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What to Expect

It’s 50:50, but we’re working on it


The first question that people generally ask when they initially discover they need chemotherapy is whether or not they will lose their hair. As a family business borne out of our chairman’s wife losing her hair whilst receiving chemotherapy for breast cancer, Paxman know first-hand the thoughts and feelings that will naturally arise at the prospect of losing one’s hair.

We also know that many patients rank hair loss as their most feared and experienced side effect of chemotherapy treatment. The psychological effect is high and can have a dramatic impact on self-esteem – but there is an alternative. Scalp cooling, also known as the 'cold cap', can be used to combat chemotherapy-induced alopecia and has a hugely positive impact on the confidence, strength and hope of the people that choose to use it.

It’s time for you to take back some control.

two patients during scalp cooling procedure

Will Scalp Cooling Work for Me?

Many thousands of patients throughout the world have retained their hair using the Paxman Scalp Cooling System when receiving their chemotherapy treatment. Successful scalp cooling depends on many factors such as type and stage of cancer, age, hair type, hair condition and general health. It is important to understand that hair loss does vary from one person to the next and retention of all hair cannot be guaranteed.

Research has shown that scalp cooling (the cold cap) is very effective across a wide range of chemotherapy regimens. Please consult your medical team to ascertain whether scalp cooling is applicable.

You may experience a little hair loss and overall thinning whilst using the cold cap, and the normal shedding cycle of the hair will continue. If some hair loss is experienced we would encourage you to persevere with the process – many patients report hair growth during their chemotherapy treatment whilst using scalp cooling, as new hair growth is also protected from the chemotherapy.

Why Does Chemotherapy Make Hair Fall Out?

Chemotherapy works by targeting all rapidly dividing cells in the body. Hair is the second fastest dividing cell and this is the reason why many chemotherapy drugs cause hair loss. The hair follicles in the growth phase are attacked, resulting in hair loss approximately 2 weeks after the commencement of the chemotherapy treatment.

Does the Hair Always Fall Out?

Many chemotherapy drugs including taxanes and anthracyclines used to treat cancer will cause hair loss. The best people to advise on this are your medical support team of doctors, nurses and specialists who deal with the medication every day.

How Does Scalp Cooling Work?

The damage that chemotherapy causes to the hair follicle can be alleviated by scalp cooling and the cold cap. It works by reducing the temperature of the scalp by a few degrees immediately before, during and after the administration of chemotherapy. This in turn reduces the blood flow to the hair follicles, which may prevent or minimise the hair loss. The Paxman Scalp Cooling System offers a comfortable and tolerable option over other scalp cooling methods due to its excellent heat extraction technology.

Lady having cold cap fitted

Your Checklist

Following your initial scalp cooling consultation and first treatment you may find it useful to make a note of the size of cap that has been selected for you. A different sized inner silicone or outer neoprene cap cover may be used in conjunction with each other to provide the best fit. If you are unsure your nurse will be able to advise you.

Inner silicone cap sizes are available in extra small, small, medium, large and extra large.

Outer cap cover sizes are available in extra small, small, medium, large and extra large.

Things to take with you to hospital:

  • Warm clothing
  • Hat or head covering
  • Conditioner*
  • Wide tooth comb*
  • Fabric elasticated hairband
  • Pain relief

*Your hospital may provide these.

Important points to remember

  1. The first 10-15 minutes of your cold cap treatment may feel very uncomfortable but the feedback we receive from people who have experienced the Paxman Scalp Cooling System tells us that they are delighted they persevered!
  2. Pain relief is available to help you bear the initial feeling of cold – please consult your medical team.

The Treatment

How Do I Prepare My Hair?

We recommend that the hair underneath the scalp cooling cap is lightly dampened prior to the fitting of the cap using lukewarm water – a water spray bottle is ideal for this. This ensures the best overall cooling conductivity between the cold cap and the scalp, as the hair has insulating properties. The hair does not need to be very wet and any lengths of hair below the cap line do not need to be dampened.

A small amount of mild, perfume-free conditioner (an amount no larger than a coin) should then be applied to the dampened hair. This helps with the removal of the cold cap on completion of treatment. The hair should then be gently combed back using a wide toothcomb or fingers so that the front hairline is visible. This is especially important if you have a fringe.

As the hair will still be damp on completion of cold cap treatment, you may find it more comfortable to take a hat or head covering with you to wear on the way home.

Do I Need to Cut My Hair?

There is no real need to cut your hair shorter prior to starting your chemotherapy treatment, however if your hair is very long or thick it may be helpful to cut it shorter to reduce some weight and make it more manageable.

How Does the Paxman System Work?

