Everything You Need to Know about Derm Approved Hairstyles to Prevent Traction Alopecia
By Nnenna Ezeh, MD and David G. Li, MD, MBA
Nnenna Ezeh is a med-derm resident at the Harvard Medical School Combined Dermatology Program. She has a special interest in rheum-derm, hidradenitis suppurativa, ethnic skin and hair, health equity and policy.
David Li is a board-certified dermatologist in private practice in downtown Boston and the Founder of BDA. Previously he was a resident at the Harvard Medical School Combined Dermatology Program.
Traction alopecia is a form of hair loss caused by excess tension on the hair follicles from too-tight hairstyles. Styles like tightly-pulled cornrows, top knots, extensions, weaves, and tight braids or buns can literally pull hair out over time.
While traction alopecia is reversible if caught early, without intervention it can lead to permanent patches of baldness around the hairline, sides, or nape of the neck.
In this article, our team of board-certified dermatologists and dermatology residents share their best tips on hairstyles to avoid further damage, products that promote healthy hair regrowth, and techniques to relieve discomfort from styles. Read on to learn how to reverse traction alopecia hair loss and wear braids, weaves, or wigs safely.
What's Causing Your Traction Alopecia?
Traction alopecia occurs when excessive, prolonged tension is applied to the hair shafts and roots resulting in breakage or loss of hair follicles. Over time, the damage from this type of hair loss can become permanent.
Common causes include:
Very tight cornrows, braids, buns, or ponytail pulling on scalp
Heavy hair extensions weighing down on natural hair follicles
Rubbing from fabrics against tight styles causing friction near hair part or nape of neck
Chemical processing or heat styling along with tension damage
High tension hairstyles on hair that is chronically dehydrated and at higher risk for breakage.
Styles like box braids and Senegalese twists can take a major toll on hair health if done incorrectly. Traction alopecia tends to first appear along your edges and hairline as sparseness or receding perimeter. Over time, noticeable thinning spreads to the crown and temples. Without intervention, smooth, shiny scarring develops devoid of follicles so hair can no longer regrow.
Warning Signs Your Styles Are Too Tension-Inducing
Pay attention if tight styles cause any of the following around your edges or scalp:
Frequent headaches or neck tension
Uncomfortable stinging, burning or throbbing sensation along hairline
Acne-like red bumps or scabbing near braiding tracks
Sudden increase of hair shedding when brushing or washing
Widened hair part making forehead appear larger
Thinning hair at temples or crown with increase in fragility
Discontinue damaging styles immediately at the first signs of discomfort or unusual hair loss. Leaving hairstyles alone despite pain may only worsen follicular damage.
Choose Low-Tension Hairstyles
You don’t have to sacrifice your gorgeous braids or weaves. There are still chic styles to try that minimize risk for traction damage.
Dermatologist-recommended options include:
Flexible knotless braids instead of heavier box braids. This type of hairstyle can reduce excessive pull on the roots. However, it does not erase the risk altogether, because the hair root can be more exposed. It’s still recommended to cleanse the hair regularly even when using braids.
Lightweight clip-ins or tape-ins release tension far better compared to heavy sew-in weaves depending on your natural hair for anchoring.
Low buns and loose updos reduce strain on the fragile hairline compared to stringent slick-backs and tight top knots.
Alternate location of buns and updos to minimize stress on the same areas of the hairline
Half-wigs clipped to natural hair puts less tension on hairline edges versus standard full wigs relying on glue or constricting combs at the perimeter.
Soft fabric headbands and wraps minimize rubbing against hairline compared to metal or plastic hair bands squeezing hairs flat all day.
As you choose new styles, remember the looser and more flexible the better to avoid damaging follicles through pull, friction, or smothering. Change hairstyles at least every 6 weeks allowing the scalp and hair to relax between installations while ensuring to cleanse the scalp every 7-10 days to restore hydration and remove product buildup.
