You'll have heard of the Beaufort Scale. And no doubt you're more than familiar with the Richter Scale.
But have you any idea what the Norwood Scale is all about?
Most people will have no idea that it is something to do with hair.
When male pattern baldness begins to strike there is a dedicated measure which assesses the severity of hair-loss.
A Norwood type 7 is the most severe delineation of male-pattern hair loss. Not everyone who has hair-loss will get to a stage 7 as genetic factors may mean that you remain at one of the other six stages.
But you’ll probably never have given much thought to all the possible stages of hair-loss and what, if anything, can be done to take someone with severe hair-loss back to an earlier stage on the scale.
Here you will find a careful categorization of the various stages of male-hair loss.
You’ll be able to check your own pattern of hair-loss against the pictures we present and work out where you sit on the Norwood Scale.
It will also give you a good idea of the further trajectory of your hair-loss and when the best time might be to start to tackle it.
Below are the different areas of the hair that can be lost in the Norwood Scale.
NORWOOD CLASSIFICATION OF HAIR-LOSS
The Norwood system of hair loss classification was published in 1975 by Dr O’Tar Norwood and is still the most widely used classification for hair loss in men. Using this system we can more accurately predict future hair loss and design transplants that will always look natural.
Everyone starts at Stage 1. If you are destined to be a Stage 7 you will first go from Stage 1 through stages 2, 3, 4, 5, 6, and on to stage 7. But not everyone is destined to be a Stage 7. This is determined by your genes from both sides of your family, and will evolve over time. Genes and time combine to develop your individual hair-loss pattern. At some point in time you will arrive at your pre-determined hair-loss stage and your hair-loss will stop.
At Paradigm we can reverse a pattern one or two stages to create a bespoke hair transplant that will enable you to to find that delicate balance between your inner self and your outer appearance.
NORWOOD STAGE 1
This traditionally represents an adolescent hairline. It is not actually balding, but is the first stage in maturing from a teenage hairline to an adult male hair line. We would not recommend transplanting someone with Norwood 1 stage of hair-loss as it would damage healthy hairs. We would also want to see how the hair-loss might progress over time. If there is some indication of further hair-loss, we may possibly recommend medication to stabilise the hair-loss.
At this stage, any thinning that may develop can be treated with one or both of the only FDA approved medications, Propecia and/or Rogaine. Both these medications have undergone clinical trials and have been proven to reverse the balding process. They are effective in 90% of patients whilst they are being used. If you stop using them their effects will wear off and your normal balding process will continue.
NORWOOD STAGE 2
This pattern indicates a further progression to an adult hairline. The temples deepen slightly and the hairline recedes up from the brow crease.
We would not recommend transplanting someone with Norwood 2 as this will damage healthy hairs.
At this point it is tempting for young men to ask for their temples to be filled in – but this can be disastrous in future life if you progress on to a stage 4 or more. This is because you will not have enough hair to join the temples to the new receded hairline. It is difficult to design a natural looking hairline if the temples have been placed at a point that is too low.
Medication can be used to slow down any hair loss at this stage.
Family history and age will determine whether you are destined to progress on to Norwood 3 or more but however old you are, transplantation is never recommended at Norwood stage 2.
NORWOOD STAGE 3
Norwood 3 is said to be the earliest stage of male pattern hair-loss. The temporal recession deepens and a frontal tuft is established. Further hair-loss or thinning can be stabilized by medication.
We would consider transplanting this pattern depending on the individuals age, their future hair-loss pattern and their personal expectations of a transplant.
Medication can help to slow-down hair-loss at this stage but suitability for transplantation would depend on your age and your expectations.
However, the forelock can be stabilized with a transplant and/or with medication. The design would be dependent on your future hair-loss and your age – but the goal is always to create a transplant that looks natural now and in the future. It is also important that the transplant isn’t dependent on
either further transplantation or medication for its naturalness. It must look natural for the whole of your life no matter how much hair-loss you experience.
NORWOOD 3 VERTEX (CROWN)
Norwood 3 Vertex represents hair-loss on the crown. This can come with a deepening temporal recession – or you may have a stage 2 in the temples and some hair-loss on the crown.
It is universally accepted that you do not transplant the crown of a man under the age of 45 as he is likely to lose more hair. A transplanted crown in a younger man with Norwood 3 vertex could become isolated as his hair-loss progresses. This would potentially leave a circle of bald skin around a premature transplant. This will look unnatural. It would also be difficult to correct if you progress on to Norwood 5 or more.
In a man of 45 years of age or older we would be comfortable transplanting the crown as long as we were able to future-proof the crown by transplanting an internal hair-line through the rim of the crown. Medication can also be used to thicken the remaining hair.
A transplant could fill in the crown, this would free the individual up to style his hair as he pleases rather than to cover his baldness.
