While the ISHRS is a medical society dedicated to educating doctors and patients on the most updated and effective medical and surgical treatments for hair loss, many patients find non-medical camouflage agents can offer an immediate and relatively inexpensive and easy cosmetic solution for hair loss. These agents are particularly helpful for patients with early thinning who may not yet be candidates for surgery, or patients who have started medication therapy but would like a more immediate cosmetic improvement while they are waiting to assess their response. Camouflage agents work largely by eliminating the color contrast that occurs when light passes through hair and reflects off a lighter colored scalp. While camouflage agents seek to improve the cosmetic appearance of existing hair, when hair is absent or areas of hair loss are particularly large hair prostheses such as wigs, or hair pieces may offer a more cosmetic immediate alternative. Hair prostheses as noted can provide hair coverage over small or large areas of hair loss—including eyebrows and eyelashes. The following includes descriptions of camouflage agents, followed by a list of available commercial products. After that a brief introduction to scalp prostheses is provided.
Scalp Micropigmentation (SMP)
Scalp Micropigmentation (SMP) is a tattoo technique where tattoo pigments are placed on the scalp in a stippling pattern to look like a shaved head of hair. When done properly, an observer can’t tell the difference between a shaved head and a tattooed head. Many patients with Alopecia Totalis have been treated with SMP.
- Scalp Micropigmentation (SMP): What is it?
- Scalp Micropigmentation (SMP): Semantics, Terminology, And Standards
This group of non medical concealers for hair loss and hair thinning includes wigs, hair pieces and hair extensions.
Wig hair fibers can be synthetic, or made of human hair. The latter are more expensive depending on the source of the hair. Wig foundations can vary from a synthetic base, to mesh net foundations and both can be attached to a lace cap. Hair strands can be attached by machine or individually hand tied to the lace allowing for more natural hair movement and styling. Human hair and hand made wigs are typically more expensive. Custom made wigs are the most expensive, requiring a plaster mold to create a silicone or polyurethane vacuum base that attaches securely using vacuum pressure, to the scalp allowing the user to swim and engage in other physical activities without worry that the seal will be broken. Wigs require frequent care to increase their lifetime. An integration wig incorporates the users own hair to be pulled through perforations in the wig, and blended or integrated with the prosthetic hair. Standard inexpensive synthetic wigs need to be replaced every 3-6 months, while more expensive human hair wigs may last for several years with close attention to care and maintenance.
Hairpieces are often used to achieve partial scalp coverage or to cover localized areas of hair loss, and are made from animal hair, as well as synthetic or human hair. Hairpieces can be attached to the scalp with clips or other adhesives. These areas of attachment may undergo traction hair loss over time. The adhesives have also been known to incite an allergic reaction in some people causing erythema and ulceration, resulting in permanent scarring. Maintenance of the hairpiece is essential, and represents a substantial expense over time.
Hair extensions are made from synthetic, human or animal fibers attached to a persons natural hair fibers by glue, clips, twisting, sewing or fusion in order to improve hair volume or length. Although these are very popular, patients must be cautioned they can actually create or exacerbate long term hair loss by causing traction induced hair loss. Traction induced hair loss can create temporary hair loss that turns into permanent hair loss over time with continuous exposure to the scalp trauma.
Wool crepe hair is used by actors to create moustaches, beards and eyebrows. These can be attached using Spirit gum, and removed with alcohol. Premade eyebrow prostheses are available for peel on and off use as well from online suppliers such as headcovers.com.
Topically Applied Pigmented Agents
Topical camouflage agents are products applied to the hair and/or scalp which give natural hair the appearance of being fuller without actually adding hair. They are mainly for treating thinning areas in patterned baldness but can be used for scarring or traumatic injuries in select patients. They work best with some existing hair in the treated area, even if the hair follicles are quite miniaturized. They can help camouflage a totally bald or scarred area as long as the area is small (less than 3cm) and surrounded and covered by hair of normal density.
There are a variety of fibers made from wool or rice keratin, rayon or human hair that are used to coat the hair and scalp in order to mask alopecia or areas of thinning. Most fibers come in a multitude of colors to match the patients’ hair color and blend to the scalp. Both hair and the fibers have natural static charges which help the fibers maintain their attachment.
Skillfully applying the fibers, either sprinkling or dusting with diffuse distribution over the thinning area is critical to an effective natural result. Over applying can create “caking” on the scalp which can be a cosmetic problem. Fibers should be applied near the hairline, but never on it.
The advantage of fibers is that they are quick to apply and easy to remove with shampooing. They keep the sheen of the hair quite well as opposed to the sprays and powder cakes. Newer products claim to be resistant to rain, wind and perspiration.
To apply, the fibers can simply be shaken onto the affected areas of the scalp.
However, the most elegant results come from using a spray pump attachment. With this technique you pull up groups of hair and blow the fibers onto the lifted hair, letting the fibers coat the hair and then rain down onto the scalp.
These are a scalp make up, colorant to be applied either dry or with a wet sponge from a powder cake. When applied wet, it becomes one of the most resistant to water and sweat. It is somewhat slower to apply than fibers but has been very popular.
Cream or Lotion
Applied with a dry or slightly dampened sponge, this product is a little slower to apply but has a strong following of over 20 years. The products come in a tube. After application, allow the product to dry, and then brush it out. Some add fibers after the hair is brushed.
Often maligned, the sprays are fast and easy to use and are relatively water resistant. There have been a few complaints of them coming off on furniture and pillows, but with use the patient usually can control this problem. Can give you hair a little less sheen. These dry fast (less than 1 minute).
For those who would like more detail regarding camouflage agents or scalp prostheses the following reference articles are recommended:
- Hair camouflage: A comprehensive review, Saed, S, Ibrahim, O., Bergfeld, W. , International Journal of Women’s Dermatology, 2 (2016) 122-127
- A review of scalp camouflaging agents and prostheses for individuals with hair loss, Donavan, J., Shapiro, R., Shapiro, P., Zupan, M, Pierre-Louis, M., Horidnsky, M, Dermatology Online Journal, Vol 18, Issue 8, 2012