The Norwood scale: which stage is your hair loss?

What does the Norwood scale measure?

The Norwood scale describes recession of the hairline and opening at the crown in seven stages. It is not a diagnostic instrument; it is a shared language.

Its job is to make the conversation precise. “It has opened up a bit there” means something different to everyone; “stage 3 vertex” describes the same picture to two different doctors.

The scale does not give a graft count. That number comes from measuring donor density and the square centimetres of thinning area.

What separates the seven stages?

The stages progress on two axes: how far the hairline has moved back, and how far the crown has opened. The graft ranges below are figures typically discussed, not commitments.

• Stage 1 — the juvenile hairline is intact; no measurable loss. A transplant does not arise.
• Stage 2 — 1–2 cm of recession at the temples. Considered a mature hairline; a transplant is usually not planned.
• Stage 3 — clear temple recession, the forehead has taken an “M” shape. This is where the first transplant is most often discussed; typically 1,500–2,500 grafts.
• Stage 3 vertex — recession plus the beginning of opening at the crown. Typically 2,000–3,000 grafts.
• Stage 4 — front and crown clearly open with a band of hair still between them. Typically 2,500–3,500 grafts.
• Stage 5 — the band has thinned and the two areas have moved closer. Typically 3,000–4,500 grafts; priorities are discussed.
• Stage 6–7 — front and crown have joined and only the side and back band remains. The aim is selective density, not full coverage.

How do I read my own stage?

Three views are enough: the hairline from the front, the crown from above and the temple corner in profile. Look at dry hair in its natural state.

Answer two questions in order: have the temple corners receded, and is scalp visible at the crown? Recession only means stage 2–3; crown opening only means stage 3 vertex; both together means stage 4 and above.

Looking at wet hair, or under a single overhead light, makes thinning look worse than it is. Assessment is therefore done on dry hair in diffuse light — which is also why the photographs you send us should be taken by a window, not in a bathroom.

Why do two people at the same stage need different graft counts?

Of two patients at the same Norwood stage, one may get an adequate result from 2,000 grafts while the other needs 3,500. Three measurements make the difference: donor density, hair calibre and the colour contrast between hair and skin.

Typical donor density is 60–80 follicular units per square centimetre. Below 50, more area has to be harvested for the same result and the total budget narrows.

Thick hair — roughly 70–90 microns — covers the same area with fewer grafts. Low contrast between fair skin and light hair also hides thinness, which lowers the graft count needed.

What is done at stage 5 and above?

At stage 5 and above, trying to cover the entire bald area exhausts the donor budget and leaves every region thin. The correct approach in that picture is to set priorities.

Priority usually goes to the frontal zone and the hairline; that is the area which frames the face and the one you see most in the mirror. The crown may be left to a second session, or left alone.

The density targeted at the front is 35–45 follicular units per square centimetre. Given that natural hair density is 80–100 units, the aim in a transplant is to create the impression of fullness with roughly half of natural density.

Is Norwood used for women too?

The Norwood scale is generally not used in women. Female pattern loss progresses not by hairline recession but by diffuse thinning along the parting.

The Ludwig classification is used for that picture and has three grades: mild widening of the parting, clear thinning, and diffuse loss. Planning follows that grading instead.