Frequently Asked Questions about alopecia

Appendix A


Copyright © 1995 Peggy Knight. No portion should be reproduced for commercial purpose. Individuals are free to distribute its contents, as long as they are not altered, and the source is appropriately acknowledged.


For men, women, and children with hair loss there are many options on wigs and hairpieces. Some synthetic wigs can be purchased for as little as $39.00 through mail order catalogs. Some custom made hairpieces with human hair cost as much as $4,000. What you need and want may fall between these two extremes. This booklet is designed to provide some practical information that you can use to find the right selection.


Ready Made

The ready-made styles are the most common. In this design, the cap is generally made in sizes petite to large with the majority in size medium, to fit a wide range of head sizes. The back has a series of hooks and eyes or Velcro on a thin elastic band that can be adjusted to make the wig fit snugly. Machine produced ready-made wigs with synthetic hair, offer low cost, ease of care and fast delivery often within 3-4 days if in stock. Many styles are available through catalogs and prices range from $39 to $300. Hand-tied ready-made wigs provide a more natural looking scalp. They can be made of synthetic or processed human hair and allow individualized styling. Hand-tied ready-made wigs range in price from $400 to $800.


Some manufactures offer semi-custom shaped net base wigs. This is usually accomplished with a series of different cap sizes and shapes that are fit to the client's head. Both the circumference and the shape of the dome can vary. Semi-custom versions offer the advantage of a more secure fit and can be made in 4-6 weeks. The hair is usually hand-tied onto a net base to provide a more natural look. They range in cost from $1,200 to $1,800. Some allow for fitting while the client still has hair and can be worn trough hair loss and re-growth patterns common with alopecia areata or chemotherapy treatments.


The custom molded bases are usually used for permanent and total hair loss. A plaster mold is made of the client's head and the base is formed from this mold. The precise fit creates what is called the suction or "vacuum" type fit. These hairpieces can be worn without adhesive and are the most secure and natural looking. They require 4-6 months to make and range in price from $2,000 to $4,000. Plaster molding of the head is done for other form-fitting custom hairpieces, which improve the comfort and security but do not provide a "vacuum" type fit.


You will have a choice of either synthetic, processed human or unprocessed human hair for your wig or hairpiece. Each type has advantages depending on your life-style and hairstyle you desire.

Synthetic Hair

In general, synthetic wigs may be the best choice if you have a short hairstyle, a limited budget or have little time or capacity to provide home care and maintenance. The major benefits are easy care, reasonable price, permanent color and usually quick availability. Most synthetic wigs today are made with Kanekalon fiber that holds its shape and color. On the negative side, some synthetic wigs tend to be stiffer and less flowing that human hair. Constant rubbing on the collar of a blouse or exposure to heat causes the fiber to frizz. The base is sometimes itchy or irritating to sensitive skin and the synthetic fiber can not be highlighted or colored. Most synthetic wigs range in price from $39 to $800 depending on cap construction and method of attaching the fiber to the base.

Human Hair

Human hair wigs are considered the best choice for longer hair styles, when the budget is more flexible and when you want to look and feel the most natural. The major benefits of human hair wigs are they flow and move like growth hair, feel soft to the touch and on your neck and provide the most natural appearance. These pieces can be premed and colored and generally last longer than synthetics. The drawbacks are that they need care like growth hair and are generally more expensive.

Processed Human Hair

The term Processed Hair is used to describe human hair, which has had one or more chemical processes in an attempt to change its outward appearance. Most of the processed hair which is used in the manufacturing of hairpieces is of Indian, Indonesian or Chinese origin because of it's availability and affordable cost. This hair, which is naturally black, course and straight, must be chemically processed in order to achieve the appearance of natural unprocessed hair. It is first lifted of color (bleach); than color is deposited (dyed) than permanently curled (permed) and finally stripped of it's outside cuticle layer (decuticalized).

Unprocessed Hair

Unprocessed Hair (European quality) is the finest quality hair available because it requires no chemical processing. This hair is gathered in the form of ponytails, which are blended and matched according to color, length, texture and curl pattern. It takes up to 12 unprocessed ponytails to manufacture one vacuum hairpiece. The European quality hair is not only the finest but also the most expensive, and has a much longer life expectancy. The European quality hair is carefully blended without disturbing the cuticle direction, resulting in tangle free styling. Less frequent repairs and chemical processes are needed because of the healthy hair shaft.


