Hair Weaving, Bonding & Extensions

A question frequently asked by my patients is about hair weaving and bonding. Some of them think it is a variety or technique of hair transplant. In fact, it is not. These are just ways to attach artificial non growing hairs or wig to your scalp. This confusion has occurred because clever new age salesmen wanted to overcome the negative connotations that the words "wig" "hairpiece" and "toupee" conjure up in the minds of most men. Instead of calling their products wigs, we now have "hair extensions", "hair weaves" or some kind of fancy "non surgical hair restoration systems".

Listed below is a list of all the different types of wigs with an explanation of each.

Wigs & Toupees

Wigs are artificially arranged animal, human or synthetic hair traditionally used to conceal hair loss . Toupees are similar to wigs meant for a smaller area. The most popular way to attach a wig to the scalp is with tape or glue. The problem is that with perspiration and body heat, this glue melts and the grip of the wig loosens. The wig can come off easily, causing embarrassment and humiliation in public or amongst friends.

Some wigs are firmly held in place by wire loops or clips that pinch the scalp skin. In such situation the chances of wig falling off is reduced. But these clips or wire may cut through the skin causing infection. Also due to constant pressure by clips the hair in that region are destroyed permanently.

A wig is a wig.

The biggest aesthetic problem with a wig is unnatural appearing frontal hair line, which appears too full and too straight, without usual irregularities. If the wig is not color and hair texture matched, then it looks ugly. Another problem is that the sun and water can cause the wig to discolour and become frizzy thus making it stand out from the wearer’s original hair.

Wigs are highly visible and extremely delicate. To keep them looking presentable, they must be of high quality, and be maintained with scrupulous care. Ideally a person would have three wigs, one for wearing while one is being cleaned and a spare for any catastrophe that may occur. The cost of regular replacement is high and hygiene can also be a severe problem.

Hair Weaving

Hair weaving is a technique whereby the wig is attached by weaving wig’s artificial hair with remaining scalp hair. Sometimes, strands or wefts of hair are used for the weave.

The biggest problem with weaving is that the procedure itself causes more hair loss. This permanent hair loss is caused due to pulling of hair roots during retying or tightening of the wig. It also means that as your own hair grows the wig loosens. Therefore retightening needs to be done at least once a month. After about six months a person can begin to lose hair permanently along the stress point where the wig is tied. This is known as traction alopecia.

Hair loss due to weaving

The initial cost of the weave may seem very reasonable, which is a major selling point, but the real expense comes in the monthly visits to have the weave re-tightened, this will add to the cost considerably. Moreover, since these are non-growing hair wear and tear means regular replacement of the hair fibers as well.

Hair Bonding-Fusion

In this technique hair, artificial fiber or dead human hair, is bonded with a glue to your existing hair and scalp. It needs to re-tightened on a regular basis as your own hair grows. Again the initial cost may be comparatively low but you have to continually go back to the clinic to have the hair piece re-glued. Allergy to glue and pull on existing hair roots during combing and styling are other problems.

 Hair Extensions

Hair extensions are used to increase density or provide volume to existing hair. They cannot cover a bald patch and are useful for long hair only. This method is useful for females wanting long thick tresses. Re-tightening and servicing is regularly required.

To summarize, artificial hair is not a good choice health wise or aesthetically. But if one has to resort to it, a customized hair piece should be used. Scalp care should be immaculate to maintain hygiene and health of existing hair.

Stages of Hair Loss

It is a common knowledge that baldness occurs in degrees and is a gradual phenomenon. Since it is not possible to convey the extent of baldness in words, a classification system was developed by Dr. Norwood. This is the most commonly used sytem today, although other more complicated systems are also available.

Broadly speaking, Norwood classification attempts to divide baldness in seven stages with stage I  being normal adult hairline and stage VII being total possible baldness. Although, there are many flaws in this system, it still gives a basic idea regarding the extent of baldness in an individual.

Stage I

Essentially normal adult male hairline (not to be confused with 'juvenile hairline'). Temporal recessions are well defined   with frontal hairline in normal position. No miniaturisation in crown region.

Stage II

The frontal hairline shows slight recession(< 2 cm), with more pronounced recession in temporal area.
The "A" variant implies that hair line is receding uniformly and that frontal forelock is not spared. This means
exaggerated appearance of baldness and larger requirement of hair during transplant.

In this stage hair transplant should be done if the baldness is stable. Usually a single session is adequate.

Many surgeons defer operating in such patients, especially if they are young.

Stage III

This stage can be considered as watershed for transplant, because now the baldness is very obvious
and most transplant surgeons would consider performing a procedure in such patients. There is definite recession
in frontal hairline combined with deep temporal areas and usually thinned out look in most of frontal area.
Crown may also show miniaturisation and/or actual hair loss (Stage III Vertex)

State IV

This is a more advanced state of baldness, in which frontal and frontotemporal recession is deeper than in State III
and the density of hair in these areas is noticeably reduced. As the baldness moves from front to back,
and circumferentially in crown area; a bridge of healthy hair remains in the mid section of scalp.
This area called the 'bridge' is characteristic of stage IV.  Loss of bridge, is seen is considered a feature of
advanced baldness.

Stage V

Area of baldness keeps increasing and thinning of bridge segment is present.

Stage VI

In this stage there is total disappearance of the bridge segment that separates the two main areas of baldness.
The depth of the frontal and crown areas has expanded sideward and backwards.
In some individuals, frontal forelock may be spared to become 'isolated forelock'.

Stage VII

This is the most advanced stage of hair loss. In this stage only the universal safe zone remains.
Hair transplant is useful only in those individuals of stage VII who have good hair characteristics.

Hair transplant is possible from stage II through VII. Advanced stages of baldness usually require more than
one session to achieve maximum benefit.
In selected individuals mega sessions can be planned to cover large areas in one go.