Classification

The Norwood scale

The standard way surgeons describe male pattern hair loss. Seven stages, from barely-there temple recession to a horseshoe rim. It is shorthand for a pattern — useful for discussion, not a treatment plan on its own.

The renders below show the same head at each stage, viewed from above so the hairline and the crown are both visible.

The stages

Seen from above

Stage 2

Slight recession at the temple corners. The mid-scalp and crown are still fully covered. Often barely noticeable to anyone else.

Stage 3

Deep triangular recession at both temples forming a clear M. This is the stage at which most men first seek advice.

Stage 4

Frontal recession plus a separate thinning area at the crown, with a band of hair still running between them.

Stage 5

Both areas larger, and the band separating them is narrowing and thinning.

Stage 6

The band has gone. Front and crown have merged into one continuous bald area across the top.

Stage 7

Only a narrow horseshoe of hair remains around the sides and low back. Donor supply is the limiting factor.

Illustrative 3D renders, not patient photographs.

What it does not tell you

The stage is not the plan

Two men at the same Norwood stage can have completely different options, because the scale describes what has been lost and says nothing about what is available to move. Donor density, hair calibre, scalp laxity and how fast the pattern is still progressing all matter more.

Published guidance in the ISHRS Hair Transplant Forum International describes a typical safe lifetime donor supply of roughly four to eight thousand follicular units, and cautions that removing more than twenty to thirty percent from a single zone in one session risks permanent visible thinning. At the higher Norwood stages the arithmetic gets tight quickly, which is why coverage is prioritised rather than promised.

The other thing the stage cannot tell you is whether the pattern has stabilised. Operating into rapidly advancing loss is one of the most reliable ways to end up with an island of transplanted hair and a widening gap behind it.

Straight answers

Questions

Most people can place themselves within one stage by looking down at the top of their head in a mirror, or from a photograph taken from above. Exactness is not the point — the stage is shorthand for a pattern, and what actually determines your options is donor density, measured under magnification.

Not automatically, but it changes what is achievable. At stages six and seven the bald area is large and the donor supply that has to cover it is finite, so coverage is usually prioritised rather than complete, and often staged. Anyone promising full restoration at stage seven is overselling.

Female pattern loss is usually described with the Ludwig scale instead, because it is typically diffuse thinning over the top with a preserved frontal hairline rather than the receding M-shape the Norwood scale describes.

Sources: ISHRS — Safe Donor Follicle Harvesting in FUE · American Academy of Dermatology

Keep reading

How many grafts?The donor area Am I a candidate?What causes hair loss

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