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Part 2: Hair, Hair Loss and Cancer as a Woman of Color

In this two part series, StyleEsteem Founder Sonya interviews Dr. Alexea, a cancer survivor and Infectious Disease and Internal Medicine Physician, on her hair insights as a woman of color who faced diagnosis and hair loss. 
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Sonya:  Let’s talk about regrowth. For many people, when their hair grows back after treatment, it can come back a different color or texture, and some people will see chemo curls. Did your hair maintain its previous curl pattern or did you see something different?

Dr. Alexea:  When my hair grew back, it grew back white and bone straight! And I remember like, wow, I'm about to be like a Marvel superhero! I'm going to have white hair. You gotta be kidding me.

Sonya:  Wow! How did you handle that?

Dr. Alexea:  Well, I didn’t know what to expect next. Would it change colors? Red, orange, black or something else?!  But my oncologist reassured me. She said because the pigment cells come back last, it wasn't unusual that my hair was coming in white. I think I was more upset that my hair was growing in bone straight than anything else. I thought, oh my gosh, chemo took my curls. I'm not going to be able to deal with this. Nobody told me my hair would come back different.

Sonya:  Since then, clearly things have changed. Your hair is now coming in dark and thick. Have you noticed a difference between your hair now and your hair pre-chemo?

Dr. Alexea:  Now my hair has one new curl pattern. Before I had four different curl patterns. So in some ways it's easier to take care of now. I used to have to braid or twist my hair for the curls to look uniform. Now I can just wake up, moisturize, finger comb it and go.

Sonya:  How long did that transition take? From bald, to bone straight, to curls?

Dr. Alexea:  My hair didn't start growing for two and a half months after chemo. I remember being bald all the way through radiation. When it started growing back, I didn't see even the semblance of a curl. Then came the waves at four or five months. I got my first haircut at nine months, and by then it was half curls and half coils. Though the ends were still bone straight.

Sonya:  How did that first post-chemo haircut go?

Dr. Alexea:  I remember getting that first haircut and my stylist having to blow out my hair and pick it out just to delineate where the curls stopped and where the bone straight hair started. And it was odd because as bothered as I was about that white and bone straight hair, I didn't want to let it go. She had to convince me to let it go! She was like, no, this hair does not serve you. You're not going to be able to style your hair the way you normally would unless let it go. And once she was done, my hair looked so good!

Sonya:  Emotionally and physically that first post-chemo haircut brings you back to the haircut at the start of chemo. It’s tough to relive that and to part with hair that you waited for so long. Any advice for making that first trip back to the salon easier? Especially with the salon’s significance in for black women?

Dr. Alexea:  I was so excited that when I had just enough unruly hair to be able to go see my stylist and say, could you trim this up? Can you shape up my edges? I went to the salon all by myself. I didn't come in on a Saturday morning when there were other clients there, because it just was a different time in my life. Sometimes it isn’t the time to be at the salon, gossiping and laughing, talking about music and reading magazines. Sometimes you need one on one time with your stylist, maybe before the salon opens, so they can kind of teach you what to do with your hair during regrowth.

Sonya:  Once you were able to achieve a consistent curl pattern after cutting the bone straight hairs, did you mourn your original curl pattern? Or did you take it in stride? How did you cope?

Dr. Alexea:  I just embraced it. I was just so happy to have a curl back. That's all that mattered to me. The hard part was those awkward phases of hair growth. But it taught me to finds ways to style my hair and shape it without having to cut it again. I remember returning to work and not having very much hair at all. And that was hard for me, because even though my returning patients knew I was sick, I wasn’t sure how new patients and other staff would view me. I was very concerned about people seeing me as a sick person and doubting my abilities because I was sick.

Sonya:  Was hair a big part of your image at work? How did your patients react to the hair changes?

Dr. Alexea:  The hardest part about having different hair is that people tend to invade your space, touch your hair and make comments. And I’m just like, can we just focus on why you're here? Like we're not here for my hair. We’re here because I am your doctor and you are my patient.

The worst scenario I had was a brand new patient who had researched me online, came in for his first visit and said “Wow you look a lot different than your pictures. I guess you took your weave out.” I'm just like, no, I had cancer. I lost my hair to chemotherapy and now my hair is growing back.

