Braids and extensions without damaging your hair

Braids, dreadlocks, extensions and weaves are, for many people, much more than aesthetics: they are identity, culture, practicality and a way of protecting natural hair. There is no need to give them up. But they must be used in a way that does not make you pay the price years later, with thin hair at the temples and front hairline.

The dermatologists who study traction alopecia insist on this: the aim is not to ban styles, it is to teach how to wear them with less risk. This guide brings together what the evidence says about tension, weight, time and chemicals, the risks of each type of extension and the practical rules for before, during and after.

Why they can damage the hair

The damage does not come from the braid or extension itself, but from four factors that add up:

• Tension: the tighter, the more force on the root. The margins (temples, front hairline, nape) have finer hairs and suffer first.
• Weight: long extensions and braids with a lot of added hair pull continuously, even if they are not tight.
• Time: the same tension kept up for weeks, without a break, gives the follicle little time to recover.
• Chemicals and heat: relaxers, straightening and bleaching weaken the hair shaft; the heat of irons and heat-bonded glues adds damage.

When the tension continues for years, the inflammation around the follicles can progress to scarring and permanent loss. See Traction alopecia: what it is and how to recognise it.

There is also more immediate damage to the hair shaft: hairs broken when styling or undoing the hairstyle, tangles, and breakage near the attachment points of extensions.

Hairstyles by risk level

Haskin and Aguh (2016), of Johns Hopkins University, reviewed the evidence on hairstyles and traction alopecia and ranked them by risk:

Source: Haskin and Aguh, 2016.

This table does not mean braids and extensions should be avoided at all costs. It means they need more care: less tension, less weight, less time and no combination with chemicals.

The recommended timings

• Braids: two to three months at most.
• Extensions and weaves: remove after six to eight weeks and allow a break before putting them in again.
• Alternate styles between applications, so that the same areas are not always under tension.

Types of extensions: risks and care

Allergies and irritation

Glues, adhesives and some dyed synthetic hair can cause contact dermatitis: intense itching, redness, spots or burning on the scalp. If you have known allergies (for example, to latex or hair dye), tell the professional and ask for the product to be tested on a small area. Severe itching in the first days should not be ignored.

Wigs

They are an alternative with less traction, but they are not risk-free: tight caps, hair ties and glues can irritate and pull. Prefer satin caps, a comfortable fit and remove them at night.

Practical rules

Before

• Start with healthy hair and scalp. If there is hair loss, spots, patches or itching, treat that first.
• Do not combine with chemicals: no braids or extensions on relaxed, straightened or recently bleached hair.
• Choose a professional who listens when you say it hurts. Say straight away if it pulls.
• Ask for wider, lighter sections, especially at the margins.

During fitting

• If it hurts, it is too tight. Pain, burning, red dots or headache are not "normal in the first days". Ask for the ones that hurt to be undone.
• Leave the margins looser or without braids or extensions: the front hairline and temples are the most fragile areas.
• Do not use painkillers to put up with a painful hairstyle.

While wearing

• Wash the scalp regularly, with diluted shampoo applied between the braids, and dry well.
• Moisturise the hair and the ends.
• Sleep with a satin scarf or pillowcase and avoid fastening braids in a high, tight bun.
• Watch for spots, crusts, pain or hairs coming loose at the margins.

On removal

• With time and patience: detangle from the ends towards the root, with conditioner or oil, without pulling.
• It is normal for more hair to come out on removal: these are hairs that fell out naturally over weeks and stayed trapped. But tufts with roots at the margins are not normal.
• Use a proper remover for glues and adhesives.

Between applications

• Take a break of a few weeks, with your hair loose or in low-risk styles.
• Alternate the direction, the parting and the type of hairstyle.

Children

Traction alopecia can start in childhood. In a study in South African schools, the prevalence rose from 8.6% in the youngest girls to 21.7% in the final-year pupils, which shows that the damage accumulates from an early age (Khumalo et al., 2008).

Specific care for children:

• Avoid very fine, tight braids, especially near the margins.
• Do not use extensions or hairpieces on young children.
• Do not use relaxers or chemical straightening on children.
• Listen to the child: if they complain of pain or headache or cannot sleep, the hairstyle is too tight.
• Soft hair ties, without metal, and low, loose ponytails.
• Breaks between braided hairstyles.

Teaching these habits early is the most effective way to prevent traction alopecia in adult life.

Warning signs

The earlier the tension is relieved and the inflammation treated, the greater the chance that the hair will return. See Scalp pain from hairstyles: when to worry.

At Luxmed, the Hair Medicine consultation assesses the hairline margins with trichoscopy, to see whether the follicles are still active, and helps to plan safer hairstyles, without asking you to give up your style.

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

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