Some companies offer a blend of human hair and synthetic fiber. Sometimes this provides the advantages of both, i.e. some sway and movement and the natural feel of the human hair along with the style keeping and easy care of the synthetic. At other times it can present problems in care and maintenance, as each type of hair requires different processing methods to keep it in style.


There is a variety of attachment methods available depending on your individual pattern of hair loss, personal life-style and desire for security. Hair weaving or bonding (i.e. gluing or tying a hairpiece to existing hair) is generally not recommended as it can place too much strain on the existing hair. Full wigs can be attached to growth hair with mini clips or to parts of the head without hair using double-sided tape. When hair clips are used they should be rotated periodically to avoid putting prolonged pressure on the same area. For women with total hair loss, a custom molded "vacuum fit" or suction cap will require no tape or clips.



Machine-Made wigs are almost always less expensive. In most styles, this means the hair fibers are machine sewn onto a "weft" in a fixed pattern. The wefts are then assembled together on an open net base. Generally this type of construction is meant to be worn when you have hair as you can see through the wefts when the wind blows.


Hand production methods involve hand knotting on net base hairpieces or hand inserting on custom molded base hairpieces. Hand construction methods usually provide a more random and natural appearance. Most hand knotting or implantation is done overseas as the process is tedious and very labor intensive. On some type hairpieces, there is over 140,000 individual hair shafts that need to be inserted. There are a wide variety of price and appearance options with hand production methods that is explained in the following section.


On almost all wigs and hairpieces, hair is attached to the wig base with "ventilating needles". Ventilating needles come in various sizes and have small hooks at the end designed to pull a specific number of hairs from the hair bundle and insert them into the base material. The needles with the smallest hooks will pull one hair shaft at a time. Larger hook versions can pull up to 8 hair shafts at a time. Single hair shaft knotting or implanting is the most natural looking but also the most expensive.

Hand Implantation on Molded Bases

Hand implantation is a process on the suction or "vacuum fit" hairpieces. Once the molded base has been formed, the hair is implanted into the base either one shaft at a time or up to five shafts at a time. The single shaft method duplicates the pattern of growth hair and provides the most natural looking results. The multi-shaft implantation can save money but may be less natural especially at the part line or crown. When hair is implanted, the angle of implantation varies over the surface of the base to duplicate that of growth hair on the scalp. Special treatments are often provided at the front hairline and the nape of the neck depending on the style of the hairpiece.

Hand-Tied Knotting Methods

On net base hairpieces, the hair is tied onto the net with the use of the ventilating needle. The designated number of hairs are first picked up from the hair bundle then pushed through the net, knotted, then pulled back through the net again. Most net base hairpieces will knot more than one hair shaft at a time. Often the pattern in the front may be 2-5 shafts at a time while in the back it can be 5-8 shafts at a time.


Net base wigs come in variety of styles. The best quality will use a very fine net sometimes called "micronet". The fine net designs keep the hairs closer together and provide a more natural appearance. Some net base designs come with a polyurethane liner that provides a surface area for taping to areas of the head that may have no hair. The liner also helps provide a more natural looking scalp at the part line.

The vacuum fit or suction type hairpieces are made of several different materials ranging from fiberglass (hard) to silicone (soft). The soft bases generally are lighter and slightly more comfortable. The hard bases are more durable. All the vacuum type bases will be slightly warmer to wear than the net base wigs.


One of the most critical areas in wig design is the front hairline. Many styles do not have a very natural looking front hairline and this forces the client to wear styles with bangs or with the hair pulled more forward and into the face.

For the best appearance, we suggest you consider styles with whispy bangs or hair styled slightly off the face. You should always ask about any styling limitations before you purchase your hairpiece. Some wigs come with a special feature where hairs are hand-tied and "under-vented" on the edge to provide the most natural appearance.Creative styling techniques can also be used to give the appearance of a whispy natural looking bang line.


If you are selecting a wig for a temporary hair loss condition your first decision may be whether you want to duplicate the style and color of your growth hair or to use the opportunity to experiment with different looks.

Synthetic wigs can be purchased in a wide variety of colors and styles. The main advantage with synthetic wigs is that the fiber will hold most of its color even with prolonged exposure to sun. Many ready made synthetic wigs come ready made in highlighted colors and blends. Some custom made synthetics can be ordered with several colors mixed throughout the hairpiece to provide a more natural appearance. Styling of synthetics is done with steam or heat. It is not recommended that you attempt home styling as the temperature must be closely controlled to prevent damage to the synthetic fiber.

