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All Hair Pieces / Systems related posts


My girlfriend and I don’t think that we have hair loss problems (at least not yet), but we would LOVE to have fuller hair so that we wouldn’t need to use hair extensions (which I assume all the celebs use because no one has hair like that!). Could transplants do this for us too?

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Historical Perspective: It is important to understand that many of the accoutrements that adorn our bodies arose from earlier, less sophisticated times. The use of wigs date back to the Egyptians in the years between 4000-300 BC. They were used extensively by men and women. The Greeks were the first to popularize wigs and braids and that began the long torturous route to hair styles that cycled in popularity for the next few thousand years. In the middle ages (1200-1400 AD), single women showed their health and vitality by demonstrating full heads of hair, much of the hair manufactured from animals. Once married, only the husband could see the head uncovered, so it was the young single, female that had to appear healthy and capable of producing healthy children. Even back then, women were packaging themselves for the marriage process. As the populations started to concentrate more and more in the cities, the disease tuberculosis, took its toll. For the malnourished females whose heads were uncovered, their hair showed a window into their core health. Those women who were not sick but had the misfortune to have a fine hair, appeared sickly. So women with a thin head of hair wore a wig or used braids to increase the fullness of their hair, thus appearing healthier. Sexual attractiveness and a healthy appearance were inextricably linked early in our evolving society. Paintings since the late renaissance, showed women with abundant body fat and full heads of luxurious hair. As tuberculosis is blind to socioeconomic conditions, the successful artisans were engaged by wealthier clients to create the illusion of health with abundant hair and lots of braids. The concepts of portrait art, showed what the person wanted to look like, not what they actually looked like. As the hair became thicker, it hid signs of illness or malnutrition. Braids became common place and the use of wigs and other hair extensions remain part of our cultural heritage, as our question suggests.

No, hair transplantation should not be used to increase the fullness of a normal head of hair, but the use of hair extensions and other such devices comes with a hidden cost for some people. That cost can be progressive hair loss. When it happens, it is caused by the continuous pulling that these devices produce on the hair at the point where they are attached. If you weave your existing hair into the matting of the extension to hold it, then the constant pulling from the attachment can produce Traction Alopecia (hair loss from pulling) and it can be permanent if the process continues. I have seen women with patches of hair loss or hair thinning from these extensions. What they do to manage the proble, is put in more extensions around the thinning area. This successfully masks the thinning area while it damages the healthy area nearby. Eventually, these damaged areas become confluent. My advice to you is to respect your hair and watch carefully for any signs of Traction Alopecia. Make sure that you are not starting a cycle that worsens with time.


My earlier post about smelly hair systems generated a lot of good responses…

I loved yesterday’s question on the smelly hair system. It does not even compare to my problem. I have already found the secrets to keeping it from smelling decent, but that does not deal with the ladies when they want access to my head. I am working the internet dating scene and this problem is killing me. I find myself fearing the intimacy that I fantasize about. Now it is not fantasy, but a pending nightmare each and every time I start up a new relationship. If I do not wear the hair piece, I can not be myself. How does one deal with the no-touch zone that puts the fear of God into the rug wearer when a woman wants to run her fingers through the piece?

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When a man embraces a woman, there is a tendency for the woman to want to run her fingers through her man’s hair. This is a deal breaker for hair system wearers and it puts them on-guard every time they establish a new relationship, often impacting behavoir as the wearer tenses up during intimate moments. I have spoken to many men and this is a common problem. The answer is that the rug wearer needs to keep one hand free at all times to fend off the roaming hands of the woman. It does put the kybosh on the freedoms one wants in real intimacy and it excludes such activities as bathing, swimming and the like. I have found that these problems are not addressed well in long term relationships either. I have done hair transplants on men whose wives have told me that they have never seen their husband without his wig on, not even after 30 years of marriage. I am afraid there is no real answer. Every hair system can be felt, even with the best of weaves. The only real answer to this question is a good hair transplant.


I read with great interest, your answer to the person who wore a hair system that stunk. Systems stink and it’s not only the smell that I am talking about. This is only one of the problems I am faced with. I don’t have a lot of money. If I did, the place where my system is serviced would take care of me as often as I want. They suggest once a week, but they want $60 for a full service. Frankly that is alot of money when you consider that I have to take off from work to have it done. In the past 10 years, I have spent over $10,000 in hair systems and the costs of replacing the one I have now will be another few thousand dollars. It really does need to be replaced. I want to know how much will a hair transplant cost me and how many transplant procedures will I have to suffer through? I am 35 years old.

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Most people who are 35 have already established a mature pattern of hair loss, so first you need to find out what Class of hair loss you have. Read Assessing Hair Loss and then get back to me with photos of yourself with wet hair and dry hair, showing the full extent of the hair loss. A phone consultation with me will be specifically focused on your individual needs. Generally, the less the balding, the less expensive will be the process. A Class 3 reconstruction might run between $3000-$6000 and if your hair loss is stable, then more surgeries may not be necessary. For the very bald person, the cost can climb to range between $10,000-$15,000 (these prices are based upon our least expensive Standby program). Please see Fees and Financing for more information.


