Traction alopecia is an especially distressing type of hair loss to experience. Unlike other types, it’s caused by repeated, prolonged tension on the hair follicles. When caught early enough, the condition can be reversed and hair can resume healthy growth. In advanced cases, the follicles are too damaged to recover, and hair loss is permanent

Although we always say “knowledge is power,” the knowledge unfortunately sometimes comes too late to prevent permanent hair loss from traction alopecia. The situation is not hopeless, as we’ll answer our own question now and affirm that a hair transplant can restore hair to the areas of the scalp left bald or patchy by traction alopecia. However, learning more may help you recognize if you’re experiencing this condition in its early or advanced stages, and take the appropriate action.

Common Causes of Traction Alopecia

Traction alopecia is the term for hair loss from mechanical damage to the hair follicle caused by repeated tension or pulling. This can be caused by wearing the same hairstyle for long periods of time – especially those that tug on the hair. Tight hairstyles applied to chemically relaxed hair can lead to even greater damage. 

Because traction alopecia progresses over time, those affected may not connect the hairstyling method they’ve practiced for years with the reason for their hair loss. Moreover, many of the styling techniques that cause traction alopecia – collectively known as protective styles – have a long tradition in Black cultural identity and beauty.

A protective style refers to hairstyles that tuck away the ends of each hair strand to protect them from the elements, as the end is the oldest, most fragile part of the strand. Protective styles include but are not limited to twists, braids, updos, weaves and wigs. However, protective styles ultimately have the opposite effect. According to Kimberly Lewis, CEO and co-founder of CurlMix – a clean beauty brand for curly hair – protective hairstyles actually damage hair and hurt hair growth.

“Tension can be worse when you have short natural hair because the braider has to pull tighter to get all of your hair into the braid,” says Lewis. “Braids can seem like a better alternative to straightening your hair because there is less risk of ruining your natural texture but that doesn’t mean there is no risk. And many styles even go a step further by adding extra weight. The excessive use of ponytails weaves, and extensions are working double-time to give you tension damage. And what happens when your hair is pulled tightly and something heavy like extensions is weighing on it?”

What happens is the beginning of traction alopecia. However, women – and men – of color who wear protective hairstyles aren’t the only ones at risk. Gymnasts, ballerinas and women in fields that require their hair be pulled back can also develop it, as well as those who wear helmets or hats over extended periods, and repeatedly put them on and take them off. 

Recognizing the Early Signs of Traction Alopecia

When caught early, the effects of traction alopecia can usually be reversed. The signs aren’t always obvious, so it’s important to be aware of them in order to take action and avoid permanent hair loss.

The first signs of traction alopecia can include:

• Redness or soreness around the hairline or scalp.
• An itching or stinging sensation.
• Pimples, small bumps or ulcers on the scalp or around the hairline.
• Areas of thin or broken hair, especially where the hair has been under particular strain.

Should these early warning signs not be recognized, signs of advanced traction alopecia include:

• Extensive hair loss and bald patches.
• Irreversible scarring – the scalp may appear smooth and shiny.
• A tender, inflamed scalp.
• Frequent headaches.
• A receding hairline – which typically occurs around the forehead, nape and temples. For some, the part might also widen over time.

Steps to Prevent Traction Alopecia

The best way to prevent traction alopecia is to wear a hairstyle that doesn’t create constant tension on the roots. If you must pull your hair up into a ponytail or bun, keep it loose and low on your head.

Other recommendations include the following:

• Change your hairstyle every couple of weeks. For example, alternate between braids and wearing your hair down.
• If you wear a ponytail, don’t use rubber or elastic bands to hold it in place. They can pull out your hair.
• Avoid chemically processing your hair if you use weaves or braid your hair. The chemicals can damage your hair, making it more likely to break.
• If you have weaves or extensions, wear them for only a short period of time and take a break between each use.
• When you braid your hair or put it in dreadlocks, make the braids thick. Thinner braids pull more tightly.
• Don’t use hair relaxers.
• Keep the heat setting low on your hair dryer and flat iron.
• Don’t sleep in rollers. Wrap your hair instead.
• If you wear a wig, choose one with a satin wig cap, as it won’t pull as hard on your scalp.