A soft, lightweight silicone cap is placed on your head and is connected to a small compact refrigeration system. The scalp temperature is lowered by circulating a special coolant through the cold cap and is maintained at a constant temperature throughout the treatment period.

cold cap fitting

Helpful Cap Fitting Tips

  • The front of the cap should be positioned approximately 2mm below the hairline on your forehead.
  • The cold cap needs to fit around the entire hairline at the back and needs to be tight; otherwise hair loss is possible at the back and/or sides. If the cap is too large you will be able to put your hand up the back of the cap.
  • It is important that the top of the cap is touching the crown of the head.
  • If the cold cap moves when you press on your head it is a sign of poor cap fitting.
  • If you feel you are in between cap sizes, for example a ‘small’ cap is too small and a ‘medium’ cap is too big, then we recommend that the ‘medium’ cap is used with a ‘small’ cap cover to achieve a tighter fit. This method can be used with all cap sizes.
  • Likewise, if a cap does not reach the whole hairline, use the larger cap with a smaller cap cover to again ensure full coverage.
  • A fabric, elasticated headband should be used to cover the forehead and ears before the cold cap is fitted, to create a barrier between the cap and skin to reduce the discomfort. Alternatively, gauze should be used over each ear and on the forehead.

How Cold is it?

Tolerance of the cold feeling experienced whilst having scalp cooling treatment varies widely from one patient to the next. It is very important to remember that the often intense feeling of discomfort or even aching that is felt in the first 10-15 minutes of the treatment is transient and will go away as you acclimatise to the cold.

Deep breathing can really help at the initial stages of scalp cooling. The benefits can include immediate relaxation as well as an improved ability to handle stress and to regulate emotions. Please persevere with this and ensure that you dress warmly in layers – even in warm weather. Hot drinks and blankets are another good way to alleviate the coldness you may experience.

If, after the first 20 minutes of scalp cooling you are still finding the cold hard to bear, consult your medical team about pain relief that may assist with your tolerance levels.

How Long Does it Take?

This depends on the type of chemotherapy you are to receive, however the average time the cold cap is worn is 2½ hours. The cold cap is worn for approximately 30 minutes pre-infusion cooling, during infusion and for up to 90 minutes after drug infusion.

Looking After Your Hair

We work in collaboration with leading consultant Trichologist Iain Sallis, who has assisted in giving his expert advice on how you can best care for your hair when using scalp cooling whilst undergoing chemotherapy treatment.

How Can I Protect My Hair?

It is advisable not to do too much to your hair whilst having chemotherapy treatment, including avoiding colours and other chemical procedures. This is simply because even if the hair has been retained or is not affected by the chemotherapy, it may still be a little more fragile than usual, and your skin may be extra sensitive to chemicals that you or your hairdresser would usually use.

Helpful Tips for Hair Care During Chemotherapy

  • Be gentle at all times with your hair.
  • Don’t be afraid of brushing your hair. It is sensible to use a good quality brush - poor quality ones will snag and tear your hair.
  • Do not perm or colour your hair whilst receiving chemotherapy treatment.
  • Avoid using excessive heat on the hair; dry gently and do not use hair straighteners!
  • To deal with tangles in the hair it helps to brush out with a wide tooth comb whilst in the shower, with a lot of conditioner in your hair. It also helps to hold the hair above the tangles so that it does not stress the hair roots.
  • Instead of tying your hair back tightly with elastic bands or strong ‘bobbles’; use the softer ‘scrunchie’ types to place your hair in a loose ponytail.

man having hair treatment with conditioner

How Often Can I Wash My Hair?

You can shampoo your hair about twice a week in most cases without ‘hurting’ the hair or scalp, and it's important to be gentle with the hair whilst washing. Use lukewarm, tepid water and a mild shampoo, as the scalp can become sensitive to the perfumes and preservatives in cosmetic shampoos.

We have developed a special range of products that help achieve the best results from using our system and provide essential aftercare. The Paxman Hair Care range includes a gentle cleansing shampoo and nourishing conditioner.

Helpful Washing Tips

  • Use a gentle shampoo and conditioner on your hair; there are specific ones out there for people undergoing chemotherapy now.
  • When having chemotherapy and scalp cooling it is recommended to wash your hair at least 24 hours before treatment.
  • If you are feeling up to it you can wash your hair immediately after your chemotherapy treatment. This may help you feel more comfortable especially if your hair has been dampened and conditioned prior to commencement of scalp cooling treatment. There is no need to leave the conditioner in your hair unless you feel unable to wash it out.

Patient care is at the heart of everything we do and it’s our goal to ensure that everyone, no matter where in the world, has the opportunity to keep their hair during chemotherapy. Paxman Scalp Cooling Systems are used to treat tens of thousands of patients every year, giving them the choice to maintain their own level of privacy and control.

We welcome feedback and would be delighted to hear about your scalp cooling journey – share your story and read other people’s cold cap experiences at our Facebook community and on Twitter @scalpcooling

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