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For many cancer patients, hair loss is the most distressing and feared side effect of chemotherapy and radiation treatment. If you don't want anybody to know you're losing your hair, wigs may be your answer.

BEFORE YOU BUY

Ask Your Doctor

Not all treatments cause hair loss, so discuss the possibility with your doctor. If there is a high probability you will lose some of your hair, get a prescription for a "hair prosthesis" for your insurance company (most cover wigs needed for medical purposes). Also, ask about steps you can take to help retain your hair.

Call Your Hairstylist

When you book your appointment, let the receptionist know you'll need some extra time, and ask if there is some place private you can talk. If not, request a slow time of the day. As the person who knows you, your hair and, most likely, other clients with cancer, a hairdresser can be a great resource. He or she may able to suggest a local wig shop or even order one for you. Once you've bought the wig, your stylist can trim and style it for your face.

Take a Short Cut

Even if you have always worn your hair long, getting a short haircut is one of the biggest breaks you can give yourself during treatment. Long hair, pulled down by gravity, is more likely to fall out sooner. Short hair masks initial hair loss better and makes less of a mess when it does fall out. Just remember to keep a good-sized lock of hair to use as a guide for wig shopping.

Give Yourself Options

Since wigs can be uncomfortable and troublesome, you probably won't want to wear one everyday, all day. A hairpiece peaking out from under a hat or scarf can give the illusion of hair without the annoyance and bulk of a wig. Most wig stores and cancer specialty shops stock a wide variety of bangs, side pieces, ponytails, curls and falls. Many of these are designed to be Velcroed into a hat.

WHERE TO BUY A WIG

In addition to asking your stylist, call the American Cancer Society or ask your doctor for recommendations on wig retailers and wig salons. Many shopping malls and department stores have a fun-wig shop at the very least, but you may want more privacy and a higher quality of service that a wig salon offers.

If you can't afford a wig, CancerCare (800-813-HOPE) and The American Cancer Society provide free wigs to those in need.

No matter where you go, make sure you're comfortable with the store and the staff. Call beforehand and make sure the store or wig salon specializes in cancer patients, offers refitting, can provide a private area for try-ons and has a variety of choices, including hairpieces. Also, find out if you can try on the wigs and return them (many state's health regulations prohibit this).

You can purchase wigs online, but there's no way to tell what you are really buying until it arrives at your door. If you do buy a wig over the Web, be sure you can return it for any reason.

CHOOSING A WIG

A wide range of factors will influence your choice of wigs: human hair or synthetic; short or long; custom- or machine-made; and price (which can range from $40 to over $4,000).

Synthetic vs. Human Hair

Most people prefer synthetic hair. It's easier to maintain and less expensive. Most synthetic wigs have their style molded into them, but some can be reset. The advantage to style-able wigs is that you can change their look, just as with real hair. The disadvantage is that they have to be reset every time they're washed. Synthetic hair also dries faster than real hair. Well-made synthetic wigs may look real, but they never totally feel or move the way real hair does. Nor can you treat them like your own hair -- they literally fry when exposed to heat. So no curling irons or blow dryers unless they are specifically designed for wigs. Hot rollers can be used, but only at low settings. And avoid exposing the wig to any intense heat sources such as an oven. The blast of heat will cause frizzing.

Wigs made of human hair will obviously look and feel more like your hair, but are expensive, starting at $1,000, and are far more time consuming. You can use heated appliances on them for touch-ups, but you'll probably want to take them to a professional to be washed and styled. There are three types of real hair used in wigs: Asian, Indonesian and European. The most readily available and least expensive is Asian. It is also the heaviest and least like the hair found on Western Europeans. Indonesian is slightly finer and considered a mid-grade hair. European is the finest and most rare, and is priced accordingly. Since all these wigs are cleaned, stripped, dyed and possibly permed, it is often difficult to tell what type of hair a wig is made from by the color or the curl alone.

Wig Construction

The way a wig is made affects how it looks just as much as, if not more than, the type of hair used. A quality synthetic wig is preferable to a poorly made human one. There are three different types of wig constructions: custom, hand-made and machine-made.

  • Machine-made wigs are the least expensive and most widely available. If you've ever worn a wig, this is probably the type you are familiar with. Wefts of hair are sewn together in a straight line, cut and assembled into a wig. (When you look inside a machine-made wig you can see the lines.) Many look extremely realistic as long as they are not parted, pulled back or otherwise altered. Some people find these wigs more comfortable because the construction creates vents that allow air to circulate to the scalp.
  • Hand-made wigs look the most natural of the prefabricated choices because individual strands are knotted on to a skullcap rather than wefts of hair being sewn together. These wigs can be parted and styled with accessories because there is no chance the vents will be exposed. The hair also falls and moves more naturally.
  • Custom-made wigs are almost indistinguishable from natural hair. They are usually not a viable option for cancer patients, as they are extremely expensive and generally take more than two months to complete. Make sure that you have final approval on the choice of hair and style. And unless you have prior knowledge of the shop, call your local chapter of the American Cancer Society to double-check that you are working with a reputable establishment.

