en
TR 
SK 
ITA 
FR 
DE 
ES 
BG The Norwood Scale is the most widely used classification system for describing male pattern hair loss. It provides a standardized way to identify the extent and pattern of hair recession and balding, allowing clinicians and patients to communicate more clearly about hair loss severity.
Although the Norwood Scale is a valuable clinical tool, it is often misunderstood. Proper interpretation is essential for realistic hair transplant planning.
What is the Norwood Scale?
The Norwood Scale, also known as the Hamilton–Norwood Scale, categorizes male pattern hair loss into a series of stages. These stages range from minimal recession to extensive baldness involving the frontal, mid-scalp, and crown areas.
For a general overview of hair transplantation, see:
What Is Hair Transplant?
Overview of Norwood stages
The scale consists of seven primary stages, with some intermediate variations. Each stage reflects a recognizable pattern rather than a precise amount of hair loss.
Norwood I
Norwood I represents minimal or no hair loss. The hairline shows little to no recession and is considered within the normal adult range.
Norwood II
Norwood II is characterized by mild, triangular recession at the temples. This stage is common in adult men and does not necessarily indicate future baldness.
Norwood III
Norwood III is the earliest stage often considered clinically significant hair loss. Temporal recession becomes deeper, forming a noticeable M-shaped hairline.
Norwood III Vertex
In this variation, hair loss appears primarily at the crown while the frontal hairline remains relatively preserved.
Norwood IV
Norwood IV involves more pronounced frontal recession combined with a distinct bald spot at the crown. A band of hair usually separates the two areas.
Norwood V
At this stage, the separating band of hair becomes thinner and weaker. The frontal and crown bald areas enlarge.
Norwood VI
Norwood VI is marked by the complete loss of the mid-scalp bridge. The frontal and crown areas merge into a single bald region.
Norwood VII
Norwood VII represents the most advanced stage. Hair remains only in a narrow band around the sides and back of the scalp.
How the Norwood Scale is used in hair transplant planning
The Norwood stage helps estimate the surface area requiring coverage and influences graft distribution strategies. However, it does not determine donor quality or density.
Density considerations are discussed here:
Hair Transplant Density Planning
Norwood Scale limitations
The Norwood Scale has several limitations:
- Does not assess donor area quality
- Does not measure hair density
- Does not predict future progression accurately
Norwood stage vs. donor availability
Two individuals at the same Norwood stage may have vastly different donor capacities. Donor anatomy plays a critical role:
Donor Area Anatomy Explained
Norwood Scale and age considerations
Age influences how Norwood stages should be interpreted. Early-stage hair loss in young patients requires more conservative planning.
Age-related strategy is discussed here:
Age and Hair Transplant Planning
Common misconceptions about the Norwood Scale
A frequent misconception is that higher Norwood stages automatically disqualify patients from surgery. In reality, planning must consider donor quality, expectations, and long-term strategy.
Clinical value of the Norwood Scale
Despite its limitations, the Norwood Scale remains a useful communication tool. When combined with donor assessment and density planning, it supports informed decision-making.
References
- NIH – Androgenetic Alopecia Classification
- American Academy of Dermatology – Male Pattern Hair Loss
- DermNet NZ – Androgenetic Alopecia
Medical Disclaimer:
This article is provided for informational and educational purposes only and does not constitute medical advice.
It is not intended to replace a face-to-face consultation, diagnosis, or treatment by a qualified physician.
Individual treatment decisions should always be made in consultation with a licensed medical professional.
