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My sister is undergoing chemotherapy for breast cancer. In the past three months, she has become infertile, gone through menopause, is losing pounds per day, shed all her hair and will soon surgically remove her breasts. Cancer and its treatments, she says, stripped her of her femininity. And while going soon is the least of her worries, it’s the only side effect she cannot hide, even while wearing her favorite gray beanie.

Wigs can help give chemo patients some semblance of normalcy and make them feel and look like themselves, even for a few hours a day. “The majority just want to look normal,” says Hana, owner of Hana Designs in Littleton, Colo., who went through chemo for breast cancer 30 years ago. “It’s bad enough going through the doctor’s appointments and then the procedures and always getting poked. We just need a little calm so that when we step out into the real world, the real world talks back to us like normal.”

But cheap wigs found online for $22 will do quite the opposite, as my sister realized after an impulse Amazon buy left her itchy and looking uncannily like an American Girl doll.

Luckily, there were comfortable and natural-looking wigs available at shops in town. They also came with expert advice from professional stylists and shop owners who have been helping chemo patients for decades.

My sister got a wig that brought her megawatt smile back to her face, and we also came away with tips for anyone who is about to go down the same road, including how to prepare for hair loss, the differences between various types of wigs, what to do if you cannot afford one and how to file a claim with your insurance to have one covered.

According to the American Cancer Society, hair starts to fall out within one to three weeks after starting chemotherapy and may become noticeable one to two months later. Some scalps become tender and extremely sensitive to the touch.

Some people cut their hair shorter before chemo to make the transition less stressful. But if you’ve already begun chemo, it might not be worthwhile. My sister paid for an Anne Hathaway pixie cut to attempt a transition. But within a half-day, it already looked less red-carpet Hathaway and more “Les Miserables” Hathaway, and we had to shave it off.

When you’re ready to shave, use electric clippers, not razors, and never clip down to the scalp, Hana says. Leave an inch in length, especially if you have stiff or coarse hair like Asians do. “If you clip it to the scalp, the rigid hair will push back inside and make your sensitive scalp even more tender when you sleep on it or touch it,” Hana says. “Leaving a little bit of length will let it fall flat into a forgiving cap.” You might find itchy hairs all over your pillow and clothes during hair loss. Wearing a mesh cap can help catch the strands.

If your goal is to match your wig to your real hair color, keep a lock of it to show your wig stylist. Visit a stylist before you lose all of your hair, if you can. Or at least take photos of your hairstyle as a reference. For the most seamless transition, select your wig before starting chemo and then wait until your hair is just starting to thin to begin wearing it.

A confidence boost for women who lose their hair to cancer: A free wig and stylist

You might want to wear it even as your hair begins to grow back. According to this 2019 study, most people experience hair regrowth around three months after completing their cancer treatment and stop wearing wigs one year after chemotherapy. But some people continue to wear wigs until their hair grows out longer or because their hair regrowth is initially different from their pre-chemo hair.

During chemotherapy, it’s important to take care of your scalp, which will dry out because your skin stops producing body oils. “Support the health of your hair follicles so that the day that you stop all your treatment, your hair can start to grow back prolifically without any deterrence,” Hana says. Dry skin, she explains, is a deterrent because those layers of dead skin cells block the openings and make it hard for new hair to break through the surface. Exfoliate your scalp often using a soft brush or exfoliating gloves in the shower. A cleanser with salicylic acid or leave-in treatment, such as Aveda’s Scalp Remedy, also helps slough off dry skin, Hana says. And finally, keep it moisturized with a gentle conditioner. Some people use castor oil to promote healthy hair regrowth, too.

Cleopatra used it as a beauty aid. Now castor oil is staging a cosmetics comeback.

Shop locally if you can. Ask your oncology team or cancer support group for recommendations. Trying on wigs in person with a professional stylist at the helm will offer the best experience. You’ll leave with a wig that suits your style, color tone and budget. The stylist might even be able to customize the wig by trimming bulky areas and adding a more natural hairline, such as baby hairs and sideburns.

If you must shop online, make sure the store has a good return policy and instructions for measuring your own head using a sewing measuring tape.

The in-person salon consultation, which should be free, should be a conversation about your style, your activities, and how you’re dealing with chemotherapy treatment and cancer. The shop should also be able to help you file a claim if your health insurance company covers or subsidizes wigs.

If your insurance doesn’t cover wigs, there might be a wig bank in your area or nonprofit organizations that offer donated wigs or financial assistance. Hana started a nonprofit group called Hana’s Hope to help people who can’t afford a wig. You can also call the ACS’s cancer helpline (800-227-2345); you’ll either be directed to a wig bank in your area or given a gift certificate so that you can order a wig through TLC (Tender Loving Care).

How to file insurance claims

Before buying a wig, make sure you understand the procedures and policies outlined by your private insurance plan. If need be, call your insurance company to check for coverage. Medicare parts A and B do not cover wigs for people undergoing chemotherapy, but some Medicare Advantage (part C) plans offer limited coverage.

