-old social worker came to my office complaining of excruciating head pain. She had already had a several-thousand dollar work-up that included an MRI of her brain and cerebral arteries. The MRI ruled out several serious causes of head pain.

As I examined the scalp over her left temple, the region she described as most tender, she winced in pain. My fingers had discovered several rows of tightly braided hair extensions that had been placed two weeks earlier, about the time that her symptoms had begun.

This was not the first time I had seen a patient with headaches caused by a hairstyle: tightly pulled ponytails, braids, and chignons can cause them as well. While those styles are easily undone to give the scalp a rest from the pressure, my patient was reluctant to have her extensions removed. That’s because she had invested eight hours in a salon chair having them installed, and decided to bear the pain.

Hair extensions, which transform even the thinnest head of hair into a luxurious mane by adding volume and length, are now quite the rage. Throngs of celebrities are rumored to wear them. Made of human hair, synthetics or mixed blends, hair extensions can be added individually, in groups (weft), or by clip-on method. In the strand-by-strand method, small tufts of hair are attached to sections of natural hair. In the weft method, a curtain of hair is attached horizontally. In both methods, the hair is then attached to the head by bonding, gluing, heat fusing, metal tube clamping, or sewing. A typical full-head application that can make short hair long can involve between 100 and 200 extensions, and can cost hundreds to thousands of dollars as well as many hours at the salon.

The process can cause what is called traction alopecia—hair loss and balding from the pulling and excess weight. The hair loss is believed to be caused by loosening of the hair shaft from the follicle, as well as by chronic inflammation. Extensions can cause hair tangling, matting and loss of shine, itchiness, and yes, pain, like my patient experienced. They can also cause contact dermatitis and, in rare cases, life-threatening allergic reactions from sensitization to glues, rubbers, or other chemicals used for extension application and removal.

Randee Bank, a petite brunette who goes to the hair salon I use, said she had loved the look of extensions so much that she wore them daily, and was willing to tolerate the headaches. It was when she began to notice several bald spots where the extensions had pulled out chunks of her hair that she finally stopped. A dermatologist told her that because of permanent damage to the hair follicles, her hair would never grow back.

“They’re all a disaster,” Bank says, describing the various methods she had tried over the years. “When you take them out, you look like a rat has chewed on your hair, so it becomes addictive and leaves you with little choice but to put them back in to hide the damage they’ve caused.”

Celebrities, too, may be starting to think twice. Photographs of bald spots on singer Britney Spears and model Naomi Campbell have appeared in the tabloids, and Jennifer Aniston has admitted that her hair had become thin from extensions.

Consumer Reports’ advice? This is one beauty trend best avoided.

Read more of Orly Avitzur's columns on dangerous beauty and other topics.

Orly Avitzur, M.D.

Medical Adviser

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