Tips to choose the best wig to help cope with chemo-related hair loss
Chemotherapy sucks. Yes, it’s a lifesaving procedure, but it sucks nonetheless. As the drugs kill cancer cells, they also kill and damage other cells in your body. Chemo can suck your lifeforce, it saps your energy, and it can make you feel far from whole.
My sister is currently undergoing chemotherapy for breast cancer. In the past three months, she’s become infertile, gone through menopause, is losing pounds of weight per day, shed all her hair, and will soon surgically remove her breasts. Cancer and its treatments, she says, stripped her of her femininity. And while going bald is really the least of her worries, it’s the only side effect she can’t hide, even while wearing her favorite gray beanie.
“People are staring,” she’d say when we went out in public. I’d try to reassure her that they weren’t and that it’s all in her head—the exact thing you should never ever say to anyone going through something you have zero personal experience with.
“It doesn’t matter if she imagined it or not,” says Sunee Kim Watts, owner of Kim’s Wig Botik in Denver. “What matters is how she felt. She felt uncomfortable and self-conscious. She didn’t feel like herself.”
Wigs can help give chemo patients some semblance of normalcy and make them feel and look like themselves, even for a few hours a day. “The majority just want to look normal and have their lives be less intrusive,” says Hana, owner of Hana Designs in Littleton, Colo., who went through chemo for breast cancer 30 years ago. “It’s bad enough going through the doctor’s appointments and then the procedures and always getting poked. We just need a little calm so that when we step out into the real world, the real world talks back to us like normal.”
However, cheap wigs found online for $22 will do quite the opposite, as my sister realized after an impulse Amazon buy left her itchy and looking uncannily like an American Girl doll.
Luckily, there were massive selections of comfortable and natural-looking wigs available at the wig shops in town, starting at a couple of hundred dollars and up to several thousand dollars. They also came with expert advice from professional stylists and shop owners who have been helping chemo patients for decades.
My sister walked away with a wig that brought her mega-watt smile back to her face, and we also came away with tips for anyone who’s about to go down the same road, including how to prepare for hair loss, the differences between various types of wigs, what to do if you can’t afford one, and how to file a claim with your insurance to have one covered.
According to the American Cancer Society, hair starts to fall out within one to three weeks after starting chemotherapy and may become noticeable one to two months later. Some scalps become tender and extremely sensitive to the touch.
Some people cut their hair shorter before chemo to make the hair loss less stressful. But if you’ve already begun chemo, it might not be worthwhile. My sister paid for an Anne Hathaway pixie cut to attempt a transition. But within half a day, it already looked less red-carpet Hathaway and more “Les Miserables” Hathaway, and we had to shave it off.
When you’re ready to shave, use electric clippers, not razors, and never clip down to the scalp, Hana says. Leave an inch in length, especially if you have stiff or coarse hair like Asians do. “If you clip it to the scalp, the rigid hair will push back inside and make your sensitive scalp even more tender when you sleep on it or touch it,” says Hana. “Leaving a little bit of length will let it fall flat into a forgiving cap.” You might find itchy hairs all over your pillow and clothes during hair loss. Wearing a mesh cap can help catch the strands.
If your goal is to match your wig to your real hair color, keep a lock of it to show your wig stylist. Visit a stylist before you lose all of your hair, if you can. Or at least take photos of your hairstyle as a reference. “If being able to look just like yourself is important, I would like to meet you while you still have hair to best understand where your hairline is and how dense your hair is,” Watts says.
For the most seamless transition, select your wig before starting chemo and then wait until your hair is just starting to thin to start wearing it.
You might want to wear it even as your hair begins to grow back. According to this 2019 study, most people experience hair regrowth around three months after completing their cancer treatment and stop wearing wigs one year after chemotherapy. But some people continue to wear wigs until their hair grows out longer or because their hair regrowth is initially different than their pre-chemo hair. Hana says her hair grew back looking like a blue S.O.S. steel wool pad.
