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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.

Feb 07, 2023

Your post is very informative, thank you.
I am about to have Chemo session 8 of 12 next week. My hair has thinned and fallen out in patches and I have bald spots. I was thinking of shaving my head just before my 12th session as I am concerned with the result of new hair growing back and having some existing, they will possibly be very different. I would love some feed back on this as I am very confused what to do.
Warmest wishes,

Feb 07, 2023

Cut my hair pixie style before I started chemo which helped me and everyone around me get used to it. After 1st dose chemo cut hair down to #2 which helped me. I wear a beanie most of the time. Also bought 2 wigs to match my pixie cut, when I had hair. My wig style definitely looks better than my real hair ever did and I get compliments on it whenever I wear it out. I still prefer to wear a beanie. Now I’ve had 3 chemo treatments and my hair feels pokey on top. I was debating shaving my head but after I read your advice I think I’ll just leave it alone.

Feb 07, 2023

I start my first round of chemo 16 November 2021. I have not cut my hair yet. I will do it today. This page has been helpful. I am nervous about being completely ball, however I love my hair short so maybe I am nervous for nothing.

Feb 07, 2023

Thank you so much for this hugely helpful video/information. Listening to you was like listening to a friend. Your kindness is most appreciated.

Lauren Kohns
Feb 07, 2023

Can’t thank you enough for your advice. It was spot on. Exactly 2 weeks after my first chemo, my hair started falling out. By the 3rd day I had it shaved with #2. Traumatic but keep reminding myself that this means my chemo is working!

Kathy Walker
Feb 07, 2023

Hi, I have a question not a comment. I never lost my hair during chemo. I am now however in advanced stage 4 MBC. My hair is medium to long length and drives me crazy. I can’t take care of it myself anymore and I hate to keep asking my daughter, even once a week, for help. I have to constantly wear it up in a scrunchie because it’s all I can do. I really want to just shave it now. I have about4 maybe 6 months left. My daughter is very much against it but everyone else is ok with it. My question is would this method work on my hair even though I’m not going through chemo or experiencing hair loss.
Thank you so much!

Feb 07, 2023

It is exactly 2 weeks after my first round and I experienced my first clump of hair to fall out. It really bugged me. I was wondering what would be the best way to cut it. This has helped me.
Thank You

Michelle Johnson
Feb 07, 2023

Thank you so much for this important information. I am a hairdresser and will have my first chemo patient next week. She has told me she wants her head shaved and I am so grateful to have run across your article beforehand so I know what to do and what to say to my client.

Feb 07, 2023

Thank you so much, such useful and kind advice!! I really wasn’t sure how this would go so I’m really glad I found your post


Abbi Nash
Feb 07, 2023

Thank you for this excellent article.
I’ve read it several times and find it very reassuring to have everything laid out so clearly.
Today is Day 14 after 1st chemo and my hair is just starting to come out. It is still long but I think today is the day for cutting it short.

Kirsten Maron

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