If they say "beauty is pain," then the beauty of achieving long, luscious locks is becoming more and more painful for many women.
Hair extensions have become the must-have accessory of celebrities and starlets on the red carpet and in magazines.
Now more and more women are following suit and using the extensions at home and work. Some as young as 19 are experiencing the dangerous side effects that come with trying to transform one's natural hair with hair pieces that make their hair longer and fuller.
"We have patients who are in their early 20s come in after wearing hair extensions for six months or one year, and they actually have bald spots," Dr. Eric Schweiger, a New York City dermatologist, told "Good Morning America."
Doctors say people particularly at risk for damage from hair extensions are those with already thin or weak hair, or with a pre-existing medical condition, like anemia.
Hair extensions, in which hair is attached onto a person's existing hair or scalp by either weaving, gluing or clipping it on, may cause little damage to some women but, for others, the hairpieces can cause nightmarish results.
Twenty-two-year-old Maya Ramos of Delray Beach, Fla., experienced the dark side of hair extensions firsthand after she began using clip-on extensions to make her shoulder-length hair longer and fuller.
Just three months after her extension adventure began, Ramos saw signs of trouble.
"My hair was really falling and falling," she told "GMA." "I was shedding a lot of hair in the back toward the extensions."
The damage caused by the extensions, which she described as "heavy" and "uncomfortable," was so severe that Ramos feared the worst.
"I was freaking out," she said. "I thought I was going to lose my hair by the time I was 30."
Concerned, Ramos sought the help of a hair loss expert.
The specialist diagnosed Ramos with traction alopecia, a form of gradual hair loss caused primarily by a pulling force being applied to the hair. Within a year of quitting the extensions, Ramos' hair, much to her relief, had grown back.
Not so lucky is Chioma Odimegwu of New York City. Odimegwu is considering a hair transplant at the age of 25 after six years of using hair extensions resulted in permanent hair loss.
Odimegwu began using 14-inch glue-in extensions at the age of 19. When the extensions caused her hair to thin, she had a professional stylist apply tie-on extensions to cover the hair loss.
The new extensions worsened the problem, and Odimegwu's hair loss spiraled out of control.
"When I took (the new extensions) out, my whole head of hair was very, very thin," she told "GMA" of her post-extensions appearance.
Odimegwu tried a host of doctor-recommended products, including female Rogaine, in an effort to re-grow her hair,and worked to cover her hair loss in other ways.
"I wear lots of hats," she said. "And really fat headbands."
Ramos and Odimegwu are not alone. Even celebrities are experiencing difficulties related to hair extensions.
"Nothing destroys your hair faster than hair extensions," Jennifer Aniston, whose own shag-style cut in the '90s sparked a worldwide hair craze, told Harper's Bazaar magazine in a 2006 interview. "I decided to have a couple of extensions, never knowing you end up with 400 things in your hair that cause your hair to break off."
Advocates of hair extensions, like New York stylist Angelo David, argue that extensions are still a great asset, and option, for any woman - provided they are installed and worn correctly.
"Everybody can wear hair extensions," he told "GMA." "You just need to wear extensions that fit your head."
His eponymous New York City salon does a brisk business, outfitting women with long locks and custom-made extensions.
David takes pains to make certain his extensions are appropriate for a woman's individual hair type so that extensions are neither too heavy or too tight.
The couture hair extensions offered at David's salon cost anywhere from a few hundred dollars to upwards of several thousand dollars.
David's clients are thrilled with the results.
"I think that extensions add so much attractiveness to people," salon client Reilly Chaffin said. "I look at them and I think that I look so much better."
Something everyone from stylists like David, who favor hair extensions, to doctors like Dr. Schweiger who remain skeptical of their safety, agree on is that women who choose to use extensions should do so with care and attention to detail.
"You need to create the right fit," said David. "The important thing is getting into the right extension."
"It's very important that people out there know the risks of hair extensions before they get them done," said Dr. Schweiger. "If you're going to do any extensions, just use them for a few hours and take them out. That's the safest way."