NORWOOD STAGE 4
Norwood 4 is characterised by further frontal hair loss and an enlargement of the crown – but with a solid bridge of hair separating the two balding areas.
Depending on your anticipated future hair-loss, we could transplant either the crown or the frontal forelock. You would need to decide what your priority is as there is not enough donor hair at this stage to give you density in both areas. A significant factor in design would be your potential future hair-loss pattern. But if this is as far as your hair-loss goes, we could make a significant difference in both areas.
Medication will help to hold on to the hair you have whilst a transplant will fill in the bald areas.
Age and family hair-loss history are the determining factors in the design of this transplant. In a man below the age of 45 a conservative approach would be to assume that he will lose more hair and go on to develop a Norwood 5, 6 or 7 depending on his age and his family history. He will have inherited his hair-loss pattern from someone in his family.
A forelock would establish a permanent hairline with some density. This could blend in to the bridge or stop short of the bridge.
As long as you have hair, medication will help to thicken that hair and prolong its life so it’s always worth considering using Rogaine and/or Propecia (Finasteride).
NORWOOD STAGE 5
At Norwood 5 you’re experiencing a significant amount of hair-loss.
There is a small tuft remaining in the forelock, the bridge is beginning to split in half and separate and your bald crown is getting bigger. The temples are receding now so the shape of your face is changing as more bald skin is visible. The frame of your face is breaking down, changing your appearance more comprehensively.
We would transplant this pattern. The main design consideration would be where to position your hairline. A low hairline would require more grafts and reconstruction of the temples. A higher hairline would leave more hair to use in the crown.
You may want to use medication to slow down hair-loss on the bridge and crown.
Once again, you will have to decide whether the crown or the forelock is your priority as there is never enough hair to turn you back in to a Norwood 2.
By broadening the forelock and filling in the bridge you can revert to a Norwood 4. This would establish a permanent hairline. You can have a thin covering on the crown to take the bald look away – but even at this stage you need to be cautions as the crown can widen. The universal rule of thumb is to leave the crown in a man below the age of 45 as more hair-loss here will widen the bald area significantly.
If the crown is your priority – and your hair-loss pattern in that area has been established – you could fill in the crown with density as long as you keep the hairline position high. You can have a broad hairline with some density.
Naturalness is the key to any hair transplant.
NORWOOD STAGE 6
This occurs when the bridge of hair separating the crown from the frontal tuft in Norwood 5 disappears leaving a large bald area. The temples have often receded but the sides above the ears and around the crown remain high.
At this stage donor hair is limited but the FUE method is able to harvest hair high in the sides above the ears (lateral humps) which the strip surgery method would not be able to harvest.
The main priority with any design is always naturalness. The high sides in a Norwood 6 give a point at which the new hairline can be joined to the existing hair. Hairline position is key to naturalness, a lower hairline will require the reconstruction of the temples and this can use up a lot of grafts at the expense of the crown.
The amount of available donor hair is reducing whist the amount of bald skin to cover is increasing. The forelock and the bridge have now gone but the high sides above the ear that held the bridge in place are still intact.
A Norwood 6 can be reverted in to a Norwood 5 or 4. You can take the bald look from the crown with a small amount of grafts scattered over the crown. But this only looks natural when the forelock has been re established, as such extensive hair-loss wouldn’t naturally come with a thinned crown.
NORWOOD STAGE 7
Norwood 7 is the most extensive pattern of hair-loss. If you progress to this point, you will have lost the high sides of a Norwood 6 and your crown will have dipped down leaving a narrow strip of hair around the back and sides of your head. The temples will have receded.
The greatest restriction in transplanting this pattern is the amount of donor hair left to redistribute. In addition, there is a large area of baldness to cover.
A stage 7 pattern is the most difficult to design.
We would spend a lot of time with the individual patient discussing their design as it must look natural and it must suit the face-shape of the individual. This may involve multiple pre-operative design consultations.
The sides have dropped down and the temples have receded backwards leaving a large expanse of forehead. This is when you need the right shaped head to carry off the bald look.
This is particularly difficult from a design perspective as all of the hair structures have fallen away leaving just a rim of hair around the sides and back. A small amount of grafts could create a forelock which is not attached to anything, this is called an isolated forelock. It’s difficult to get the design right on this to make it look like a naturally occurring pattern but it is very effective in framing the face and uses only a small amount of grafts.
The other option is to rebuild the area above the ears ( the apex of the lateral hump) to create a Norwood 6 and then replace the bridge and forelock to create a Norwood 5. Density is a personal preference as a thinned look is perfectly natural.
At this stage the crown is large and the bridge must be designed to make the crown look natural. A thin scattering of fine hairs can look natural on the crown if designed well.