Cosmetic Options in Female Hair Loss

Female hair loss is a common issue addressed by dermatologists. It is a time-consuming problem to assess and treat. This article provides a methodical approach to female hair loss, including cosmetic options.

Determining Internal vs External Causes of Hair Loss

Examination of a shed hair shaft is the simplest method to distinguish between internal and external causes of hair loss. Internal causes typically result in a hair with an intact bulb—an elongated bulb suggests anagen effluvium, while a club-shaped bulb indicates telogen hair shedding. External causes generally produce broken hairs, which suggest hair shaft weakening.

Patients should be asked to bring 5 plastic bags of shed hair to their evaluation appointment. Each bag should contain a full day’s hair loss, including hairs from the sink and brush, labeled with the collection day and whether shampooing occurred. The dermatologist can then examine the types of hairs being shed and perform a hair count. Normal hair loss is approximately 100 to 125 hairs per day. Any count exceeding this range warrants further evaluation (Table 1).

Evaluating Hair Shaft Cosmetic Attributes

After ruling out internal causes, evaluate the potential for external trauma from grooming. Assess the following:

• Hair shine
• Hair softness
• Orderliness of hair strands
• Use of styling aids
• Natural hair color consistency with eyebrows, eyelashes, and body hair
• Hair texture (curly or straight)
• Hair length and time since last cut

Shiny hair reflects an intact cuticle with smooth, overlapping cuticular scales. This smoothness enhances light reflection and tactile smoothness. Damaged cuticles lead to frizz and rough texture. Conditioners can temporarily smooth the cuticle. However, permanent dyeing, waving, and straightening often cause damage. Longer hair is more susceptible to damage due to prolonged exposure.

Cosmetic Techniques for Improved Hair Appearance

Hair should be treated gently, like fine silk. Shampoo only as necessary, followed by instant conditioner in the shower and leave-in conditioner on towel-dried hair. These products coat the shaft and temporarily smooth the cuticle.

The hair should be allowed to air dry, if possible. While a blow dryer can speed the drying process, it can also cause loss of water from inside the hair shaft if high temperature is used.  Since water is the plasticizer of the hair, loss of hair shaft water results in dry, easily fractured hair shafts and cannot be replaced. If the heat is high enough, the water in the hair shaft turns to steam and rapidly exits the hair shaft, causing the cuticle scale to be removed and creating a condition known as bubble hair.  

Avoid combing or brushing wet hair. The belief that 100 brush strokes a day can benefit hair is incorrect. Combs should be selected for their smooth, widely spaced teeth so that they glide freely through the hair. Brushes should have widely spaced bristles with rounded tips for the same reasons.  

Scalp Camouflage Techniques

While identifying causes is of utmost importance, cosmetic camouflage can benefit many patients. Thinning is characterize by increased scalp show (Table 3).

Hair Styling Techniques

A variety of hair styling techniques can optimize the appearance of thinning hair. Styling products such as gels, mousses, and sprays can create volume by allowing hair to stand away from the scalp. A small amount of gel or mousse is massaged into the base of the hair shafts and then the hair is dried with a blow dryer while combing the hair away from the scalp. This will increase the ability of the hair to stand away from the scalp, creating the illusion of volume. The styling products lose their hold once the hair is combed or wetted, so reapplication is needed after washing or combing.

Permanent waving inducing curling of the hair shafts increases the apparent hair volume, allowing less hair to cover more scalp; however, chemical curling damages the hair shaft by decreasing its strength, degrading its structure, and causing protein loss. This damage can be minimized if the permanent wave is performed with care by wrapping the hair loosely around larger curling rods, resulting in a looser curl that is shorter lasting but also less likely to fracture the hair shaft. 

Permanent dyeing is often essential for self-esteem but is also damaging. Many female patients with hair loss will want to permanently dye their hair to cover gray, but permanent hair dyeing is very damaging to the hair shaft. Table 4 includes recommendations to minimize damage.

Summary

Once the cause of female hair loss has been determined, it is worthwhile to offer some ideas on how to maximize the cosmetic appearance of the thinning hair. A few simple pointers can aid during the regrowth phase, possibly preventing further hair loss due to poor hair grooming and hair care practices.