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Some people want “a little extra” to enhance medical or surgical hair restoration (hair implants). Other people are temporarily or permanently unable to grow hair and are therefore not candidates for transplantation. And some may want to avoid any type of surgical procedure (hair implants) or may be attracted to the promise of unlimited density and fullness.


In these instances, the answer may be nonsurgical hair addition or replacement. Twenty years ago or more a nonsurgical hair addition or replacement would have been a device called a toupee, hairpiece or wig. In the Twenty-first Century, toupees have disappeared from our vocabulary and a broad variety of hair devices, or hair extensions for hair loss, have come into being to address the need for nonsurgical hair addition or replacement.


The modern definition of a nonsurgical hair addition or replacement is “any external hair-bearing device that is added to existing hair or scalp to give the appearance of a fuller head of hair.” [Mahoney MJ, Nonsurgical hair replacement. In: Stough DB, Haber RS (eds.) Hair Replacement. Surgical and Medical. St. Louis: Mosby; 1996:399-411]. Covered by this definition are hair weaving, hair extensions for hair loss, hair fusions, hair pieces, hair prostheses and hair-replacing wigs. The material used to extend or replace hair may be human hair (from the patient, if possible), hair-like synthetic materials, or a combination of human hair and synthetics.


When custom-made under the supervision of a specialist, hairpieces and replacements can meet very real needs of selected patients.

Who is a Candidate for Nonsurgical Hair Addition or Replacement?


Total hair replacement by a prosthesis or wig may be an effective temporary measure for a person with temporary total hair loss caused by chemotherapy or a medical condition, and an effective permanent measure for a person with a genetic condition that renders them unable to grow hair. In situations where the cause of the hair loss is not known, patients should see a physician before choosing a nonsurgical hair addition.


Hair Additions and partial hair replacements may be effective measures for a variety of persons:

  • A patient with inadequate donor hair to provide transplants for all desired scalp areas may find satisfaction with a hair addition recommended by the hair restoration surgeon.For example, scarce hair follicles in the donor area may be used to provide a natural hairline in the frontal area of the scalp and a hair addition used to fill in the crown area.
  • A person who is considering hair transplantation, but is not yet ready to commit to the surgical procedure, may use hair additions as a half-way measure until transplantation is undertaken.


In rare instances, a medical condition may rule out surgical hair transplantation. Hair additions under the guidance of a physician hair restoration specialist may be a satisfactory alternative to transplantation.

Working with the Physician Hair Restoration Specialist


Choosing hair additions or replacement requires more than simple selecting “off-the-shelf hair.” Considerations that should be taken into account include:


The hair addition or replacement must be designed to be esthetically pleasing. For example, the hairline should be correctly placed, hair volume and density should be adjusted to avoid “too much” or “too little”, and a total hair replacement should look exactly like a full natural head of hair. Good esthetics requires an experienced specialist.


The material used for the hair device, as well as the materials used in hair-to-hair and hair-to-scalp attachment must be safe for use by the patient. Medical conditions such as allergies to adhesives may make some materials better than others for the individual patient. The variety of choices for hair addition (hair weaving, hair extension, hair fusion, etc.) may be confusing for the patient. To make an informed choice, patients should investigate different devices and actually examine closely someone who is wearing a system in which they are interested. Researching on the Internet is a particularly effective way to learn about the devices and materials that are available. Patients should be wary of fancy, technologically intriguing names and find out what is truly different in a particular device.

Long-Term Care


Hair additions and replacements require regular, long-term care. Hair additions and the scalp underneath must be kept clean by regular cleansing. A condition called seborrheic dermatitis (commonly referred to as dandruff) can develop from failure to keep the hair addition and scalp clean. Total hair prostheses and wigs also must be maintained in a clean condition, and the scalp regularly cleansed.


Both hair additions and hair replacements should be inspected regularly for changes in color or texture. A hair addition can be expected to last about 18 months before it begins to lose its natural appearance and needs to be replaced.

Cost of Hair Additions and Replacements


Custom-made hair additions and replacements are generally more satisfactory than off-the-shelf products, but custom-made products are more expensive. As discussed above, hair additions usually must be replaced as they lose their natural appearance over time. Immediate and replacement costs of hair additions and replacements should be considered when making a decision because the long-term investment can be substantial. Hair transplantation involves much greater initial cost, but because the results are permanent, may ultimately be less expensive when compared to costs of hair additions over time.

Changing to Surgical Hair Restoration


Some people may grow dissatisfied with the maintenance and cost associated with wearing a nonsurgical hair addition and decide to have hair transplantation. Many have made this transition successfully and are pleased to have their own natural hair growing again. Certain precautions, such as not wearing the hair addition for a specified time after the surgery, should be discussed with the hair restoration surgeon to ensure the best results.

Synthetic Hair Implants


Synthetic hair has been implanted into the human scalp for more than 30 years, with varying degrees of success. The use of synthetic hair implants is currently banned in the United States due to a number of side effects reported in the 1970s. In some countries other than the U.S., synthetic hair made of newer polymer fibers produced by companies in Japan and Italy is being used as implants in patients who have inadequate natural donor hair for transplantation. Clinical trials of synthetic hair made of these newer fibers are being reported in medical literature and may be discussed in future updates.

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