I would also get asked, “Why do you change your hair so much? You got a different hairstyle every week.” I’d feel uncomfortable back then and say “Oh, cause it's the only thing I have control over in my life is my hair.” But the truth is, hair is a form of self-expression and cultural expression. I want to be free to be me.

Society routinely calls into question the hair styling choices of black women. And I know this doesn’t happen to men the same way. Nobody comes to their male doctor and questions their hair choices, or for that matter, my white counter parts.

Sonya:  Why do you think this happens? Does this change how you express yourself through hair?

Dr. Alexea:  Well, I’m sure people ask questions because there’s a level of curiosity. But at the end of the day, I can’t let it change how I approach my hair. It is an expression of myself, of how I want to look. Sometimes I want to wear my hair naturally curly, and sometimes I want to blow it out and wear it straight. And sometimes I want braids down my back because it's fun. It's exciting. I want to add color and play with it. And post-cancer, especially, I want to be able to express that. I just wish I could do it without the pain, discomfort and awkwardness of other people questioning my cultural and self-expression.

Sonya: That’s understandable, especially as your hair is growing back, there is a natural excitement as you look forward to having fun with it and enjoying it again. What advice do you have about how long one should wait before having more elaborate hair styles done – like braids or a weave?

Dr. Alexea: It’s important to remember the hair that initially grows back is not always our permanent hair. Some women will have their hair shed or grow in phases.

So the longer you wait to do things that require braiding or extensions, the better, because the shorter the hair is, the tighter your new hair will need to be pulled. And that tension is not good for the hair or the scalp. It will break the hair from the scalp. It can damage the hair follicles. And it makes you more prone to something called traction alopecia, which is hair loss that happens due excessively tight hair styling.

So you should wait for adequate length before styling your hair, because the tension can be very damaging and can cause permanent scarring that can inhibit your hair growth and the ultimate thickness and fullness of your hair. I didn't get braids until my hair was about two or three inches long. And I probably could have waited even a little longer.

Sonya: How can you make sure your hairstyle isn’t damaging your new hair?

Dr. Alexea:  It is important to monitor our hair and scalp. When our hair is pulled too tight, we tend to get these little red or white bumps around where the follicles are being pulled. If you're seeing that, or if the scalp is wrinkling or rippling, it's probably best to remove or loosen your hairstyle so you don't suffer permanent damage or setback your hair regrowth. Definitely let your stylist know that you are a recovering chemo patient so they are extra gentle with your hair and scalp.

Sonya:  Coloring and relaxing hair is also a big part of self-expression in the black community. How would you advise someone newly out of treatment to incorporate this back into their hair styling?

Dr. Alexea:  It is really important to stay away from heat. The only time I ever put heat to my hair is actually when I'm all done styling it. If I have some buildup of product, I'll blow dry it on warm air just to get the product to absorb into my hair.

But I know, we are all desperately trying to grow our hair out, to get it back to a length where we can style it like before. We want to minimize doing things that damage the hair. So if you are going to apply heat to your hair, whether you're blow drying, flat ironing or curling it, you definitely want to use a product that protects the hair from heat. Heat damage can permanently change the texture of your hair and cause you to lose your curls.

When it comes to coloring, our hair is coarser and finer and tends to take up less color. If you are trying to achieve a particular color that requires more than one treatment or a longer application of hair dye or bleach, your scalp may be too sensitive for this post-treatment. So just keep that in mind.

Sonya: It’s also super important to see yourself at every stage of hair growth, and to celebrate your hair at every length. Do you have any suggestions for less permanent alternatives to relaxing your hair?

Dr. Alexea:  I’d suggest any kind of temporary straightening, with a flat iron or blow dryer. That way you can experiment with your look and still be gentle on your new hair.

Sonya:  When it comes to self-styling, how did cancer change the hair products in your beauty cabinet?

Dr. Alexea:  Prior to my cancer diagnosis, I didn't even consider that some of the things I put on my scalp might be toxic. I began to cut out or use less frequently any products that have sodium lauryl sulfate or EDTA. I try to use more natural products – like coconut shampoo that is moisturizing. Or straight food grade coconut oil to condition my hair.

One of my favorite companies that I recently discovered is TGIN - Thank Goodness It’s Natural, which was created by a black woman who’s a breast cancer survivor. During her own treatment she decided to stay away from things that were potentially carcinogenic and toxic. And she wanted to moisturize and help her curls pop, while avoiding frizz. Their shea products work well with my hair.

