The specialty shop for cancer patients at Beth Israel Deaconess Medical Center may be called Windows of Hope, but as Dianne Austin stood outside it, looking through the glass, all she felt was frustration. It was 2015, and without even entering the store, she could tell there was nothing there for her — a Black woman with breast cancer, searching for a stand-in for the natural hair she lost almost immediately after starting chemotherapy. This was the third stop on her journey to find a wig — after Dana-Farber Cancer Institute and Massachusetts General Hospital — and the third time she was realizing just how unprepared cancer center boutiques seemed to be to serve patients looking for anything other than straight-haired wigs.
Hospitals in other parts of the country also came up short. Austin had a prescription from her oncologist for a medical wig and insurance coverage of up to $350 — but nowhere to buy one. She wondered, Why can’t I get a wig just because my hair type is different?
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In 2019, her acute frustration with this health care disparity led her to found Coils to Locs, a Boston-based company that sources curly and kinky wigs and sells them mostly to hospital boutiques. Austin’s first move was to land deals with the hospitals she felt herself alienated from: The cancer shops at Beth Israel, Dana-Farber, and MGH now carry Coils to Locs wigs. (She also supplies a salon in downtown Boston, a boutique in Georgia, and a hospital in Texas.)
“The bottom line is: If a hospital is providing a service for its patients, [it] needs to provide the service for all patients,” she says.
Throughout her dead-end search for her own medical wig — also sometimes called a cranial prosthesis — boutique managers kept giving Austin the same advice: Go to a salon in a community of color and find your own wig, or buy a straight wig at the hospital with insurance coverage, and then go to a salon to chemically “kink it up.”
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But she would’ve had to pay out of pocket for that chemical treatment, and if she’d bought a curly wig at a salon, getting insurance reimbursement would’ve been chancy. Salons that sell cosmetic wigs frequently offer only a register receipt after purchase, which not all insurance companies will accept. Cosmetic wigs are also not designed to account for the scalp soreness that chemotherapy can cause, and sometimes they require an existing base of hair to attach to — an impossibility if you’re dealing with complete hair loss. And many of these shops don’t offer the same level of privacy and sensitivity one can expect at a cancer center.
All of this was also on Nikia Londy’s mind when she decided to pivot her business, Intriguing Hair, to serve customers in search of medical wigs. When she opened her store in Hyde Park in 2015, she was mostly catering to Black women looking for cosmetic hair extensions. But she saw over time that more and more of her customers were people of many ethnicities looking for medical support as they experienced the loss of their curly hair. Her shop is now outfitted with a private space for one-on-one consultations, and the business is also certified to bill insurance companies directly, something that’s extremely rare outside of hospital boutiques. “A lot of times I find that customers don’t know they can even get their wig reimbursed [by insurance companies],” she says. So increasingly her job is equal parts adviser and coiffeur.
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Most medical customers ask her for a monofilament wig, where individual strands of hair are sewn into a scalp cap that can be slipped on and off easily. But monofilament wigs usually have a white cap — which can be a problem for women of color.
“If you’re another complexion, it typically doesn’t work for you,” she says. Instead, she advises people to get custom wigs that skip the cap altogether.
While Austin and Londy cater mostly to adults with hair loss, Tiffany Fitz and Sheritta Coleburn’s Esteem Hair is focusing on a different community. Launched in Boston in 2016, what started as an online wig business serving adults with alopecia soon became one of the few companies selling medical wigs for kids.
Fitz’s mother and Coleburn herself live with alopecia, an autoimmune disease in which the immune system attacks hair follicles, causing hair loss that lasts for life, unlike chemotherapy-induced hair loss. In this context, finding a wig that mimics natural hair can be an even more crucial part of restoring normalcy and confidence — although not everyone wants to wear a wig every day. In an interview with The Root this year, Representative Ayanna Pressley shared that she too had been living with alopecia and wearing wigs. But since then, she’s been rocking a bald head on the House floor.
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Esteem Hair’s online business reaches customers dealing with hair loss in far-flung places, where they see neither their identity represented in medical boutiques nor their medical needs represented in cosmetic salons. In addition to finding wigs that match textured hair types, “the big need is for wigs that are kid-appropriate,” says Fitz.
When Austin first started scoping out her business, she spoke with people involved in all parts of the hair loss journey: patients, hospital boutique managers, and physicians. She recalls meeting one retail manager who said she’d been looking for curly and kinky wigs for her customers for 10 years. American medical wig manufacturers simply haven’t been catering to the demand. That’s where businesses like these come in.
“Cancer does not discriminate,” says Austin. So why should wigs?
Julia Sklar is a freelance science journalist in Boston. Follow her on Twitter @jfsklar.