Human hair wigs can be colored and highlighted like growth hair to achieve the look you want. The drawback is that the color will oxidize or fade with prolonged exposure to sun just like growth hair. Human hair can be recolored or highlighted. Coloring a human hair wig does take special training and should never be attempted at home. A trained stylist will always do a test strand and in some cases may try multiple tests to achieve the desire shade. Styling human hair wigs is similar to growth hair with the exception of special techniques around the hairline. In addition, the perming method is very different and should never be attempted with home permed kits. A human hair wig will tend to hold the perm as it does not "grow out" like growth hair.


All wigs will require some home care. In general, the ones that look and feel the most natural may need the most care to keep them looking that way.

Synthetic wigs usually require simple washing in cool water about every 7-10 days. They can be left to dry on a towel overnight and can easily be "fluffed" back to their original style. Hot water, hair dryers or curling irons should never be used. Hand-tied synthetic wigs can be restyled by your stylist.

Human hair wigs require shampooing and conditioning about every 7-10 days. They can be air dried overnight or a hair dryer may be used on low heat setting for faster results. If your human hair wig has been permed then you may treat it like permed growth hair.

Every hairpiece should come with recommended care instructions which should include any special shampooing procedures and recommended hair care products. Always follow these instructions carefully or ask your stylist for specific instructions.


Almost all wigs will need repairs periodically to keep them looking fresh and natural. A human hair wig will begin to lose hair at the part line and crown through the normal pressure of combing and brushing. On many styles, hair can be added in these areas to maintain a natural appearance. Processed human hair wigs may need to be decuticalized at various times. The cuticle is the outer surface of a human hair shaft, which consists of 5-10 layers that resemble overlapping roof shingles. Repeated handling and blending of the hair causes the reversal of cuticle direction, resulting in extreme tangling, especially at the nape of the neck. By dipping the hair into an acid bath, the shaft is stripped of its cuticle layer leaving the hair slick. A loss of color caused by normal elements (oxidation) requires the frequent reapplication of chemical hair color. Processed human hair will need to be recolored more frequently than unprocessed human hair.

Hand-tied synthetic wigs can be steamed and reset when they need a style change or "frizzies" need to be eliminated. This must be done under very controlled heat conditions and we recommend you use a stylist who is trained in this technique. In general, machine made synthetic wigs are crimped at the base to provide fullness and camouflage the hairline. This technique makes subsequent repairs or restyling very difficult. With both human hair and synthetic wigs the overall appearance and life span will be greatly affected by the type of home care you provide.


Regardless of the type of wig you choose, it is always a good idea to have a back-up hairpiece. With synthetic wigs, an unplanned exposure to sudden heat may cause frizzing that a professional will need to fix. While it is being repaired, you will need an alternative hairpiece to wear. With human hair wigs can last from 2 to 4 years, you will need periodic repairs several times during the life span of the piece. Some repairs can be completed in a week. Others may take up to ten weeks. Your back-up hairpiece should allow you to feel comfortable in any situation.


Insurance coverage for wigs is generally unpredictable. Payment is usually obtained only on appeal after initial claim rejection. The insurance industry views wigs and hairpieces as cosmetic even though many states now exempt them form sale tax as a necessary prosthetic item when hair loss is caused by alopecia areata, chemotherapy or other medical causes. To have the best chance of receiving payment your sales receipt must list your hairpiece as a "full cranial prosthesis" and it is helpful to have a prescription from your doctor. In some instances it may be necessary to include a letter indicating that the hairpiece was needed to maintain emotional well being.

As difficult and sometimes humiliating as the process may be, insurance reimbursement it is worth the battle. There are several hairpiece companies and women's support group organizations that are actively fighting the battle for better insurance coverage. Check with the National Alopecia Areata Foundation (415-456-4644) for additional tips in filing a claim.


inexpensiveoften stiff and itchynatural looking part linemore expensive
fast-availabilitycan see through "wefts"colors can be blendedusually 4-8 weeks to make
wide range of styles and colorsoften looks "thick" and unnaturalnatural looking densitywill shed hair overtime
Synthetic HairHuman Hair
least expensivemay look stiff and unnaturalprovides the most natural lookgenerally more expensive
easy to maintainlow resistance to heatmoves and feels like growth hairrequires upkeep like growth hair
wide variety of colorscan not change coloreasily styled, colored and permedwill require periodic repair due to normal shedding
minimal color fadingmay frizz to due to fictionlast longer
Peggy Knight
Peggy Knight Solutions
180 Harbor Drive Suite 221
Sausalito, CA 94965
Voice: (800) 997-7753 or (415) 289 1777
Fax: (415) 331 8839