I have a hair system and it smells. I am compulsively clean and I used to wash my hair once or twice daily. Now, with the hair system on, I can not wash frequently. A close friend told me that the colognes I use do not help hide the smell, so when I heard this, I was devastated. Now I think that everyone is smelling me, my dates, the ladies around the office and strangers I meet, but I am so embarrassed that I do not know what to do. Any suggestions?

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Just in case you weren’t sure, the term hair system is another term for a toupee, a wig or in local slang, a rug. Systems have been around for centuries. They have been found in Egyptian tombs, on frozen mummies from Alaska’s Eskimos, and on your late night TV showing quick fixes for hair loss. My saddest story reflects a less than ethical wig-salesmen (only some are bad folks), who introduced a 21 year old with early frontal balding for a free trial. Before he knew what was happening, his head was shaved and then a ‘mop’ was put on this poor soul’s head, glued to his shaved scalp. Of course, he could have walked out and not purchased one, but alas, with the front of his scalp shaved bald and the back of your head with long luxurious hair, he knew he was going to look kind of funny walking into the office in the morning. So, like a few fixes of Heroin, he got hooked on a ‘system’ and found it part of his persona for years. Worse still is the hidden reality that these systems promote hair loss from traction, accelerating the genetic hair loss and promoting the addiction even further. Hair piece cripples are created and they live their hell almost every day.

When a poor self image is perpetuated in the mirror every morning, the smell may be less of an issue. This emaiiler’s main point is the smell. To deal with the smell, the only satisfactory solution is to have a series of wigs, use clips to attach them so that they can be taken off at night and then wash the wig often. Daily washing of the scalp is not a problem when the wig is off the head. Washing the wig will cause it to wear out sooner and the result will be more frequent replacements. The use of clips are not promoted by those who sell these systems. For reasons I can not fully understand, glues and tapes are more popular, and weaves are gaining in popularity. These last three fastening methods keep the soap and water away from doing a proper cleaning of the scalp, despite what the wig salesmen say. If you can’t wash the scalp with the system off, the scalp will smell and if you do not wash the wig, it will smell. I have rarely seen a person in my office with a system that does not smell, but sometimes I can not tell if it is the system or the patient. Does it matter what smells?

Today, the cost of a hair system properly fitted and maintained in a 5 year period of time will often run more than the cost of a hair transplant procedure.


I live in Brasil, I’m 41 year old and my grade of baldness is 6 / 7. I use a hairpiece for 18 year and i want to get free of this, but i have a problem, because when i started using , i was able to avoid peolple noticing that was a hair piece, as was very natural and my baldness was class 2/3 and as i used to travel a lot i didn4t see people so frequently. My case i believe is needed a scalp reduction for a start, but i’m afraid of procedures go wrong and i cannot remove the hairpiece to much in advance. Please help me . I can travel to NHI if necesary but I can forward photos to a better evaluation of my case

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Your story of how one starts with a hair piece and then gets caught in a cycle of more and more dependence as the hair loss advances, is a common story. Many of our patients have been where you are now. The problem for advanced hair loss patterned people is the availability of supply. The basic point is to find out if there is enough donor hair, when combined with good styling, to produce the type of coverage you want or need. That depends upon many factors, of which the number of hairs available for transplants is only one of these factors:

  1. A better match of hair and skin color will work to your advantage, wavy hair and coarser hair also will work to your advantage if that is what you have. What is your skin and hair color?
  2. How loose is the skin in the back and sides of your scalp. For those who have loose skin, the availability of donor hair is generally higher.
  3. Is your hair wavy or straight?
  4. Is your hair coarse or fine?

Sending me a good set of pictures is important for me to establish a good baseline. Please answer the questions above for me in your responsive email. You can use the form or my email address on the Contact page.

In answer to your other point, the idea of using scalp reductions, I will just say that this procedure has fallen into a bad reputation and most good surgeons do not do them anymore. The problems are that there is severe scarring on many patients and thinning of the donor hair to such a degree that there is not enough donor hair to restore the frontal area. Although there are some patients that may do well with them, there are far too many risks for the average patient. I know about these risks because I had three scalp reductions in the early 90s and was left with scars and a return of my entire balding area. I eventually got transplants and had enough donor hair to fill in the crown defect. Best of all for me was that I had no frontal hairloss. Had I been a Class 6-7 balding pattern, I would have been in trouble. So in conclusion, cutting out the bald spot is a risky surgery with many things that could go wrong. The key to a good hair restoration procedure is low risk and a normal, hairy outcome in a reasonable time-frame.


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