Location: the United States of America

Hair regrowth with scalp cooling

Most people choose scalp cooling to try and retain their hair through chemotherapy, but increasingly we are seeing faster and healthier hair regrowth with scalp cooling become a key decision making factor.

For some people facing challenging regimens now consider fast regrowth to be the most important part of scalp cooling, with any hair retention being a bonus.

As we know, retention rates with cold capping can vary a lot from drug to drug as well as from person to person – even those with the highest rates of hair retention see shedding, so faster regrowth is a true benefit to anyone who chooses to scalp cool.

For a long time, it was believed that scalp cooling resulted in faster regrowth, and now there are several clinical studies to confirm this.

A study conducted in Japan in 2019 called ‘Efficacy of Scalp Cooling in Preventing and Recovering from Chemotherapy-Induced Alopecia in Breast Cancer Patients: The HOPE Study’, concluded that scalp cooling resulted in faster recovery of hair volume within 12 weeks of chemotherapy, even in patients where scalp cooling failed to prevent chemotherapy-induced alopecia.

This was particularly important for the patients in the trial who received TC (docetaxel and cyclophosphamide), or AC (doxorubicin and cyclophosphamide), both of which are particularly challenging regimens for hair retention.

As you can see from the photos, not only are the hair retention rates higher for patients who scalp cooled, but the rate of hair regrowth is notably faster than the patients in the control group who did not scalp cool.

Hair recovery over 12 weeks after final chemotherapy in patients receiving AC (doxorubicin + cyclophosphamide)

End of chemotherapy
4 weeks after
end of chemotherapy
8 weeks after
end of chemotherapy
12 weeks after
end of chemotherapy

Hair recovery over 12 weeks after final chemotherapy in patients receiving AC (doxorubicin + cyclophosphamide)

End of chemotherapy
4 weeks after end of chemotherapy
8 weeks after end of chemotherapy
12 weeks after end of chemotherapy
A study conducted in 2020 in India – ‘Randomized Control Trial of Scalp Cooling for the Prevention of Chemotherapy Induced Alopecia’ - concluded that scalp cooling patients saw significant hair regrowth at both 6 and 12 weeks post their final chemotherapy treatment.

At 6 weeks, 89% of the patients who had scalp cooled saw grade 0/1 alopecia (less than 50% or no noticeable hair loss), whereas the control group who didn’t scalp cool saw 12% of patients with grade 0/1 alopecia. By week 12 this had increased to 100% of the scalp cooling group, and 60% of the control group.
As you can see from these study images, faster regrowth is important for those with good levels of hair retention, but even more important for those that see significant hair loss. Hair regrowth will happen naturally, but scalp cooling can help speed that process up, from a timescale of months to weeks.

It is also worth noting, that it is not uncommon for patients to see regrowth occurring before the end of their chemotherapy treatment with some drug regimens.

Examples of regrowth from patients who have scalp cooled

Helen Doxorubicin, Cyclophosphamide
Helen 2 months post final chemo
Tessa – 4 rounds of Docetaxel, Cyclophosphamide
Tessa – 1 year post final chemo
Louise – 3 rounds of Epirubicin, Cyclophosphamide and 8 rounds of Taxol
Louise – Regrowth 8 weeks post final chemo
Teresa – 6 rounds of Docetaxel, Cyclophosphamide, Herceptin, Perjeta

Teresa – 9 weeks post final chemo

Minall – 4 rounds of Epirubicin, Cyclophosphamide
Minall – Regrowth 1 month post final chemo
Jessica – 12 rounds Paclitaxel and Carboplatin
Jessica – 2 Months Post final Chemo
Sarah – 6 rounds of THP
Sarah – Regrowth 2 months post final chemo
Zara – Epirubicin, Cyclophosphamide
Zara – 2 months post final chemo

Commonly asked questions on regrowth

When will I start to see regrowth?

There is no fixed answer for this. Some people may see regrowth before the end of their chemotherapy treatment, but this is usually only with taxane drugs. For others it can take many weeks. As seen in the studies listed above, most patients will see regrowth by 12 weeks after their chemotherapy treatment is completed.

Will regrowth start before I finish chemotherapy?

It is possible, particularly if you are receiving a taxane drug (such as docetaxel or paclitaxel) and you are having more than 4 rounds. However, don’t feel if you don’t see regrowth before the end of treatment that scalp cooling has been a failure. It may take a little time, but the regrowth will happen.

It’s been weeks since I finished chemotherapy, why haven’t I seen regrowth yet?

This can be disappointing but try not to be disheartened. Seeing regrowth at 12 weeks is common - this can feel like forever but know that it will happen and try to be patient. Many people will search and search for regrowth and all of a sudden, it’s there.

New hair is growing in but I’m still shedding, why is this?

It’s completely normal for hair shedding and regrowth to happen at the same time. It is just the normal hair growth cycle happening. Some hair follicles have reached the end of their growth period while others are just starting.

Why is my new hair growing in a different color and texture?

The texture of your hair is dictated by the shape of your hair follicle – which can be altered by chemotherapy. Straight hairs grow from round follicles, while wavy and curly hairs come from follicles with an elliptical or a flattened shape. Chemotherapy can change the shape of your follicles and many people see what are commonly called ‘chemo curls’. Those with shorter hair often have a more pronounced texture, which can then become less obvious as the hair gets longer and heavier – you may start with ringlets and then end up with waves.

The same can also happen with the part of your follicle that provides pigment to the hair. Most often people will see grey regrowth, but it can change to a different color too. This may not be permanent, and after a while the color may return to what you had pre-chemotherapy.

I am so glad to see regrowth, but my hair is lots of different lengths and looks dreadful, what should I do?

This can be a tricky one. While it is tempting to act as soon as your chemo is finished it can be worth waiting a while until you know what your regrowth will look like. Have a conversation with your hairdresser – they may have advice on how to manage the awkward stage without having to cut all your hair off. You may not end up with your haircut of dreams for a little while, but there is a lot that can be done if you can be patient. For example, it may be possible to create a transition short bob that will grow out smoothly rather than having to go for a full pixie cut.
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Of course, it would have been ideal to retain 100% of my hair. But, being prescribed Taxotere that can cause permanent hair loss, I am happy to retain roughly 40% of my hair and now 9 months later, I have extremely fast hair regrowth.

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