If you plan to file an insurance claim, ask your doctor for a “cranial hair prosthesis” prescription that includes a diagnosis code and a National Provider Identifier (NPI) code. The wig shop will need these codes to generate an invoice to submit to your insurance company. Also, have your doctor sign off on your insurance claim form.

Make sure the invoice says “cranial hair prosthesis” and not “wig,” says Sunee Kim Watts, owner of Kim’s Wig Botik in Denver. The invoice should also include the shop’s tax ID number and the appropriate health-care common procedure coding system (HCPCS) codes, which are standardized insurance codes for medical procedures, supplies, products and services.

If your claim is denied, you can appeal by writing to the medical review board, emphasizing that a prosthesis is necessary and not a cosmetic item. Include pictures of yourself without hair and detail the emotional effects your hair loss has had on your life. Your employer can also help by writing a letter.

If your insurance will not pay for the wig, save your receipt for a potential medical tax deduction. A flexible spending account (FSA) or health savings account (HSA) also can be used for a wig purchase.

Synthetic vs human hair wigs

Wigs are made from either synthetic fiber, human hair, or a combination of both.

Non-costume wigs can cost anywhere from $200 to several thousand dollars. And while a higher price often does mean better quality, a good synthetic wig can cost about $300. Wigs made of human hair are more expensive, costing between $800 and $6,000.

Synthetic wigs are often made of modacrylic fibers produced in Japan. They hold their style even on humid days and don’t need to be washed as often as human-hair wigs — something to consider because going through chemo doesn’t afford you much energy to do things such as regularly washing and styling a wig. You just need to keep these wigs away from heat — dryers, hot tools and even the stove. Generally, synthetic wigs last for up to five months with daily use.

If you opt for human hair, you can choose the ethnicity, style and texture for a more natural look. Wigs made of human hair are primarily cut in Asia. Wigs made with finer European hair are less common and as much as 20 times more expensive. Human hair can withstand the same treatments your natural hair could, including rolling, cutting, hot tools and dyeing. But these wigs are heavier than synthetics and require more maintenance. Human hair wigs last for up to one year with daily use.

Wigs are constructed in two ways: machine-made and hand-tied.

Machine-made wigs are the most affordable, featuring open wefts — strands of hair fibers that are sewn or glued to tracks of stretchy material to make layered curtains of hair. The back and sides are open for ventilation while the hair on top is often lightly teased or crimped to hide the cap. “They’re less expensive [$200 to $400] but can be itchy and uncomfortable on a cancer patient’s sensitive scalp,” Watts says. “They would need to wear a cap underneath to make it more comfortable.”

Hand-tied wigs feature soft, flexible mesh caps to which individual hair strands are tied. The cap molds to the shape of your head, and you can part a hand-tied wig in any direction and have more freedom to style it however you’d like. The hair looks like it’s growing right out of your scalp because you can actually see through to your scalp without bulky fabric in the way. Hand tied wigs generally start at $400.

Monofilament wigs can feature both types of construction — the back and sides are machine-made while the front and top are hand-tied for a more natural look.

Another characteristic you might want in your wig is a lace front, which is a fine mesh along the front that companies sew hair into to mimic a natural-looking hairline.

When hair falls out, the scalp may feel tender or sensitive. Some wigs can irritate the scalp, so wearing a bamboo or cotton skullcap between the scalp and the wig can provide a protective barrier — and help secure the wig and absorb sweat. Hana says to avoid nylon or fishnet caps that can pinch and bind and aren’t breathable.

A velvety wig band can be worn instead of or in addition to a wig cap. The fabric’s nap acts like a grippy headband that helps keep the wig in place. Most of them also feature a sheer mesh patch that sits underneath the wig’s part in case you have a monofilament wig.

When you’re not wearing your wig, you’ll want to store it on a wig stand away from sunlight, heat, moisture and dust.

Wearing a wig isn’t complicated, but proper alignment is key. If you’re buying your wig in a walk-in store, the stylist should show you how to put it on and adjust it.

Look Good Feel Better, the charitable arm of the Personal Care Products Council, which represents the personal care products industry, offers free wig workshops that go over these details. You can search for one in your area or sign up for a virtual workshop.

Generally, a wig should be washed after 14 to 18 wearings, but because chemo patients have such dry scalps, they could go up to a month before washing. You should wash your wig more often to remove sweat and dirt if you’re especially active outdoors. Gently swirl your wig in a mixture of cold water and gentle shampoo. Let it soak for a few minutes, then rinse with cold water. Lightly wrap the wig in a towel to remove excess water and drape it on a wig stand to dry. Once completely dry, brush it with a plastic or wire brush using light, short strokes. A wire wig brush is best, as a standard hairbrush with nylon bristles can overstretch and damage wig hair.

You shouldn’t use heated styling tools or a hair dryer on a synthetic wig unless it is labeled “heat friendly” or “heat defiant,” a feature that can double the price of the wig.

A good wig stylist can also help maintain, trim and repair your wig to make it last longer. Synthetic wigs can get a little crunchy over time.

Copyright 2022, Consumer Reports Inc.

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