What you need to know: Do tight ponytails and braids *really* ruin your hair?

I first experimented with wearing braids as a protective style during the pandemic. This style helped me maintain my thick, coily hair during lockdown when I couldn’t get my fortnightly salon blow-dry. I chose for a long time box braids— smooth, wide, rope-like — similar to the version worn by Janet Jackson poetic justice.

Not only do you look and feel great with minimal effort, you can’t ignore how easy box braids have become. Effortless style was the perfect choice for me, a low-maintenance woman who wanted an effortless style that looked sophisticated. I loved the freedom they gave me. You no longer have to spend 20 minutes every day meticulously detangling and styling your multi-textured hair. Instead, I was able to get up and get to work right away, without having to worry about my hair, and enjoy the precious time I was saving.

So it was a no-brainer that I decided to keep my braided hairstyle even when hair salons were allowed to reopen. I had my box braids professionally redone every 8-10 weeks. However, after 18 months of continuously braiding my hair, I noticed that the edges were thinning. “It looks like traction alopecia,” my professional hairstylist told me while inspecting my fragile hairline during my appointment, so in the end I realized that the protective style I had chosen was I wondered if it was “protection” in the first place. In reality, hairstyles that create tension at the roots of your hair (such as braids, buns, ponytails, and tight headbands) put you at risk for hair loss, hair fall, and, in severe cases, traction alopecia. Possibly.

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To determine if traction alopecia is the cause of thinning edges, I contacted Dr. Carl Truesdale, a board-certified facial plastic surgeon and hair transplant surgeon. Dr. Hadley King, Board Certified Dermatologist. Trichologists Bridget Hill and Sophia Emmanuel discuss everything you need to know about traction alopecia, including how to recognize it, how to prevent it, and how to grow your hair back after hair loss.

What is traction alopecia?

Traction alopecia is hair loss caused by repeated pulling or tension on the scalp. According to Dr. Truesdale, with the growing popularity of braids, extensions, wigs, and pulled-back hairstyles such as buns and ponytails, putting undue stress on the hair follicles is very common. meanwhile Anyone You may experience traction alopecia, a condition that is more common in black women and affects one-third of women. According to research. “Traction alopecia can affect any area of ​​the scalp that has been pulled, but primarily affects the hairline, crown, and nape of the neck,” Emmanuel says. “Long-term use of high-tension hairstyles can cause permanent hair loss due to irreversible damage to the hair follicles.”

Dr. Truesdale says the cause of traction alopecia is usually chronic inflammation that occurs in the hair follicles when the hair is pulled too much. “Continued inflammation can lead to thinning, damage, and eventually baldness of the affected area,” he says.

What causes traction alopecia?

Traction alopecia can be caused by hairstyles that pull or tense the scalp too much. These styles may also include what some refer to as “protective styles,” such as braids, twists, locks, weaves, extensions, buns, and ponytails if tied too tightly. “If done improperly, it’s no longer considered protective,” Hill said. “They’re more of a ‘style of convenience’ because they can cause more harm than good if performed strictly.” Hill also notes that using bulky extensions with some protective styles can add weight to the extensions. strands, which can end up being pulled and causing physical stress on the strands. “When adding hair to your style, be careful not to weigh it down or carry a lot of weight,” she warns.

Emanuel also notes that clip-in hair extensions can cause traction alopecia by repeatedly pulling and compressing the scalp, and doing this repeatedly can weaken the hair follicles over time. said. Similarly, an unsuitable wig that is ‘too small or too loose’ can cause chafing on the wig edges and cause hair loss,” she adds, adding that the adhesive used to secure the wig He noted that agents may also help thin the natural hairline. Factors that can cause hair follicle weakening are the use of taut hair accessories, such as tightly wrapped rubber bands, ponytail holders, and tight headbands.

What are the signs of traction alopecia?

According to Dr. Truesdale, early symptoms of traction alopecia include an itchy, tender, or red scalp, small pimple-like bumps due to tension along the hairline and temples, and hair breakage. That’s what it means. “As the condition progresses, hair thinning becomes noticeable and, in severe cases, hair follicles are permanently damaged,” he says. Usually, when diagnosing traction alopecia, hair follicle damage is visually obvious, Dr. King says. However, your doctor may perform a biopsy to rule out other possibilities of hair loss.

How to treat traction alopecia?