Be Gentle Applying, Removing and Maintaining Braided Styles with Extensions
How you care for your hair while in braided, weaved, or wig hairstyles matters equally in preventing excessive tension that triggers hair loss. Protective styles are not a shortcut to length retention or the key to healthy hair. It is critical to prepare and maintain your hair to prevent traction alopecia and breakage. Here’s where to be gentle:
Avoid Harsh Chemical Processing
Chemical relaxers and dyes compromise hair integrity making strands more prone to breakage before braiding. Consider transitioning to your hair’s natural curl pattern if possible, using gentler dyes instead, or waiting at least 2 weeks, preferably 4-6 weeks, after dying or relaxing your hair before braiding.
Shampoo and Condition Scalp Regularly (even while hair is in braids)
Use sulfate-free shampoos to cleanse hair and rehydrate gently every 7-10 days. Dilute shampoo and condition with water and apply directly to scalp with a nozzled bottle to avoid application on the braids, minimizing frizz. Once rinsed, set with a styling mousse or other holding products and dry with a dryer (hooded preferably) until hair is completely dry.
Minimize Product Use
Reduce product use to limit product build up. remembering that oils and other products do not provide moisture, only water can. Products like edge control gels or oils can increase product build up. Use water-based gels and lightweight mousses to reduce frizz and flyaways during installation and maintenance.
Loosen Braids During Washing
When shampooing braids under extensions or wigs, carefully pull them apart to cleanse and reduce tension on the scalp underneath before taking styles out completely. Separating plaits while cleansing prevents matting as shed hairs release.
Apply Leave-In Conditioners
Hydrating, detangling leave-ins make combing out braids or extensions less uncomfortable while providing more slip to enhance detangling. Avoid ripping hair out by patiently removing knots section-by-section with a wide-tooth comb.
Gently Brush Your Hair
Consider the amount of force that is applied by the comb or brush, as this can also lead to damage to the hair follicle, resulting in hair breakage.
Regularly Trim Your Hair
Consider regular trims about 4 times a year by a licensed cosmetologist. Split ends and single stranded knots make the hair shaft more prone to breakage and leads to decreased length retention.
Do Not Keep Styles Installed Too Long
Plan to remove your style after 4-6 weeks to minimize dehydration and breakage. The longer the style stays installed, the more product and debris build up that can occur. Removing the install at 4-6 weeks along for you to cleanse the entire hair shaft from root to end. Take at least two weeks prior to reinstalling a hairstyle.
By being gentle overall with chemical processing, tension upkeep, washing, detangling, and regularly trimming hair you sustain health from root to tip. This keeps follicles strong enough to withstand minor intermittent trauma from styles.
What To Do If You Have Traction Alopecia Already
If you’re already struggling with sparseness at your edges, hairline, crown or temples from past traction damage, don’t panic. Timely intervention that can manage traction alopecia early in the disease course can stimulate regrowth in patches where follicles aren’t permanently scarred.
Ask your dermatologist about:
Minoxidil liquid or foam to reactivate dormant follicles to start producing hair again through vasodilation. Topical minoxidil can help regrow hair that is not fully scarred at the follicle and can cause hair to grow out thicker than before. The 5% minoxidil (often marketed for men) is the preferred topical choice.
Oral minoxidil is another good option if topical is not sufficient.
Corticosteroid injections help calm inflammation damaging follicles in active stages of hair loss.
Red light therapy devices use wavelengths that penetrate skin to stimulate cellular activity needed for hair regrowth. Handheld combs provide convenient at-home adjunct treatment. This is not meant to be a standalone treatment, but data suggest a role for red light in hair loss as a supportive modality.
As follicles repair, adopt gentle hair care routines using the tips above to prevent further breakage and thinning. Be patient - regrowing traction alopecia can take up to 6 months for initial sprouting and 12-18 months for complete coverage as strands inch outward slowly. Avoid chemical processing or hot styling during recovery.
Most importantly, ditch intensive styles which cause strain on follicles, eliminating the root cause of damage. Give your scalp and edges ample chance to rejuvenate before cautiously trying less-constricting, low manipulation styles again.
