Alopecia totalis and universalis remove the two things most wig design assumes: a natural hairline to blend into, and residual hair to conceal a cap edge. The prosthesis has to create both.
1. Coverage and the Artificial Hairline
A full-cap prosthesis carries its own hairline, so the front edge must be ventilated at a density and knot style that reads as a hairline rather than a border — typically a graduated 100–120% at the front rising to 140–150% at the crown. The front contour is drawn from the client's brow-to-crown measurement, not from a stock cap template.
2. Grip on a Smooth Scalp
Without hair to grip, adhesion or vacuum does all the work. Medical-grade silicone adhesive suits clients who remove the unit nightly; a vacuum cap suits clients who wear continuously and have a suitable cranial shape. Both require a clean, oil-free scalp and a correctly sized perimeter — a 3mm gap at the mastoid is enough to break a vacuum seal within a day.
3. Weight and Pressure Points
Keep the finished unit under 180g for extended wear. Distribute weight by tapering density away from the crown, and check for pressure at the temples, the occipital protuberance and behind the ears during fitting. Red marks that persist more than 20 minutes after removal indicate a cap that needs reshaping, not a client who needs to adjust.
