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 transition less stressful. But if you’ve already begun chemo, it might not be worthwhile.

When you’re ready to shave, use electric clippers, not razors, and never clip down to the scalp. Leave an inch in length, especially if you have stiff or coarse hair. 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. Leaving a 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 colour, 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. For the most seamless transition, select your wig before starting chemo and then wait until your hair is just starting to thin to begin 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 from their pre-chemo hair.

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. Dry skin 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 also helps slough off dry skin. And finally, keep it moisturised with a gentle conditioner. I recommend you use coconut oil  to promote healthy hair regrowth, too.

Where to shop for a wig
Shop locally if you can. Ask me 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, colour tone and budget. The stylist might even be able to customise 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.

Synthetic vs. human hair wigs
Wigs are made from either synthetic fibre, human hair, or a combination of both. Wigs made of human hair are more expensive, costing between $800 and $6,000.

Synthetic wigs are often made of acrylic fibres 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 such as 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 five 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. But these wigs are heavier than synthetics and require more maintenance. Human hair wigs last for up to one year with daily use.

Wig types
Wigs are constructed in two ways: machine-made and hand-tied.

Machine-made wigs are the most affordable, featuring open wefts — strands of hair fibres 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. 

Hand-tied wigs feature soft, flexible mesh caps to which individual hair strands are tied. The cap moulds 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.

Another characteristic you might want in your wig is a lace front, which is a fine mesh along the front that companies sew hair into to mimic a natural-looking hairline.

Accessories
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 provide a protective barrier — and help secure the wig and absorb sweat. 

A velvety wig band can be worn instead of or in addition to a wig cap. 

When you’re not wearing your wig, you’ll want to store it on a wig stand away from sunlight, heat, moisture and dust.

How to wear and care
Wearing a wig isn’t complicated, but proper alignment is key. If you’re buying your wig in a walk-in store, the stylist should show you how to put it on and adjust it.

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 with nylon bristles can overstretch and damage wig hair.

You shouldn’t use heated styling tools or a hair dryer on a synthetic wig unless it is labelled “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.