Tight hairstyles and temple recession

When the temples seem to be rising, the first suspicion is baldness. But there is another cause, less talked about and easier to fix: the hairstyle. A tight high bun every day, a ponytail pulled back for the gym, close-set braids or hair always stretched back with a hair tie can, over months and years, make the temples recede. This is traction alopecia, and it affects men and women.

The good news is that, caught early, it recovers when the tension is removed. The bad news is that, ignored for years, it can leave scarring and become permanent. And, sometimes, traction and baldness coexist and add up.

Why the temples suffer first

• Finer hairs: at the edge of the hairline, especially at the temples, hairs are naturally finer and the follicles less robust than on the top of the head.
• More tension: when hair is pulled back and tied, the force is concentrated on the margin, which is where the hair changes direction.
• Less "cushioning": there is less hair around to distribute the load.

That is why the temples and the area above the ears are the most typical locations for traction alopecia, according to the review by Billero and Miteva (2018). In men, traction-related recession can easily be confused with the start of baldness, because it appears exactly where baldness also begins.

The mechanism is always the same: repeated tension, inflammation around the follicles and, if it continues, scarring. See Traction alopecia: what it is and how to recognise it.

Which hairstyles and habits pull on the temples

In men

• High bun ("man bun") or half-bun, tied tightly, every day.
• Tight ponytail for work, the gym or sport.
• Close-set braids and dreadlocks, especially if tight at the margins or heavy.
• Long hair always pulled back with a hair tie or ribbon.
• Turban over a tight knot.

In women

• High, tight ponytails and buns, the "pulled back" look of work, sport or dance.
• Braids and extensions near the temples. See Braids and extensions without damaging your hair.
• Clips and headbands always in the same place.

Occupations and activities

• Ballet dancers and gymnasts, with very tight buns for years.
• Athletes, with ponytails tied tight to train and compete.
• Healthcare, kitchen and industry workers who tie their hair up with caps and clips.
• Military and security forces with rules requiring hair to be tied up.

What makes it worse

• Styling the hair when it is wet, as it shrinks when it dries and increases tension.
• Tying hair up every day in the same position.
• Sleeping with the hair tied up.
• Thin hair ties or ones with metal.
• Hair weakened by chemicals and heat.

Traction or baldness at the temples?

Source: Samrao et al., 2011; Billero and Miteva, 2018.

The two can coexist. A man predisposed to baldness who wears a tight bun may see his temple recession advance faster because the two causes add up. Trichoscopy helps to tell them apart: in traction, broken hairs and hair casts are seen; in baldness, hairs of very varied thickness. See also Temples: natural or receding?.

Myths: caps, helmets, gel and hats

How to protect your temples

Simple changes

• Tie lower and looser: ponytail or bun at the nape, without stretching the temples.
• Alternate the position of the hairstyle and have days with your hair loose.
• Wide, soft hair ties, fabric or spiral, without metal.
• Do not tie up wet hair.
• Let your hair down to sleep.
• Leave the temples looser in braids and buns; accept a few loose hairs at the margin.
• During sport: a wide fabric band instead of a very tight ponytail; let it down straight after training.
• If it hurts, it is too tight. Adjust it.

What to expect when you relieve the tension

• In early traction, the inflammation settles within weeks and the first new hairs may appear in three to six months. Recovery is assessed at six to twelve months.
• New hairs at the temples are short and fine at first; over time, they thicken.
• The doctor may propose treatment of the inflammation and, in some cases, topical minoxidil to help the follicles that are still active.
• If there is no recovery after a year, there may be scarring or associated baldness, and it is worth reassessing.

When to assess

At Luxmed, the Hair Medicine consultation includes a history of hairstyles and habits, examination of the temples, trichoscopy to distinguish traction from baldness and to assess whether the follicles are active, and follow-up photographs. We agree with you a plan compatible with your style, your sport or your work.

This article is for information only and does not replace a medical consultation.

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