INTRODUCTION: Hair tourniquet syndrome (HTS) is a rare disorder characterized by a hair becoming tightly wound around an appendage. There is little known about the epidemiology, optimal treatment, or indications for surgical intervention in HTS. We hypothesized that HTS could be readily diagnosed and treated in the pediatric emergency department and we sought out factors predictive of surgical intervention. METHODS: We performed a single center retrospective review of all patients who presented with a hair tourniquet from May 2004 till March 2014. RESULTS: Eighty-one patients were diagnosed with HTS, ranging in age from 2 weeks to 22 years. Of these patients, 69 were located on the toes, 5 on fingers, and 7 on genitalia. The average ages for each location were statistically different (p<0.0001). Ninety-four percent of patients were successfully treated by nonoperative means. Cellulitis was found in two patients. Tissue necrosis occurred in one patient. CONCLUSION: HTS is an uncommon disorder and location differs with age. Chemical depilatory agents should be a first line treatment for this condition in most patients. If chemical tourniquet release fails, then the patient should undergo mechanical tourniquet release. If edema, erythema and pain fail to resolve after tourniquet release, then persistent hair tourniquet should be investigated.