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RO The Ludwig Scale has three grades, and progression is read from the widening of the central part rather than from a moving hairline.
| Grade | Appearance |
|---|---|
| I | Perceptible thinning over the crown; the central part appears slightly widened |
| II | Pronounced widening of the central part; scalp more visible |
| III | Extensive diffuse loss over the crown; scalp clearly visible through remaining hair |
The shape this produces — narrow at the front, wider toward the crown — is what is described as the Christmas tree pattern.
Why the grade matters in planning. Because the loss is diffuse rather than patterned, the donor area is often thinning as well. Two women at the same Ludwig Scale grade can have very different donor reserves, so the grade describes the problem without settling whether surgery is appropriate.
What it does not do. It is a staging tool, not a diagnosis. It records what is visible at one point in time and identifies neither a cause nor a likely course, and diffuse thinning has causes other than androgenetic loss.
Not to be confused with the Norwood scale, which stages male pattern loss and is built around a receding hairline. A receding frontal hairline in a woman is a sign that the pattern is not Ludwig, and that the diagnosis should be revisited rather than staged.
Related terms
- Safe donor area
- Hair transplant density planning
- Hair growth cycle
- Androgenetic alopecia
- Diffuse thinning
- DHT and hair loss
For how female pattern hair loss is assessed and what surgery can and cannot do, see hair transplant for women. For the male equivalent of this scale, see the Norwood scale.
