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Chemotherapy Hair Loss: To Shave or Not to Shave

Chemotherapy Hair Loss: To Shave or Not to Shave


Not all chemotherapy drugs cause hair loss, but the ones that do are fairly predictable. If your doctor has told you to expect hair loss, this is what usually happens: 

One and a half weeks after your first treatment, your scalp may become tender. Some people don't feel this at all, and for others their scalp becomes quite sore. This is normal and goes away after the hair loss is complete.

Hair loss begins about two weeks to the day after your first treatment and takes 3-7 days. I promise you, you will not lose your hair before two weeks, and you will not wake up one morning bald without warning.

You can generally wear your hair normally for the first few days, but by the third or fourth day (after the two week mark) you'll be ready to comb out what's left and cut it short, if you haven't already.

Whether or not to cut your hair before you begin treatment is a matter of personal preference. For some women, having their hair cut into a shorter style helps them get used to it, and it's less traumatic when the hair begins to fall.

For others, particularly if you love your hair, cutting it any sooner than you have to is more traumatic. Either way, you'll definitely want to have it cut short once hair loss begins.

100 hairs that are two inches long are much easier to deal with than 100 hairs that are 6 or 10 inches long. Also keep in mind that even before your hair begins to fall out, it will probably look dull and lose body.

In my 25 years as a hairdresser helping cancer patients through this process, here are my best recommendations:

When your scalp becomes tender is a great time to cut your hair short, down to about 2 inches. Don't shave it yet. I'll explain more later. Cutting your hair short at this point will greatly relive the tenderness.

Three to five days after the two week mark, your hair loss will really pick up speed and you'll be tired of dealing with it. At this point you want to encourage the hair to come out.

Gently comb out your hair. Then shampoo and rinse. A lot more will come out. Apply your regular conditioner and comb through your hair with the conditioner in. This puts just enough tension on your hair to gently coax it from the follicle. This will probably remove about 80% of your hair and it will not hurt.

Rinse out the conditioner, dry your hair and now you are ready to clip it down. It's very important that you do not clip it all the way to the scalp. Please use a #2 attachment.

If you clip it all the way to the scalp, those little whiskers will get caught in the follicle. They will detach from the papilla, the bulb that feeds the hair, but be stuck in the follicle. This will be like a splinter or ingrown hair and you will get tiny red bumps or sores. This is not good and can be totally avoided if you use an attachment and leave a little bit of hair.

Okay, so you've clipped your hair with a #2 attachment. Now take one of those masking tape lint rollers and roll it over your head. You will be amazed at how much more hair comes out. Use the lint roller several times a day to get the rest of it out. Your head will feel so much better. When the hair follicle is inflamed even the weight of a couple inches of hair can be uncomfortable.

Continue to wash your scalp with a mild shampoo (not bar soap) every day, even after you've lost your hair. Your oil glands will put out the same amount of oil whether you have hair or not, and this will keep your wig, hats and scarves cleaner.

Oct 06, 2022

Hi Nicki,

Just spoke to you about a hat and how to make it smaller.
Even though I’d lost my hair via chemo 20 years ago, I listened to your talk about how to best shave your head. Thank you so much! I will do it differently this time!

Great info for a veteran and so nice for ‘newbies’ to hear – your thoughts and tone were just perfect.

Karen Wold

Karen Diane Wold
Oct 06, 2022

Thank you, this was great advice for the husband cutting his wife’s hair. Every step made this challenging process go smoothly. Only step I added was first cutting her hair with a #4 and then followed up with a #2 as you suggested!

Oct 06, 2022

This is great advice! I made it to my third chemo appointment before it started coming out (but still two weeks from the start) and it was really helpful to have this resource on what to do and what to expect. Thank you!

Oct 06, 2022

Thank you for the advise..big help for me!

Oct 06, 2022

I am seeing significant hair loss from a multi-targeted cancer drug referred to as cabozantinib. It is highly likely that I will lose all hair on my head, having already lost all hair on the rest of my body. I will remain bald as long as I remain on the drug. The process is slower and lasts longer than the pattern of hair loss associated with chemo.

Deborah Jo
Oct 06, 2022

Thank you so much that was so good information, that really helped me.

Linda Card
Oct 06, 2022

I’m 34 and was recently diagnosed with stage 3 ovarian cancer. This article was so so helpful!! My hair started to fall out 13 days after my first chemo tx. I managed for a couple days, but got really sick of all the shedding. I knew it was time to cut it, but also wasn’t sure if I was jumping the gun because even though so much was coming out I still had a good amount of hair on my head. After coming across this article it solidified my decision and I’m glad I did it! Thank you!

Oct 06, 2022

Just wanted to say thank you for sharing this information. We’re so grateful that you took the time to share this guidance as it felt quite daunting when my dad started to lose his hair (as predicted by the chemotherapy nurses). We’ve cut it with a #2 as you suggested and he’s going to keep the lint roller close by.
Thank you again and take care.

Feb 07, 2023

Nice and informative post. See this too -

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Oct 06, 2022

I loved that! Just had my sister shave my head, just down to the# 2, thank goodness!! Feels great too!
Looking forward to your newsletter 💕

April Roth

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