Style

Some patients use this as a time to experiment with a number of different looks while others just want a wig that looks like their hair. Either way, a few adjustments can make your wig look as natural as possible.

  • Keep in mind that a wig cannot replicate the way your hair blends into your skin. Sure, it does in movies, but that requires a great deal of time, makeup and a team of trained professionals. For your purposes, bangs, or at least wisps of hair covering the hairline, will help your wig look more natural.
  • Even if you're staying with the cut you currently have, try a slightly shorter wig. During treatment, many people loose weight and become slightly drawn. A shorter style can add fullness. Plus, short wigs have less hair to brush out at night and don't tangle as easily.
  • Wigs which utilize wide headbands along the hairline are easy to wear and stylish, but you're locked into wearing a headband. Such models are better for occasional use or as a backup.
  • Buying two wigs in different styles can make life easier than purchasing one very expensive wig. You won't have to restyle your wig every time you want to put your hair up.

Color

Whether you're matching your own hair color or thinking about something different, try going a shade lighter. It will help offset skin tone changes that may occur during treatment. Always wanted to be a redhead? Go ahead, but stay close to your natural shade or lighter.

Make sure you get the color you want. Look at the wig outside in natural light. Look at the quality of color as much as depth. There's more to brown than light, medium and dark; check out the highlights, low lights and underlying tones too.

Shopping List

In addition to the wig, you'll need some supplies: a head form to store the wig on, a wire wig brush, hair nets, T-pins to hold the wig in place while brushing, low alcohol or wig hair spray, baby or wig shampoo, conditioner and, depending on the length, hair pins and rollers. All are available at the wig shop, a beauty supply retailer, through your hairdresser or online.

WEAR AND CARE

Wear

The wig shop or your hairdresser can demonstrate how to put your wig on properly by grasping it in the front and rolling it back over your head. It should fit securely but not be uncomfortably tight. Line up the points on the side of the wig in front of your ears, where a man's sideburns start. Your ears should be pulled out over the wig, not tucked under.

As hair loss progresses, it may become difficult to tell where your natural hairline is. It's easy to wind up wearing a wig too low or too high on your forehead. Keep a photo that shows your natural hairline to use as a guide.

Under any type of wig, you'll need to wear a cap. These are soft, snug nylon or cotton coverings that protect your scalp, control your hair and keep the wig from slipping. Buy more caps than you think you will need; it's good to have extras and rotate them regularly.

Your wig may need to be refitted after you loose your hair, particularly if you had long or thick hair when you purchased it. Most wigs have adjustable straps at the back to change the size; if the wig still feels loose, take it back to the store for adjustment.

Care

All wigs require a certain amount of daily care but probably less than the time you'd spend on your own hair. For more information, Look Good... Feel Better offers group and private instruction on wearing and maintaining wigs.

Daily Care

  • When you take off your wig, store it on a Styrofoam, wood or cloth-covered head form.
  • Smooth out the hair with a comb.
  • Pin short styles to set curls; roll or twist longer styles and secure with pins.
  • Lightly spray with low alcohol hair spray if desired and let dry.
  • Cover with hair net.
  • Store away from heat, dust and humidity.

Washing and Setting

If worn regularly, you'll want to wash and set your wig every week or two. Synthetic wigs can be washed and styled at home or taken to your hairstylist or wig shop. Human hair is more difficult to handle, so it's best left to professionals.

Washing

  • Brush wig starting at ends and work up to the scalp with a wire wig brush.
  • Submerge wig in a bowl or sink of cool water and baby shampoo or soap for wigs. Gently swish.
  • Soak for five minutes.
  • Rinse in cool water.
  • If desired, condition hair with a product for wigs or a conditioner with lanolin.
  • Rinse again in cool water.
  • Gently squeeze out water -- do not twist.
  • Blot dry with a towel.
  • Place wig on a tall, slender object like a hair spray can so air can circulate through the wig.
  • Allow to air-dry completely. Never brush a wet wig. (Only blow-dry if the manufacturer recommends it.)
  • Gently brush from ends to scalp with wig brush.

Setting:

Most synthetic wigs have the style molded into the hair, so simply control and emphasize the set with hot rollers set on medium or low. (Never use curling irons or hair dryers on synthetic wigs.)