October 2, 2022

Woman with very long extensions gathered in a ponytail

Hair extensions have long been used to boost the appearance, fullness, and length of one’s hair. In both Ancient Egypt and Rome, wigs were often considered social markers of one’s social status, attractiveness, health, and standing.

In 1952, Christina M. Jenkins invented something known as the “HairWeeve,” which she patented as “a method and apparatus by which commercial human hair [could] be securely attached to the live hair on the head,” and thus the modern-day weave was born. Weaves are one form of hair extension, sewn into natural hair braided on the scalp. Today we also see less-permanent options such as clip-in extensions, and more permanent options such as bonding.

While hair extensions may add to the appearance of one’s hair, are they subtracting from hair and scalp health? Unfortunately, the answer is yes. Ahead, trichologist Dominic Burg, Ph.D., board-certified dermatologist Stephen Shapiro, MD, and Eternal Hair & Esthetics founder Abe Ayesh share their takes on how hair extensions can impact hair loss.

Types of Hair Extensions

When it comes to types of hair extensions, the limit does not exist. Just kidding… sort of. “There is a huge range of hair extensions available,” Burg shares. “Tape in, clip in, halo, ponytail, fusion, keratin, weaves, microbeads, weft, etc. These can be made of human hair or synthetic hair. They differ in quality, length of use, ease of application (professional or at home), and the potential to damage your hair and root.”

So, what exactly are all of the above?

  • Tape-in extensions: Tape-in extensions adhere to the hair’s root using medical-grade tape. The bond is nearly-unbreakable, resulting in long-lasting extensions that need to be professionally removed.
  • Clip-in extensions: Clip-in extensions are temporary extensions that clip into the hair on your head. They can be installed at home.
  • Halo extensions: Halo extensions do not attach to the hair, but are rather shaped like the crown of your head and sit on the hair with a hidden wire. Halo extensions can easily be placed on the head at home.
  • Ponytail extensions: Ponytail extensions are pre-made ponytails that attach to your hair using clips or elastics and do not require professional help.
  • Fusion/keratin extensions: Fusion/keratin extensions are attached strand-by-stand and have glue pre-installed at the top of each piece to adhere to the hair. They are then attached with a tool that fuses the extension to your natural hair. Fusion and keratin extensions must be applied and removed by a professional.
  • Bead/weft extensions: Bead/weft extensions are made from real human hair, and are attached by a professional via a bead that clamps and lays flat to the head.

Can Hair Extensions Cause Hair Loss?

While the reasons, severity, and details may vary, the general answer to this question is: Yes, hair extensions can in fact cause hair loss. “Hair extensions can instantly add volume and length to your hair so we can appreciate the temptation to use them, however, the answer is yes—they absolutely can cause hair loss,” says Ayesh. “Traction alopecia is hair loss due to pulling of the hair follicle from the scalp. It can be caused by the overuse of hair extensions or improper use of hair extensions.”

Different types of extensions may present a different level of hair loss risk, the experts note. “The main culprits in this regard will be weaved in extensions and microbead-type extensions. These are often applied quite close to the root and worn for extended periods (many months) and, if done incorrectly or too tightly, can damage the follicle, aka the root,” Burg explains. “Each follicle has a small muscle attached to it called the arrector pili muscle which can be damaged with repeated or prolonged pressure from tight weaves or incorrectly applied extensions.”

He continues: “Once the muscle is damaged and detached from the root, the root may die, resulting in hair loss. It’s also important to note that very long and heavy extensions can also have the same impact on the follicles regardless of the type of extension, as the sheer weight of the added hair can damage the root, especially if the weight is pulling on a small or isolated number of strands.”

When asked if some people are more susceptible to hair loss from extensions than others, the experts again agreed that the answer is yes. “If you are already experiencing unwanted hair loss, wearing extensions can exacerbate the issue,” says Shapiro. “Weakened hair may be more susceptible to this strain. If you have other causes of hair loss, make sure to be especially careful with hair extensions, avoiding excessive strain on your hair.”

For those who may not be experiencing unwanted hair loss yet, note that other aggressive treatments to your hair combined with hair extensions can up your odds of facing the issue. “People who color their hair often or subject their hair to chemical treatments will often have greater chances of experiencing hair loss because the hair breakage and damage is already present,” notes Ayesh.

It’s also important to understand the reg flags that typically present themselves with extensions before hair loss occurs. “If your scalp feels sore or tender when you are wearing extensions, there’s a good chance you are putting yourself at risk for traction alopecia,” says Shapiro. “Without proper intervention, permanent scarring can occur, and the hair loss can go from temporary to permanent.”

