Ever asked yourself how our surgeons categorise the different severities and stages of baldness? Have you ever wondered why so many men seem to suffer with hair loss in the same places? Well, here you can find out why!
On this page, you’ll find out why men suffer with hair loss, how clinicians diagnose baldness, and what men can do to fix a receding hairline. You will also find out how the Norwood Scale is used by clinicians.
What is the Norwood Scale?
The Hamilton Norwood scale is a classification system used by hair transplant surgeons to gauge levels of male patter baldness amongst hair loss patients. Split into seven stages (1 being a full head of hair and 7 being the most severe stages of hair loss), the Norwood scale is a common tool used by a hair loss specialist to diagnose a patient’s patterned hair loss and devise which surgical procedures are going to be most effective in promoting new hair growth.
As can be seen in the image above, the seven stages of baldness, according to the Norwood scale, proceed as follows:
- No receding or hair loss has taken place.
- The hairline recedes slowly and begins at the temple. Sometimes, this is called a “mature hairline“.
- Clinically significant hair loss becomes present. Hair has almost fully receded from the temple area and looks like an M, V, or U shape. Hair loss also slowly takes the top of the scalp, or “Vertex” (see 3V).
- Hairline recedes even further and vertex area becomes more sparse with hair.
- Only a narrow of corridor of hair is present between the temple and vertex areas of baldness.
- Vertex and Temple areas conjoin leaving full baldness on the top and front of the head. Hair only remains around the sides and back of the scalp.
- Only a band of hair remains around the sides and back of the scalp.
Depending on where you fall in the Norwood scale helps hair transplant surgeons to work out what type of hair transplant you ay require. For those at the initial or medium stages of pattern hair loss, FUE hair transplants should often suffice. This process is minimally invasive. However, more severe stages of hair loss may require an FUT hair transplant.
Norwood Scale Stage 1
Stage 1 of the Norwood scale doesn’t actually show any hair loss at all. This shows how hair typically looks during adolescence. The hairline and crown show no sign of recession and hair looks full and thick on top.
At this point, catching hair loss early may negate the need for a hair transplant straight away. If you were to speak with one of our qualified clinicians, we may recommend a chemical treatment that is designed to slow down the signs of hair loss. Treatments such as Finasteride and Minoxidil are DHT blockers and stop hair loss whilst you take the treatment.
Sometimes referred to as the adult hairline, this is where a receding hairline first becomes present. hairline begins to receding upwards from the brow crease. At this stage, surgeons are still unlikely to recommend a hair transplant. This is because a hair transplant may actually damage your healthy hairs.
Like stage 1, the recommended treatment course is still Minoxidil and Finasteride. In fact, having a hair transplant at this stage could be detrimental to your future hair growth. As you may not have enough hair to join your temples to your new hairline, it can be difficult to design a natural looking hairline in the future.
The third stage on the Norwood scale is what can typically be defined as early male pattern hair loss. This is where further hair loss takes place beyond the “adult” or “mature” hairline as noted in stage two.
At this stage, your hairline will recede further up the temples causing a frontal tuft at the front of the head. Generally speaking, patient also feel that their hair begins to thin or feel finer to the touch.
At this stage, surgeons may begin to recommend a hair transplant as an option. However, this will dependent upon your family history, as this is the best indicator as to how your pattern hair loss is most likely to progress. Although, a hair transplant is a long-term solution to pattern baldness, it is important to consider how your hair will look in the future.
Stage 3 (Vertex)
Sometimes called the type iii vertex, this stage can be seen as an extension of stage 3. This refers to hair loss in the crown area alongside further losses in the temple region. The difficulty with crown balding is that it the balding area will expand greatly over time. This is why men under the age of 45 are unlikely to be granted a crown transplant. If a younger man goes to a hair transplant clinic with crown balding, a premature crown transplant could cause isolation. This is where a bald circle can begin to develop (between the transplant area and remaining healthy hair) as pattern hair loss continues.
If younger men are suffering with the effects of crown baldness, surgeons often recommend a chemical treatment to slow down the effects. Hopefully, this is only cause minimal hair loss, making your future crown transplant cheaper and fuller looking!
As the Norwood scale progresses, the pattern baldness continues. Hair loss in the crown and temple areas continues, with a small amount of remaining hair between the balding areas.
As patients begin to reach this stage, it is generally wise to assume that they are likely to progress onto stages 5, 6, and 7. At this stage, surgeons generally recommend a forelock transplant. This helps patients keep a permanent hairline.
By the time you pass to stage 5, there is only a small corridor of hair from keeping the crown and hairline hair loss from meeting. Natural hair growth in the temple and crown will have ceased and little or no hair will be found here.
At this stage, a hair transplant like FUE will likely be recommended where there are plenty of hair follicles that can be extracted form the donor site and be implanted into your bald areas.
If left untreated at this stage, pattern hair loss will continue and the cost of a hair transplant will increase. This is because more hair follicles are needed to be transplanted.
When a patient reaches stage 6, this is classed as a severe form of balding. Both balding areas, from the temple and vertex, have met causing full baldness form the top to the front of the head.
At this point, an FUE hair transplant can still be used to treat baldness. As the remaining hair is still fairly high upon the head, a hair transplant surgeon can rejoin the hairs together and make the pattern hair loss look like a stage 4, 5, 0r 6.
Stage 7 on the Norwood scale is the most prominent form of pattern baldness. At this point, full hair loss will have occurred on the top and front of the head, leaving only a thin strip of hair at the back and sides of the head. The main difference between stage 6 and 7 is a lowering, or dipping, of the backs and sides.
At this stage of hair loss, any form of hair transplant can be quite difficult. The job of a hair transplant surgeon is to redesign a new hair. Obviously, given that there is less hair to work with than earlier stages, there is a much larger area of baldness to cover making the surgeons job quite difficult.
At this stage, a more invasive form of hair transplant may be needed such as FUT – the “strip method”.