During chemotherapy, it’s important to take care of your scalp, which will dry out because your skin stops producing body oils. “Support the health of your hair follicles so that the day that you stop all your treatment, your hair can start to grow back prolifically without any deterrence,” says Hana. Dry skin, she explains, is a deterrent because those layers of dead skin cells block the openings and make it hard for new hair to break through the surface. Exfoliate your scalp often using a soft brush or exfoliating gloves in the shower. A cleanser with salicylic acid or leave-in treatment, such as Aveda’s Scalp Remedy also helps slough off dry skin, says Hana. And finally, keep it moisturized with a gentle conditioner. Some people use castor oil to promote healthy hair regrowth, too.
Photo: Perry Santanachote/Consumer Reports Photo: Perry Santanachote/Consumer Reports
Shop locally if you can. Ask your oncology team or cancer support group for recommendations. Trying on wigs in person with a professional stylist at the helm will offer the best experience. You’ll leave with a wig that suits your style, color tone, and budget. The stylist might even be able to customize the wig by trimming bulky areas and adding a more natural hairline, such as baby hairs and sideburns.
If you must shop online, make sure the store has a good return policy and instructions for measuring your own head using a sewing measuring tape.
The in-person salon consultation, which should be free, should be a conversation about your style, your activities, and how you’re dealing with chemotherapy treatment and cancer. The shop should also be able to help you file a claim if your health insurance company covers or subsidizes wigs. More on that in the section below.
If your insurance doesn’t cover wigs, there are other options for getting a wig free or at a reduced price if you are financially strapped. There might be a wig bank in your area or charities that offer donated wigs. Hana started a nonprofit called Hana’s Hope to help people who can’t afford a wig. Ask around to see whether there’s a nonprofit near you that can help.
People who can’t afford to buy a wig can also call the American Cancer Society’s cancer helpline (800-227-2345); you’ll either be directed to a wig bank in your area or given a gift certificate so that you can order a wig through TLC (Tender Loving Care), its nonprofit that sells affordable wigs.
Make sure you review and understand the procedures and policies outlined by your private insurance plan. You can also call your insurance company to check for coverage. Do this before purchasing a wig. Medicare parts A and B do not cover wigs for people undergoing chemotherapy, but some Medicare Advantage (part C) plans may offer limited coverage.
If you plan to file an insurance claim, ask your doctor for a “cranial hair prosthesis” prescription that includes a diagnosis code and a National Provider Identifier (NPI) code. The wig shop will need these codes to generate an invoice to submit to your insurance company. Also, have your doctor sign off on your insurance claim form.
Make sure the invoice says “cranial hair prosthesis” and not “wig,” Watts says. Request a new invoice from the store if necessary. The invoice should also include the shop’s tax ID number. The shop should also have the appropriate healthcare common procedure coding system (HCPCS) codes, which are standardized insurance codes for medical procedures, supplies, products, and services.
If your claim is denied, you can appeal it by writing to the medical review board, emphasizing that a prosthesis is necessary and not a cosmetic item. Include pictures of yourself without hair and detail the emotional effects your hair loss has had on your life. Your employer can also help by writing a letter.
If your insurance will not pay for the wig, save your receipt for a potential medical tax deduction. A flexible spending account (FSA) or health savings account (HSA) also can be used for a wig purchase.
Wigs are made out of either a synthetic fiber, human hair, or a combination of both.
Non-costume wigs can cost anywhere from $200 to several thousand dollars. And while a higher price often does mean better quality, a good synthetic wig can cost around $300. Wigs made of human hair are more expensive, costing between $800 and $6,000.
Photo: Perry Santanachote/Consumer Reports Photo: Perry Santanachote/Consumer Reports
Synthetic wigs are often made of modacrylic fibers produced in Japan. They hold their style even on humid days and don’t need to be washed as often as human-hair wigs—something to consider because going through chemo doesn’t afford you much energy to do things like regularly washing and styling a wig. You just need to keep these wigs away from heat—dryers, hot tools, and even the stove. Generally, synthetic wigs last for up to 5 months with daily use.
If you opt for human hair, you can choose the ethnicity, style, and texture for a more natural look. Wigs made of human hair are primarily cut in Asia. Wigs made with finer European hair are less common and as much as 20 times more expensive. Human hair can withstand the same treatments your natural hair could, including rolling, cutting, hot tools, and dyeing. However, these wigs are heavier than synthetics and require more maintenance. Human hair wigs last for up to one year with daily use.