How to Prevent Hair Loss From Extensions

While hair extensions can certainly be damaging, there are ways to help your hair maintain its health (and length). “The best strategy is to give your follicles a rest,” Burg states. “Don’t wear the extensions for too long and mix up the attachment areas so that you are putting tension on different follicles. If you are using permanent or semi-permanent extensions, make sure you have them applied by an experienced, expert professional.”

While this does not guarantee hair preservation, it can often help. That being said, the best way to prevent hair loss from extensions is to avoid extensions altogether, especially if your hair is damaged to begin with. “If you are already someone who has thin, fine hair or has active hair loss, the use of hair extensions could exacerbate your hair damage and thinning,” says Ayesh. “For those with normal or thicker hair who wish to use hair extensions, it is important that proper usage instructions be understood and followed and that the scalp is given resting periods so that there isn’t continuous tugging from the hair follicles. Clip-ins are the safest by far since they can be removed before sleep each day or after a special event.”

Shapiro also notes that taking care of both your hair and your extensions is the final key factor in helping prevent hair loss. “The easiest way to prevent hair loss from extensions is pretty obvious: stop using extensions,” he reiterates. “Take steps to improve the state of your natural hair by investing in quality hair care formulas, but if you want to continue using extensions, taking care of your real hair can help counteract their adverse effects. For that reason, I highly recommend using formulas like Shapiro MD’s shampoo, conditioner, and leave-in daily foamer. These formulas contain potent botanical compounds shown to fight the effects of dihydrotestosterone (DHT), a hormone that is known to cause hair loss. These ingredients are also abundant in antioxidants, nutrients that can help repel the effects of environmental stressors like sunlight and pollution.”

“Minoxidil is another great option for individuals who want fuller hair,” Shapiro continues. “Minoxidil expands the blood vessels in your scalp, allowing for more vitamins and nutrients to travel to your hair follicles. This keeps your hair follicles healthy, strong, and primed for continuous hair growth. While wearing extensions, make sure your hair is clean and free of buildup from products like hairspray, which can make hair heavy, brittle, and more susceptible to breaking and shedding. You’ll also want to avoid using heated styling tools as much as you can.”

Hair Extension Alternatives

Given the fact that hair extensions are in fact not the healthiest for your natural hair, we asked the experts what the next best options are. Turns out there isn’t exactly an answer for that… yet.

“There is no real quick fix to gaining long, amazing hair,” Burg says. “This takes time. A lot of women use extensions because they can’t grow their hair long or past a certain length. This is quite often mistaken for a breakage issue or an issue with the hair quality, but it’s actually more reflective of the hair cycle length. So, instead of extensions, you can go for a long-term fix by looking after your hair cycle. Making sure your scalp and body has everything it needs is critical to maintaining a healthy cycle.”

How exactly do you keep a healthy hair cycle? Burg shares his top tips:

  1. “Make sure you are getting enough zinc, B vitamins, iron, and vitamin D. Make sure you keep your stress levels low. Supplements can help with both your nutrient levels and your stress.”
  2. “Take care of your scalp with a serum containing antioxidants and anti-inflammatory actives, preferably natural—look for things like green tea, mangosteen, rosemary, vitamin E, and vitamin C.”
  3. “Extend your hair cycle by blocking FGF5. The damaging protein FGF5 builds up in your scalp and shortens the hair cycle, and by blocking FGF5 you can naturally maximize the length of your hair. There are a number of botanicals that can block FGF5 when applied as part of a serum, such as Sanguisorba officinalis and Swertia chirata.”

Ayesh also shares his tips for maintaining healthy hair. “[These are] not alternatives, but we do recommend adopting a few regular habits to maintain scalp health if you want to use hair extensions regularly,” notes Ayesh. “There are all-natural, drug-free hair growth supplements that can improve the strength and vitality of your hair, and we always recommend switching to sulfate-free, paraben-free, alcohol-free shampoos, conditioners, and styling products as the harsh chemicals present in many hair care products can have a significant impact on your scalp health. In addition to using milder hair care products, choosing less harmful styling options can be important as well. How often you use high heat—blow dryers, straight irons, curling irons, hot brushes, etc.—to style your hair is also a factor in preventing hair breakage and hair loss.”

The Final Takeaway

It’s safe to say that hair extensions provide aesthetic benefits at the expense of your hair’s health (and length). While good for special occasions, the experts agree that the less use, the better.