Hair Foundation
Wigs and Hair Additions

October 6, 2008
James L. Breeling

A person with hair loss from the scalp commonly wants to restore or replace the lost hair. Three options are available:

Treatment with hair restoration medications to slow hair loss and stimulate new hair growth (see Non-Surgical Hair Loss Treatment);

Surgical hair restoration by hair transplantation or other surgical technique (Link to; or

Replacement of lost hair with a wig or hair addition. Hair-bearing devices and hair extensions can also be adapted to purely recreational purposes such as making easy transitions to different hair color, hair length and hair bulk (see Importance of Hair Throughout History).


A wig provides full scalp coverage that replaces a natural head of hair. Persons who use wigs prosthetically (as substitutes for natural hair) include cancer patients who lose hair temporarily while undergoing radiation or chemotherapy treatment, and persons who are unable to grow hair due to an inherited genetic condition. A wig is attached to the scalp with an adhesive, by suction cups or by tieing it to the scalp using surgically-created skin loops.

Hair Addition
Hair additions include partial hairpieces and hair extensions.

The term "hair addition" is preferred today for the partial hairpieces that used to be called by the jocular terms "toupee" and "rug". The partial hairpiece provides hair replacement only over a defined area of hair loss. It is attached to the scalp with an adhesive, by suction cups or to surrounding hair with clips, hair weaving or bonding with a chemical sealant.

Hair extensions are techniques for bonding human or synthetic hair to existing hair to provide coverage, more density or additional length to existing hair. Techniques include hair-to-hair bonding with an adhesive, sewing or bonding of braids or cornrows to existing hair, hot-bonding with a glue gun, braiding or corn-rowing on netting bonded to underlying natural hair and clip-on extensions. Hair extensions can be adapted to purposes of hair replacement, but the most common purpose is cosmetic enhancement.

Candidates for a Wig
A prosthetic wig, providing full scalp coverage, is usually appropriate only for the person who has no scalp hair and thus no hairline. The wig completely replaces a natural head of hair.

Candidates for a Partial Hairpiece
A partial hairpiece may be a temporary or permanent solution for the person who


Wants coverage of an area of hair loss while awaiting the permanent solution of hair transplantation;

Does not wish to undergo hair transplantation and has had inadequate results from use of a hair restoration drug;

Has had hair transplantation, but wants to supplement the result with a partial hairpiece to add bulk and density to hair coverage; or,

Needs coverage of a bald spot "on demand"-for example, esthetic requirements of an entertainer, politician or business person whose public persona requires a full head of hair.

The Materials of Wigs and Hairpieces
As for all products made by human hand or machine, the quality of a wig or hair addition is determined by (1) the component materials from which it is made, and (2) workmanship. The best product is made from the best materials, to a high-quality standard of workmanship.

The foundation material of a wig or partial hairpiece-the material to which the hair or synthetic fibers the simulate hair is attached-is usually a silk, cotton or synthetic netting or gauze. Synthetic materials may better resist damage from perspiration and excessive skin oiliness. The foundation material must be light in weight but strong enough to serve as a base for the finished product.

The "hair" of the wig or hairpiece is either natural hair or synthetic fibers that simulate hair. Synthetic fibers of high quality are very acceptable substitutes for natural hair. They are superior to human hair in that they are lighter in weight, dry faster after wetting, and hold styling patterns and color longer than natural hair. High heat, as might come from a hair dryer or permanent waving tool, may damage synthetic fibers.

Human hair is often preferred to synthetic fibers because it is "natural". It may be more expensive than synthetic fibers because of supply shortages. Human hair provides a range of selections on the basis of color, texture, caliber and straight/curly/wiry shape that match the client's hair. Before it is used in making a wig or hairpiece, human hair is stripped of its outer, protective cuticle (see Hair Science: How and Why Hair Grows). If left in place, cuticle shatters into scaly projections that cause hair fibers to adhere to one another in knotty tangles.

Several techniques are used to attach synthetic fibers or human hair to the foundation material:

Hand-knotting, the most expensive technique, is used in the highest quality products;

Looping (fiber is looped through the foundation material as one would do when sewing a garment, then sealed to prevent undoing of the loops);

Punching and sealing; and,

Machine wefting, the least expensive technique, used in less expensive ready-to-wear wigs.

Ready-to-Wear or Made-to-Order?

Enter "wigs" as a search term on the World Wide Web and you will find dozens of sites offering ready-to-wear wigs. Ready-to-wear wigs are also widely available in stores and mail-order catalogues. Most of the ready-to-wear products are made for off-the-shelf immediate wearing. The customer fits the wig to his/her head by making adjustments according to instructions provided by the manufacturer. Synthetic fibers, human hair or a mixture of both are used in ready-to-wear products.

Semi-custom wigs are also available as ready-to-wear products. The semi-custom product is usually hand-knotted and made in different sizes and shapes to better accommodate to an individual's head.

A person who wants or needs a wig of the highest quality that addresses all of his/her individual esthetic and physical requirements should consider purchasing a custom-made wig. The advantages of a custom-made wig are high quality, precise fitting to head measurements, adaptation to facial esthetics and selection of hair to best complement the person's ethnicity. The major disadvantage is cost, which is substantially higher than the cost of a ready-to-wear product. The selection, fitting and attachment of a custom-made wig is best done with professional guidance and supervision-for example, under the guidance of a cosmetic surgeon or a skilled and experienced cosmetologist.

Unlike wigs, which are whole-scalp, long-term solutions for hair loss, hairpieces are partial-scalp products which frequently have a limited period of usefulness before they must be replaced. The most common reason for having a hairpiece is to cover a bald spot, which is usually due to androgenetic alopecia (male- or female-pattern hair loss). Because androgenetic alopecia is progressive, a bald spot changes in size and shape over time. A partial hairpiece that covers an area of hair loss today may provide inadequate coverage as hair loss progresses.

Because areas of partial hair loss are unique to each person, there are few satisfactory ready-to-wear partial hairpieces. A hairpiece must usually be made to order to meet the esthetic and physical requirements of the individual man or woman. The fitting and creation of a high-quality partial hairpiece requires skill and experience. A physician specializing in hair restoration can refer patients to a trusted professional. Hairpieces may also be available directly from cosmetologists who have the requisite training and experience to properly fit a hairpiece and assure its quality and workmanship.

Problems and Their Prevention
Itchy scalp and excessively oily scalp can occur under wigs and partial hairpieces. The problems are best prevented by keeping the scalp clean by washing as often as necessary. Allergic reactions to adhesives are uncommon; if a reaction occurs, it should be brought to the attention of a physician.

Traction alopecia-temporary or permanent hair loss caused by constant excessive traction on hair and the hair follicles from which they grow-is a potentially serious complication of hair additions and extensions. Partial hairpieces and hair extensions that exert excessive traction on the natural hair to which they are attached may inadvertently be a cause of hair loss (see Hair Loss and Its Causes and the section Physical, Chemical, Thermal and Radiation Injury). Careful fitting and attachment of the hair addition by a skilled professional decreases risk for traction alopecia.


Mahoney MJ. Nonsurgical hair replacement. In: Stough DB, Haber RS (eds.). Hair Replacement: Surgical and Medical. St. Louis: Mosby; 1996:399-411.

Anderson J. Wigmaking: Step by Step. Vol. I (138 pages). Vol. II (250 pages). State Medical Book and Periodical Service; 1992. (Out of print; may be located by Interlibrary Loan Service). (American Hair Loss Council)