“Human hair is ideal if you’re a person who likes to change it up because it has no limits,” says Hana. “You can flat iron it one day, blow it out the next day, and barrel curl it for beach waves another day.” There are limitations with synthetic hair wigs, but they are the most popular type for women experiencing temporary hair loss. “Like me, most of my clients going through treatment aren’t interested in these glam looks or extra work. I was tired, and that’s a lot to deal with.”
Wigs are constructed in two ways: machine-made and hand-tied.
Machine-made wigs are the most affordable, featuring open wefts—strands of hair fibers that are sewn or glued to tracks of stretchy material to make layered curtains of hair. The back and sides are open for ventilation while the hair on top is often lightly teased or crimped to hide the cap. “They’re less expensive ($200 to $400) but can be itchy and uncomfortable on a cancer patient’s sensitive scalp,” says Watts. “They would need to wear a cap underneath to make it more comfortable, but if it’s possible financially, a hand-tied wig would be most comfortable.”
Photo: Perry Santanachote/Consumer Reports Photo: Perry Santanachote/Consumer Reports
Hand-tied wigs (shown above) feature soft, flexible mesh caps to which individual hair strands are tied. The cap molds to the shape of your head, and you can part a hand-tied wig in any direction and have more freedom to style it however you’d like. The hair looks like it’s growing right out of your scalp because you can actually see through to your scalp without bulky fabric in the way. Hand-tied wigs generally start at $400.
Monofilament wigs can feature both types of construction—the back and sides are machine-made while the front and top are hand-tied for a more natural look.
Another characteristic you might want in your wig is a lace front, which is a very fine mesh along the front that companies sew hair into to mimic a natural-looking hairline.
When hair falls out, the scalp may feel tender or sensitive. Some wigs can irritate the scalp, so wearing a bamboo or cotton skullcap between the scalp and the wig can help. The cap provides a protective barrier, but it also helps secure the wig and absorb sweat. Hana says to avoid nylon or fishnet caps that can pinch and bind and aren’t breathable.
A velvety wig band can be worn instead of or in addition to a wig cap. The fabric’s nap acts like a grippy headband that helps keep the wig in place. Most of them also feature a sheer mesh patch that sits underneath the wig’s part in case you have a monofilament wig.
When you’re not wearing your wig, you’ll want to store it on a wig stand away from sunlight, heat, moisture, and dust.
Photo: Perry Santanachote/Consumer Reports Photo: Perry Santanachote/Consumer Reports
Wearing a wig isn’t complicated, but proper alignment is key. If you’re purchasing your wig in a walk-in store, the stylist should show you how to put it on and adjust it.
Look Good Feel Better, the charitable arm of the Personal Care Products Council, which represents the personal care products industry, offers free wig workshops that go over these details. You can search for one in your area or sign up for a virtual workshop.
Photo: Perry Santanachote/Consumer Reports Photo: Perry Santanachote/Consumer Reports
Generally, a wig should be washed after 14 to 18 wearings, but because chemo patients have such dry scalps, they could go up to a month before washing. You should wash your wig more often to remove sweat and dirt if you’re especially active outdoors. Gently swirl your wig in a mixture of cold water and gentle shampoo. Let it soak for a few minutes, then rinse with cold water. Lightly wrap the wig in a towel to remove excess water and drape it on a wig stand to dry. Once completely dry, brush it with a plastic or wire brush using light, short strokes. A wire wig brush is best as a standard hairbrush, and nylon bristles can overstretch and damage wig hair.
If you have a standard synthetic wig, keep it away from heat, like an oven, grill, or open fire, because it could melt. In most cases, you shouldn’t use heated styling tools or a hairdryer on a synthetic wig unless it is labeled “heat friendly” or “heat defiant,” a feature that can double the price of the wig.
A good wig stylist can also help maintain, trim, and repair your wig to make it last longer. Synthetic wigs can get a little crunchy over time. “The fibers go through a slow bake because they are right up against your body, hovering about 100 degrees, and rubbing against your clothes,” says Hana. “The heat and abrasion break down synthetic fibers, but I can defrizz it and trim the edges to bring it back to life.”
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