9 Questions About Cold Capping Answered by Someone Who Kept All Her Hair

A cold cap reduces scalp temperature during chemotherapy to preserve hair. Results are mixed, but newer technology shows promise. Here are tips for cold capping from someone who lived it.

Kimberly Bailey is a social, outgoing realtor from Fairfield, Connecticut. She takes pride in putting her best foot forward, especially when it comes to her hair.

She also gets an annual mammogram without fail, including during the height of the COVID-19 pandemic.

Although she’d just had one the year before, this time, there was something new: calcifications. This prompted a biopsy, and Kimberly was diagnosed with ductal carcinoma in situ (DCIS).

“The advice was to go ahead and do a lumpectomy and remove it,” Kimberly says. “I would give advice to everyone to talk with at least two different surgeons and just get an opinion because this is all new and it’s scary.”

She was given the choice of receiving a lumpectomy and reconstruction or also undergoing chemotherapy using Taxol. She chose the latter.

However, chemotherapy meant that Kimberly might lose her hair.

When Kimberly expressed her concern over that possibility, her nurse told her about cold capping. Read on to learn about the cold-capping process and how you may be able to preserve your hair during chemo.

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What is cold capping?

Cold capping is also known as scalp hypothermia. It involves reducing scalp temperature with a cooling cap before, during, and after chemotherapy treatment. This can help reduce hair loss.

According to BreastCancer.org, cold capping works by narrowing the blood vessels under the skin of the scalp. This reduces the amount of chemotherapy medication and metabolic activity in the hair follicles.

For Kimberly, this meant she might be able to keep her hair.

“As a breast cancer patient, so much is taken away from you,” Kimberly says. “And you lose so much control over everything that the thought of losing my hair was too much.”

Kimberly’s medical team ordered and fitted her with a Paxman cold cap, helping her through the entire process.

How does cold capping work?

The most current cold-capping technology involves a two-piece cooling cap system that’s controlled by a computer.

The computer circulates a cooled liquid through a cap that’s worn during chemotherapy treatment. A second rubber cap covers the cooling cap to hold it in place and keep the cold from escaping.

Cold-capping devices that have been cleared by the FDA include:

• DigniCap
• Paxman
• Amma

Is cold capping effective?

According to the American Cancer Society, recent research shows that at least half of the women using a newer cold-capping device lost less than half of their hair.

They note that people with thicker hair may be more likely to lose hair compared with those with thin hair. This may be because a thicker hair layer prevents the scalp from cooling down as effectively.

In a 2019 Japanese study of 48 people with breast cancer, 27% of those who underwent scalp cooling retained their hair compared with 0% of those who did not. The study also found that scalp cooling resulted in faster recovery of hair volume after chemotherapy.

One variable that plays a role in whether hair loss occurs during cold capping is the type of medication. 

One 2018 study of 60 people with early-stage breast cancer found using cold caps on 2 different temperature settings found that 33% of patients experienced significant hair loss.

Of those who received chemotherapy containing only taxane (Taxol is a taxane), 45% had the highest rate of hair loss. Other factors like hair type, age, body weight, and temperature setting did not predict hair loss.

Talk with your doctor to learn about the chemotherapy drugs that are right for you and whether they’re associated with hair loss.

How does cold capping feel?

According to Kimberly, the cap has to fit very tightly.

“It’s really important to have a really firm fit of it so it’s actually conducting and freezing your hair follicles,” Kimberly says.

Kimberly found the cold capping difficult and uncomfortable. However, she notes that’s not always the case for everyone who uses it.

“I will tell you, it was really, really hard … for me,” Kimberly says. “I cried every time, but I wouldn’t change it for the world: 100% I would do it again without a question.”

She describes the feeling she got from wearing the cap as “claustrophobic.” As the fluid starts circulating, the cap gets cold, and the pressure increases.

The nurses made an effort to distract her from the experience, offering videos to watch. Some people even fall asleep during the process.

“You do adjust,” she adds.

Are there cold-capping side effects?

There can be some minor side effects of cold capping.

These include:

• headaches
• neck and shoulder discomfort
• chills
• scalp pain

There isn’t much research available on long-term effects.

Though more studies are needed, some doctors are concerned that cold capping may protect cancer cells in the scalp, allowing them to continue growing post-chemo. However, reports of cancer in the scalp after cold copping have been rare.

How do you prepare for cold capping?

First, it takes a lot of fittings. Kimberly emphasizes the importance of getting a really close, tight fit to get the best results.

Her Paxman kit came with a shampoo, conditioner, spray bottle, comb, and headband. She says you want to get your hair as wet as possible to help conduct the cold. Don’t just spritz! The conditioner helps the hair stay damp as well.

It can also help to have someone like a friend, family member, or caregiver who can familiarize themselves with the process and be there for moral support, from trying on the cap at home to being there in the waiting room during treatments.

On top of that, Kimberly says she didn’t want to leave anything to chance.

“I did everything I could to help the situation: wear my hair in a little loose side braid, sleep with a silk hat, everything to try to make it work,” she says. “Not just like, put the cap on once a week and then hope for the best the rest of the days.”

