Whether you’re the patient or the hairdresser, hair loss during chemotherapy has always been a big concern. As the hairdresser, you may have fitted wigs, shaved a client’s head to minimize the emotional trauma of watching the hair fall out on its own and cared for new hair as it returned. If you’ve been a cancer patient, you know first-hand the sadness of losing hair during an already stressful time.

That all may change. Cold cap therapy, developed decades ago as a “long shot” idea, is becoming an accepted option in conjunction with chemotherapy treatment. Before, during and after each chemo session, the patient wears a series of tightly fitting frozen caps to narrow the blood vessels beneath the skin of the scalp, reducing the amount of chemotherapy medicine that reaches the hair follicles and causes the hair to fall out. Although there has been wide and consistent success, cold caps do not work for everyone, and some chemotherapy drugs seem to be more resistant than others.

Two methods have evolved. In the first, caps are chilled in a special freezer to a lower temperature than an ordinary house freezer can reach. After wearing a cap for about 30 minutes, the patient changes to a fresh one right out of the freezer. The Breast Cancer Organization lists three brands of this type of cold cap: Penguin Cold Caps, Chemo Cold Caps and ElastoGels.

For the second method, the patient does not change caps, because the cap is connected to a cooling unit that gradually chills the cap to the target temperature and then maintains that temperature. The DigniCap System and Paxman Scalp Cooling System are the leaders in this technology, according to the Breast Cancer Organization. Both companies’ equipment is currently involved in U.S. clinical studies, with DigniCap on the brink of becoming the first FDA-approved cold cap technology. Observers speculate that in a few years this is the method that will dominate, because patients prefer the gradual decrease in temperature as well as the ability to wear just one cap throughout the session.

Early opponents feared that any cooling that could reduce hair loss would also reduce the treatment’s efficacy, possibly leading to the cancer’s metastasis on the scalp skin. That concern has greatly diminished, according to Steve Herrmann, managing director at Chemo Cold Caps. Herrmann, who reports that studies have found no rise in scalp metastasis among cold cap users.

Although insurance has reimbursed some patients for the costs associated with the caps and keeping them cooled, coverage is not standard at this time. The Rapunzel Project and Cold Caps Assistance Projects are two charitable organizations that help with these expenses. Both accept donations on their websites.

“We have worked with the people at the Rapunzel Project, and they do a terrific job,” Herrmann notes. “It’s a great organization that has gone above and beyond the call of duty.”