This week we’re talking about hair extensions and the possible down sides of having these long, flowing locks.

The popularity of hair extensions has certainly soared in recent years – with many women wanting luscious locks every day of the week. However, with the use of hair extensions, comes the risk of severe damage to the natural hair.

Traction Alopecia

Traction alopecia is one of the main risks and is a form of hair loss caused by hair being frequently pulled (alopecia is the medical term covering all types of hair loss). Traction refers to the pulling force which places excessive stress on your roots, and can lead to them eventually ‘giving in’ and ceasing to produce new hair - this can be caused by several things:

  • Application and removal of hair extensions, which are strenuous procedures for the hair
  • Hairstyles which pull your hair tight such as tight braids, ponytails, pigtails, and dreadlocks
  • Long and heavy hair worn down – the weight can strain your hair follicles
  • Frequently wearing tight helmets or other headwear
  • Having your hair frequently pulled (although hopefully this isn’t a problem for most people!)

There is little published information about the prevalence of traction alopecia, but after some hunting around, we found a piece in the Dermatology Online Journal titled “The “fringe sign” for public education on traction alopecia” which gives some information. (You can read the piece in its entirety here, if you’re interested).

The findings from this paper, written by Nonhlanhla P Khumalo, suggest that mid-to-moderate traction alopecia is more ubiquitous in females and those with afro textured hair, and that the prevalence:

  • Is higher in African schoolgirls than boys (17.1% vs. 0%)
  • Increases with age in girls [8.6% (6-7 years), 15.6% (10-15 years), to 21.7% (17-21 years)]
  • Is higher in girls with relaxed vs. natural hair (22% vs. 5.2%)
  • Is highest in adults (31.7% in women vs. 2.3% in men; with affected males more likely to wear cornrows and dreadlocks)

Are you aware of any risks associated with using hair extensions?

We spoke to three fashion and beauty bloggers - Jessie of All Things Beautiful, Jenny of Krystel Couture, and Emily of Emilyke, to find out what they thought about hair extensions:

Jessie: “I have been so desperate in the past for my hair to be as long and flowing as Nicole Scherzinger's. I have considered having micro-ring extensions many times as these seem to be the permanent extensions that are the lightest on the hair, and supposedly do the less damage, but every time I have been put off by the risks such as my hair thinning out or snapping off”.

Jenny: “I am not aware of potential risks but from my person experience I feel they can give you hair loss and weigh down the hair causing tension on the scalp and can be irritating”.

Emily: “I’ve heard a lot about the risks of hair extensions… I would much rather have short hair than absolutely ruined thinning hair with bald patches and a sore scalp!”

So, how can you use extensions without causing damage?

Mr Bhatty


Well, we asked our colleague, Dr Marboor Bhatty, who has carried out numerous hair loss procedures, to tell us how to reduce the risk. He said “don’t pull your hair too tight! And if you begin to experience damage, leave it for 6 months without aggravating it to see how it progresses.” His main point was that people need to look after their hair, and many of the traction alopecia cases he sees come from people “being disrespectful to their hair”.




 Here are some tips on reducing the risk of alopecia:

  • Hairstyles should be painless, and if you are experiencing pain, the only solution is to loosen the hair
  • Traction hairstyles should not be done on relaxed hair until at least 2 weeks after relaxing
  • Only new growth should be relaxed. Relaxing hair that has previously been relaxed can increase the risk of damage.
  • Relaxers and dyes used in combination can further damage. These should be spaced out by at least 2 weeks.
  • Heat treatment (straighteners etc) can damage relaxed hair and should be avoided.
  • Weaves, braids, and dreadlocks present greater risk when done on relaxed hair