For model Kimberley Wallis, regularly wearing her glossy hair in a tight, sleek ponytail wasn’t just practical – it was also her ‘trademark’ look.
“I was really proud of it,” says Kimberley, 26, from Manchester.
She could never have imagined that this – and the other hair styling techniques she pays such close attention to – would contribute to a receding hairline of three inches and bald spots that would require not one but two hair transplants.
Kimberley’s hair loss was due to a condition known as traction alopecia, which occurs when hair is repeatedly pulled into tight ponytails or braids and extensions that pull hard and repeatedly on the hair.
When treated in the early stages, hair loss is usually reversible – but experts warn that if it continues for months or years, damage to hair follicles will diminish. [the tiny skin pocket the hair grows from] can become permanent.
As Dr Sharon Wong, dermatologist and spokesperson for the charity British Skin Foundation, explains: ‘Prolonged or repeated stress on the hair follicles, such as from tight ponytails, braids or other high-tension hairstyles, causes inflammation around the hair follicles, known as folliculitis.’
Model Kimberley Wallis, 26, needed two transplants to repair her receding 3-inch hairline and bald spots
Kimberley’s sleek, sleek ponytail wasn’t just practical, it was her signature look
If this continues over time, the inflammation can lead to irreversible scarring of the follicles, resulting in permanent hair loss.
‘Red bumps or tenderness on the scalp are early warning signs that the hair follicles are under excessive strain,’ warns Dr Wong.
If a woman immediately changes her hair styling habits at this point, the follicles can recover and healthy hair growth resumes.
Topical or oral antibiotics can also help reduce more pronounced inflammation, as can maintaining a healthy scalp by washing it regularly with mild (rather than medicated) shampoos.
(There is increasing recognition of the important role that scalp health plays in maintaining healthy hair, because the follicles are tightly integrated with the surrounding skin – not only structurally, but also through complex signals between the cells.)
Traction alopecia is a lesser known cause of hair loss in women, a condition estimated to affect around one in three women in the UK – equivalent to around eight million women.
The only approved topical treatment for hair loss in women is minoxidil, which can be helpful in the early stages of traction alopecia, says Dr. Wong.
It works by increasing blood flow to the scalp and enlarging hair follicles to stimulate hair growth.
This is available over-the-counter in 2 percent and 5 percent formulations and can also be effective for female hair loss, including a widening parting, a ponytail that is thinning, or individual hairs that are becoming finer.
For traction alopecia, it will help as long as the styling habits that caused the original problem are also stopped — but it won’t help once scarring has developed, Dr. Wong adds.
Then “hair loss becomes permanent and recovery is only possible through hair transplantation,” she says.
When Kimberley first noticed her hair was ‘thinning’ four years ago, she initially tried microneedling – which uses fine needles to create ‘micro’ wounds in the scalp, which would stimulate the hair follicles to trigger hair growth.
But this procedure – which Kimberley had carried out by a beautician – didn’t work: “If anything, I lost hair,” she says.
So she tried minoxidil, which she bought online. Even though I used it for a year and a half, again there was no improvement.
A variety of vitamins and nutritional supplements commonly recommended for hair health did not help either.
Kimberley still had her hair pulled back or heavily styled for shoots, and extensions were added. “I was still modeling, so it was hard to stop,” she says.
But two years ago, with her hairline visibly receding, Kimberley went to a clinic in Turkey for a hair transplant that cost £4,000 – still cheaper than in Britain.
But the procedure was “a failure,” she says, and she had less hair than before.
She had not met the surgeon beforehand; No blood tests were done, and after she got home, her hair “looked worse: sparse and uneven,” she says.
Demoralized and with her self-confidence in tatters, she turned down modeling shoots and stopped seeing her friends.
The model’s hair loss was due to a condition known as traction alopecia, which occurs when hair is repeatedly pulled into tight ponytails
Kimberley’s hair before, immediately after and a month after her hair transplant at The Treatment Rooms in London
Kimberley adds: ‘I couldn’t put my hair up anymore because I looked bald at the front.
