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The Marquesan chiefs employed the tuhuna, or craftsmen, to carve each of the unique tortoise and conch shell plaques that make up this headdress. The tortoise shell plaques were formed to match the curve of the conch shell pieces and both were attached to a woven band of coconut fiber. This band, which also had rows of thin pearl disks and tortoise shell elements attached to the fiber, was tied around the top of the head. The tortoiseshell plaques were carved with tiki figures set frontally alternating with smaller tiki figures at each side.
This meticulously constructed headdress was worn by the high-status men and women in Marquesan society. Marquesan social ranks were unique in Polynesia because the upper ranks had no connection to divine powers as they did elsewhere in the region, and status was hereditary but flexible. The majority of Polynesian cultures had strict hierarchies that did not allow for flexible movement among the ranks.
Controversy exists among scholars concerning the way the paekaha was worn. After contact with foreign travelers, the headdress was recorded as being worn with the plaques sloping down and outward, creating a rim where objects could be hung. Yet, if the headdress was in fact worn this way, the carved images and designs on the plaques would be upside-down. Many scholars conclude that it was worn the other way, keeping the figures upright, and that postcontact, the Marquesans switched styles to mimic the hats of visiting sailors.