“If you suspect you have traction alopecia, it’s important to see a medical professional or dermatologist,” says Dr. Truesdale. “Early diagnosis and treatment can help minimize hair loss and improve overall hair health.”

First, loosen up your tight style.

The first step to recovery, Hill says, is to stop wearing compromising hairstyles or using harmful techniques that pull your hair too hard or cause excessive friction to relieve tension on your hair follicles. is. This doesn’t mean you’ll never wear a ponytail or box braids again, but if you’re feeling tugged at the roots of your hair, stop and take a moment to loosen the hair tie (or remove it before bed). Please be sure to communicate with your braider or hair stylist in the following cases: The style feels tight.

Adopting habits such as sleeping on a silk pillowcase to minimize excess friction, ensuring your bonnet band isn’t too tight, and using hair care products that are gentle and nourishing to your skin can also help. “Hair loss doesn’t just happen when you first get a tight hairstyle. It happens over time. So if you can continue to keep your scalp healthy, you can get your hair back to normal. ” explains Dr. King. In more advanced cases, medical intervention may be required, Dr. Truesdale says, and treatment depends on the severity of the hair loss.

Discuss drug options with your doctor

The FDA-approved topical drug minoxidil can help stimulate hair growth when follicular scarring is not involved. Minoxidil works by improving blood flow to the scalp, which in turn helps keep hair in the anagen (hair growth phase) for longer. Some dermatologists prefer to combine minoxidil and tretinoin to improve its effectiveness and absorption into the scalp. In addition, your doctor may also inject you with topical corticosteroids (such as FDA-approved injectables) Kenalog) is injected into the affected area to reduce the inflammation caused by the condition.

In conjunction with the aforementioned scalp therapies, Dr. Truesdale also likes to treat damaged areas with red light therapy. Platelet-rich plasma therapy (also known as PRP), or exosome injection Promotes scalp health and hair follicle recovery. red light therapy It works by shining a red LED light onto the bald area to push dormant hair follicles into the growth stage.

PRP involves drawing blood from the patient, separating concentrated cells, and injecting them into the scalp to nourish damaged hair follicles and stimulate stem cells for hair growth. Exosome therapy, on the other hand, is a new scalp treatment that helps bring dormant hair follicles out of dormancy. Exosomes contain growth factors, various proteins, and activated stem cell signals that communicate with impaired hair follicle cells to promote hair regeneration.

However, if the damage to the hair follicle is severe enough to cause scarring, the resulting hair loss can be permanent, Dr. King explains. “At that stage, there’s nothing you can do to reverse it,” she says. Therefore, in that case, hair transplantation may be the only viable option. Dr Truesdale says the procedure involves transplanting healthy hair follicles from areas of the back or sides of the scalp that are usually hard to lose hair, replacing them with new hair follicles to fill in areas where irreversible hair loss has occurred. Let me explain.

How can I prevent traction alopecia?

The best way to avoid traction alopecia is to avoid tight hairstyles altogether, advises Dr Truesdale. Instead, choose a looser style to reduce tension in your hair, suggests Hill. If you wear hair extensions, braids, wigs, clip-ins, locks, or twists, make sure they aren’t too tight, wear them in moderation, and change your hairstyle often to give your hair follicles a rest midway through. Please.

Also, when choosing a braiding professional, remember to look for a licensed hairstylist or experienced artist with techniques that minimize irritation to the scalp. Most importantly, Hill says, don’t be afraid to speak up if you feel uncomfortable and get your style back on as soon as you feel pain. Pushing back a salon chair can be a little awkward, but speaking up at the first sign of discomfort can save you a lot of stress and pain in the long run.

final point

Based on the above information, I stopped braiding my hair frequently and started doing pronto, a low tension hairstyle. I also sought the professional help of a dermatologist to evaluate my hair and scalp and determine the best course of action. Thankfully, traction alopecia is often preventable and reversible, especially if treated quickly. Fortunately, the damage to my hairline was superficial and my dermatologist was able to restore my hairline to its original thickness with a combination of Kenalog shots and a prescription of minoxidil formulation. .

Will we ever return to the convenience of “protective styling”? Probably so. I’m actually thinking of getting braids for my next week off (which is totally fine), but now I have the knowledge on how to properly wear and care for braids so that my hair and scalp can grow properly. I have learned enough. to the fullest.