‘My forehead looked huge. It didn’t hurt, but it looked bad.’
Early this year, Kimberley’s hair had receded by about 8cm in some places and bald spots had developed – so she decided to have a second transplant, this time in Britain.
Here, she underwent blood tests to rule out other underlying medical problems and it was confirmed that her hair loss was indeed caused by repeated blow-drying and pulling her hair into ponytails – along with genetics (which can play a role in hair density and follicle strength. Some people are simply predisposed to finer hair or a more delicate hairline that is less resistant to physical stress, such as tight styling).
In March this year, Kimberley underwent a ten-hour FUE (follicular unit extraction) transplant, in which groups of hair are taken from a donor site (usually at the back of the head) and implanted at the front of her hairline.
(Another option for this type of hair loss is to remove a strip of skin from the forehead and pull the scalp forward, to create a lower hairline – this is more invasive and leaves a scar right at the front of the hairline, which may require a hair transplant a year later to fill in gaps and hide the scar.)
“Hair transplant surgery involves moving hair that is resistant to thinning, usually from the back and sides of the scalp, to a new area such as the hairline,” explains Roshan Vara, a hair transplant surgeon at The Treatment Rooms in London, who performed Kimberley’s procedure.
It typically takes seven to 14 days to recover from the procedure.
According to Steve O’Brien, a trichologist at the private London Center of Trichology, the number of women requesting a hair transplant has increased by about 20 percent in recent years.
There are many factors that can contribute to receding hair in women and in fact, traction alopecia only accounts for “a small minority of female hair loss patients,” says Greg Williams, plastic surgeon and vice-president of the British Association of Hair Restoration Surgery.
But while the causes of hair loss in men are quite well understood, he adds that “hair loss in women is a completely different phenomenon.”
Male pattern hair loss – androgenetic alopecia – occurs because men can be born with hair on the forehead scalp or crown that has receptors for the hormone dihydrotestosterone (DHT).
Over time, this hormone will destroy those hairs, because hairs on the sides and back of the head that don’t have DHT receptors won’t deteriorate, says Mr. Williams.
“However, we doctors don’t really understand what causes hair loss in women,” he says.
‘Hair loss in women can be influenced by stress, illness, diet and hormones. Moreover, it can fluctuate, while hair loss in men usually does not.’
Hormones may play an important role in many cases of hair loss in women – including menopause – because estrogen helps hair stay in the growth phase longer.
Menopause can also cause hair follicles to shrink slightly, causing each strand to appear thinner.
Polycystic ovarian syndrome, which affects about 10 percent of women of childbearing age, can also lead to hair loss because there are often relatively elevated levels of male hormones; These can also cause the hair follicles to shrink and spend less time in the growth phase.
Excessive hair loss, medically known as telogen effluvium, can also be caused after childbirth, as can emotional stress, nutritional deficiencies and weight loss.
Experts emphasize that not everyone with thinning or receding hair is suitable for a hair transplant.
This group includes people with a receding hairline caused by an autoimmune disease, such as frontal fibrosing alopecia, and may also involve the loss of eyebrow hair.
The model before her ten-hour follicular extraction transplant, top and after. Groups of hair were taken from a donor site and implanted at the front of her hairline
‘Autoimmune diseases that destroy the hair’s own follicle would likely also destroy a hair transplanted into the same area if the immune process is still active,’ says Mr Williams.
Other dermatological conditions may also mean that a hair transplant is not recommended.
After her second hair transplant – which would cost around £6,500 to £7,500, but she was one of four patients a year the clinic treats for free – Kimberley was told not to touch her hair for the first week and to regularly spray it with saline to keep it moist and promote growth.
She also had to wear a special cap to block out the sun, because new hair follicles after a hair transplant are very sensitive to UV damage.
It will be another 18 months before she sees the full results, but Kimberley says she can see baby hairs growing.
She is also seeing her friends again and has booked new modeling shoots for later this year.
“I can style the front of my hair to cover the new hair growth – and I will never pull, pull or use hair extensions again,” she says.