Takeaways for Preventing Traction Alopecia Hair Loss
In closing, traction alopecia doesn’t have to be inevitable with long-term braiding or wig use. By avoiding known risk factors and handling chemically processed or tightly-styled hair gently, hairlines, crowns and napes remain intact.
Follow these core strategies to sustain scalp and follicular health:
Choose loose styles over stringent looks placing less tension on roots
Wash, condition and comb hair cautiously when braided or covered
Get braids re-done every 6-8 weeks to minimize tension with a braid holiday in between installs.
Don’t ignore discomfort - adjust styles immediately when any pain or unusual shedding occurs
See a dermatologist promptly if bald patches are occurring to determine next medical steps based on your unique case
While traction alopecia remains reversible if treated early, scarring can become permanent, making regrowth impossible without surgical grafting. Pay attention to warning signs and handle fragile strands with care in the meantime for the healthiest hair possible despite your styling preferences.
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How should you wear your hair to prevent hair loss?
To wear your hair in a way to prevent hair loss, it is important to avoid tight hairstyles such as tight ponytails, braids, or buns, and to minimize the use of hair extensions or weaves which can cause traction alopecia. Instead, choose loose hairstyles that do not put excessive tension on the hair roots and scalp.
What are the best hairstyles to prevent traction alopecia?
Some suitable hairstyles for traction alopecia include flexible knotless braids, lightweight clip-ins, low buns and loose updos, and half-wigs. These styles minimize pulling on the hair and scalp and reduce the risk of developing traction alopecia.
What are the common causes of traction alopecia?
Cause traction alopecia is primarily caused by prolonged or repeated tension on the hair roots and scalp due to tight hairstyles, use of hair extensions, weaves, or hair accessories, and excessive pulling during hair styling. These actions can lead to damage and hair loss over time.
How can a hairstylist help prevent hair loss?
A knowledgeable hairstylist can provide valuable guidance on gentler hair styling techniques, suitable hairstyles, and the use of products that promote healthy hair and scalp, helping clients to minimize the risk of traction alopecia and other forms of hair loss.
What are the symptoms of traction alopecia?
Typical symptoms of traction alopecia include a receding hairline, thinning hair around the temples and nape of the neck, redness, soreness, and bumps on the scalp. It is essential to recognize these signs early to prevent further hair loss.
How can a dermatologist advise on preventing hair loss?
A dermatologist can provide personalized advice on hair and scalp care, recommend appropriate products, and perform assessments to determine the underlying causes of hair loss
How can you give your hair a voluminous look?
If you have fine hair, you can use specific hair products designed for this type of hair to create volume. Additionally, a stylist can help you achieve the desired look.
What are the clinical signs of traction alopecia?
Signs of traction alopecia include hair loss around the hairline and temples, often caused by tightly pulling the hair back into styles such as ponytails or using hair ties. If you notice these signs, it's essential to seek advice from a dermatologist.
How can you promote hair growth?
To promote hair growth, avoid too-tight braids that can lead to hair loss. Instead, go for gentler ways to style your hair and use suitable hair products recommended by a board-certified dermatologist. Topical and oral minoxidil, in addition to corticosteroid injections and red light therapy helmets may be helpful.
What is traction alopecia?
Traction alopecia is hair loss caused by damage to the hair follicle due to excessive tension or pulling, often from hairstyles like tightly braided braids or using synthetic hair extensions. It’s essential to consult with a board-certified dermatologist or a trichologist if you suspect you may have this condition.
Is it necessary to remove your braids to keep your hair healthy?
If your braids feel too tight and are causing discomfort, it may be helpful to remove them to prevent traction.
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We are a group of dermatology residents and attending physicians based in Boston, MA. Our team of Ivy League-trained dermatologists is demystifying the cosmeceutical industry by offering unbiased, scientifically supported reviews of skincare products. We are extremely passionate about skincare and making it accessible to all through education. We value integrity, practicality, and inclusivity. No sponsorships were received for the products prior to testing; we feel strongly about providing un-biased reviews. After blogs are published, following the links in this blog post may result in commission.