Kimberly’s cold-capping tips

The below tips are what Kimberly actually did before, during, and after her treatment to make the process as effective and comfortable as possible.

Items for your bag

• tea or a favorite hot beverage to stay warm
• an electric blanket, if your center allows them
• hand towel for shoulders (to prevent your shirt from getting wet)
• conditioner
• wide tooth comb for detangling
• plastic cup for wetting hair
• Ativan for side effects, if prescribed

Prepping your hair for cold capping

“I put my head under the faucet and soaked my hair and scalp. It should be wet,” says Kimberly. “You want your hair wet to best conduct the cold from the cap to your scalp/follicles.”

For this part, you may want to ditch the included spray bottle and opt for a plastic cup.

After wetting, lightly dry your hair so it’s not dripping, and apply a fair amount of conditioner. Then gently comb through.

Know your procedure time

It’s very important to make sure you’re cooling for the correct time, Kimberly points out.

“You should not depend on the nurses to know the correct time,” she says. “My drug was considered ‘long cooling’ and it was noted on my paperwork. It’s important to know so the center books the room/chair for the appropriate amount of time for you.”

Kimberly had to argue with her medical team to get the long cooling time she knew she needed. She used the Paxman Cold Capping Facebook Group to check with the company while she waited.

Putting the cap on

1. Go to the bathroom if needed, then settle into the chair.
2. Have your helper secure the inner cap on your wet hair. Adjust it so it’s positioned correctly to cover all hair.
3. Put the headband that comes with the kit or a panty liner against your forehead where the inner cap sits against it. A lot of women use pantyliners because they’re thinner and more comfortable than the headband.
4. If there are any areas you feel aren’t quite snug even when tightening the outer cap, try padding the scalp with cotton squares.
5. Have your helper invert the outer cap and press it against the crown of your head. Fold the edges of the cap down. Paxman and other brands have many videos showing how to do this. Make sure to have your helper watch them, too!
6. Check the cap positioning, then tighten the cap. You want it tight to conduct the cold of the inner cap to your scalp.

“You should be able to sip your drink and chew with the chin strap. Make it snug, but it shouldn’t hurt your jaw,” says Kimberly. “Mine hurt the first couple of times, and then I loosened it a bit on subsequent treatments.”

During the procedure

Kimberly suggests distracting yourself for the first 15 minutes, maybe watching something entertaining on your phone or talking with the nurse or your loved ones. 

Most people say the first 15 minutes are the hardest due to the adjustment to the cold.

After the procedure

1. Once the post-cooling time is finished, unplug the cap.
2. Remove only the outer cap. Don’t try to remove the inner cap right away. It’s likely partially frozen to your hair.
3. You can pack up your things while you wait about 15 minutes to remove the inner cap.
4. After 15 minutes, try removing the inner cap. It should slip off easily.

“I went home just the way I was,” says Kimberly. “If it’s winter you may want to bring a warm hat to gently put on your head.”

Does cold capping work for everyone?

The short answer is no, cold capping isn’t always effective.

As mentioned before, cold capping may be more effective for those with thinner hair. Thick or curly hair may prevent the cap from coming into contact with the scalp in some places.

Research also indicates that the type of medication plays a role. Chemotherapy drugs known as taxanes may result in more hair loss than other chemotherapy drugs.

How do you know that cold capping is working?

Kimberly says she was on the edge of her seat during treatment, wondering if “the other shoe would drop.”

“You don’t trust it,” she says. “And you do know [it’s working] because you’re shedding hair everywhere else. But you’re still careful.”

Kimberly notes she lost her eyebrows and eyelashes, but still wasn’t ready to celebrate the hair on her head.

“You’re still kind of like, ‘OK, when can I breathe?’” she says.

It’s normal to experience shedding on the scalp even when cold capping. Some will experience more shedding than others, and for some — cold capping may not work at all.

This can make it even more confusing to determine whether the process is working.

“It’s definitely very emotional,” Kimberly says.

The main factors that seem to predict cold-capping success include a tight cap fit, hair type, and medications.

Why bother with cold capping?

When asked why she recommends cold capping so highly, Kimberly was emphatic.

“You feel so vulnerable,” she says. “But to be able to not look like a patient, and to be able to keep your hair: for me, it was huge. I was like, ‘I can’t deal with that too.’”

While Kimberly acknowledges that many people who experience chemotherapy are OK with losing their hair temporarily, that just wasn’t an option for her.

“I didn’t share what I was going through with a lot of people: close friends, family, you know, close work colleagues, but not everybody,” she says. “I have some friends that have gone through it that feel OK with putting it out on social media … but I didn’t want to do that.”

Keeping her hair gave Kimberly the ability to choose who to tell about her diagnosis.

“I think it makes you feel like you’ve got control over something,” she says.

Cold capping also allowed Kimberly to feel more “normal” during treatment.

“​​I was very, very careful to not let the diagnosis and treatment become my whole life. So I tried to keep it in its compartment and still travel and celebrate milestones,” she says.

Having a full head of hair helped give her the confidence to do that.