Hair Transplantation as a Solution for Advanced Traction Alopecia

When hair loss is permanent, many women turn to wearing a wig. But having to wear a wig full-time to cover bald areas when out in public is very different from wearing one to be stylish. Even the highest quality wigs quickly become hot and uncomfortable. A hair transplant offers a permanent solution that can provide outstanding aesthetic results.

Our blog post – “Advanced Treatments for Non-Pattern Hair Loss” – relates the story of J.D. – a patient of  Dr. Marco Barusco – Founder and Chief Medical Officer of Tempus Hair Restoration – who sought treatment for her traction alopecia. At the time, J.D. was a pharmaceutical representative – a profession that requires a polished appearance when visiting multiple physician offices on a daily basis. As her hair loss progressed, J.D. tried to conceal it with wigs, weaves and extensions, which made the condition even worse. After consulting with Dr. Barusco, J.D. underwent a procedure that restored her hairline and temples with the full look of natural growth – which not only restored her confidence, but provided the extra boost for J.D. to start her own business.

Dr. Barusco typically recommends the Follicular Unit Transplantation (FUT) for traction alopecia. Also known as the “strip” method, this technique harvests hair follicles by removing a strip of hair from the back of the head (donor area). This strip is then dissected into smaller segments in order to implant individual follicles. The FUT has undergone refinements over the years so that the only evidence is a pencil-line linear scar easily concealed by hair – even at a shorter length. Dr. Barusco covers this method and its advantages for African-heritage women in his YouTube video – “Afro Hair Transplantation: FUT or FUE?” – on his Hair Loss Medical Advice channel.

The technology for the Follicular Unit Excision (FUE) procedure has developed to allow people of all ethnicities to have this option. However, it is typically not recommended for women dealing with traction alopecia, as it decreases the volume of the donor area.

The curling and twisting of African-heritage hair provides the appearance of good scalp density, which is an advantage in hair transplants. As our blog post – “Why is Ethnicity an Important Consideration for a Hair Transplant?” – covers, its curliness allows coverage of scalp areas with a fewer number of hair follicles needed to achieve an aesthetically pleasing “full” coverage – thereby reducing the number of follicles needed for transplantation.

However, hair may emerge at a variety of angles from the scalp, which can make the harvesting of donor hair more challenging. Both the follicles and hairs have a degree of curvature in relation to the scalp that must be accommodated when harvesting.

The ability to create a natural-looking hairline that’s flattering to each individual woman is essential in achieving an aesthetically successful outcome. For these reasons, it is especially important to choose a hair transplant surgeon with extensive experience in performing procedures for those with African-heritage hair.

Another factor to keep in mind is that Black patients may be at risk for developing keloid scarring. This appears as a puffy or raised pinkish area, and occurs when the skin is injured, or cut during a surgical incision. A conscientious hair transplant surgeon will ask if a prospective patient has a history of such scarring, or any other scarring scalp disorders. The surgeon will also monitor for scarring post-op, as well as watch for ingrown hairs, which can occur two to three months after surgery, when the hair begins to grow.

If you are considering a hair transplant to restore your hairline and temples due to traction alopecia hair loss, we hope we’ve provided the information you need to make an informed decision. Ultimately, choose your surgeon based on experience, results and integrity. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice.

We understand that the main concern you may have is cost, which is why we offer financing options that can place this important goal within reach. Putting yourself at risk of the consequences of a hair transplant procedure at an overseas black market clinic – or even an unscrupulous domestic clinic where unlicensed non-medical personnel harvest and implant hair grafts – isn’t worth the perceived savings.

Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device. 

Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!