Sonya: Our community loves natural hair care tips. In the past we’ve talked about how beneficial oils can be to strong hair regrowth. Do you use anything in addition to the coconut oil?

Dr. Alexea: I love oils too. I put coconut oil on my actual hair after I put in either a leave in conditioner or a water-based curl cream. This also makes it easier to detangle my hair with my fingers so I can avoid breakage and unnecessary hair loss. I then make sure to cover my hair at night before bed with a satin head wrap to lock in the moisture.

Sonya: Putting a plastic covering on your head and doing a heat application with a hair mask or hair oil is also amazing for hydration. Maybe we should create a stylish plastic turban!

Dr. Alexea:  That would be amazing!

Sonya:  What are your thoughts on hair masks, especially for women with very curly or kinky hair?

Dr. Alexea:  When you say “mask” I think of something that’s putting protein in your hair. But not all hair needs more protein. If your hair is hard on the tips, you’ll need to lean on conditioning. If your hair is kind of limp and not doing much of anything, you may need to add protein to it. You’ll want to keep the protein issue in mind as you select your styling products as well.

Sonya:  How much time do you spend on your hair these days?

Dr. Alexea:  One thing I’ve realized is, you don't have to spend all day doing your hair. A lot of times women, especially black women who have natural hair, say “Oh, it's hair day” and have this day long process of deep conditioning, styling, braiding, twisting, etc.

Nowadays, I spend maybe 30 to 40 minutes washing, shampooing, conditioning and detangling my hair on a Sunday or Monday. I figure out what’s going to be my style and then I'm pretty much good for the week. Like I just need to dampen my hair with water, or, smooth my edges with a little gel and pull out my curls in the morning. Just because your hair is growing back, don’t feel like you have to commit hours or an entire day to taking care of it.

Sonya:  I love that advice. Hair regrowth shouldn’t be something that causes us more stress and effort. Of course it’s a process getting to know your new hair, texture and styling preferences, but it’s also great to break the mold from your past hair routines. So I’m curious, how often do you wash your hair?

Dr. Alexea:  I can go seven days, or up to ten days if I don’t have a whole lot of product in it. Sometimes I might rinse a little product off if there is a lot of buildup or flakiness.  And otherwise, I only shampoo once a week because I don't want to strip it of its natural moisture.

Sonya:  Those natural oils are definitely the foundation for healthy and shiny looking hair! What did you wish you knew before you experienced hair loss during chemo? What advice would you give to someone who is starting chemo?

Dr. Alexea:  Have your game plan before your hair starts to fall out. Although I personally couldn't bring myself to shave head, I came to believe that it’s empowering for women to choose to cut their hair rather than to let chemo and cancer take it from them. Think about when and how you’ll shave your head. Maybe try out a funky color or cut to have fun and ease yourself into hair loss. Pick out a variety of head wraps that will help you feel comfortable and confident before you shave your head. I leaned on lightweight turbans as well as African print styles. You could also do a pineapple – by which we mean when you put your hair up and have it spilling out of a head wrap. I wanted to continue to be fashionable and to express myself.

Try to embrace yourself and have fun whenever possible. I believe we can definitely find the silver lining in these dark clouds. We can definitely share some smiles and some laughter and have fun in what's a very hard, traumatic and dark time in our lives. And just remember it's just part of the process for the goal of getting your health back.

Sonya:  It’s all about seeing hair loss as a moment to take back your story and choose your path forward in this journey. What does your hair represent to you now, versus before diagnosis?

Dr. Alexea:  For so long, as a black woman, I conformed to societal standards. I’d straighten my hair just to make it perfectly uniform. I’d put great effort to make every curl look the same. All this because I was trying to make my hair acceptable to everybody else. Now I'm like, this is my hair. This is my beautiful crown. Whether I put on a headband to wear it as is, or get an intricately braided hairstyle done, I just stand in the boldness of who I am and refuse to conform to what society says is a standard of beauty. I embrace myself as a black woman and all my black features, including, and especially, my hair. I just want to encourage my daughter and my niece, and all the little black girls out there, to embrace and love their hair. And know that God made us and we were born this way – perfect and beautiful just like everybody else.

Sonya:  Hair loss is truly a time when we are planted like a seed. We can all learn to embrace our natural selves and to see ourselves as whole post-cancer, hair and all.

Read the full interview series here.

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