Norwood 6-7 Type Hair Loss

Norwood 6-7 Type Hair Loss

Norwood 6-7 type hair loss is characterized by extensive hair loss in advanced patterns. Patients are typically older, and the stability of the donor area is often compromised due to advanced male pattern baldness. Extensive hair transplantation is required to cover bald areas, increasing the risk of surgery and diminishing the predictability of outcomes. The positioning of the hairline in these advanced baldness patterns is determined by the existing hair in the narrow band connecting the bitemporal and mid-anterior scalp. Patients with Norwood 6-7 hair loss present some of the most challenging cases, often requiring multiple sessions and a practical approach to efficiently utilize the donor area. This chapter will discuss the surgical restoration of these patterns in detail from both the FUE and FUSS perspectives.

Norwood 6-7 type hair loss occurs exclusively in men and follows a distinctive pattern. It manifests in patients with advanced mid-pattern and vertex hair loss, leading to deep bitemporal recession. Eventually, only a narrow band of hair remains, connecting the bitemporal regions with the mid-anterior scalp. This bridge of hair may also diminish over time. Norwood 6-7 type hair loss represents the most severe form.

The goals of surgical hair restoration for Norwood 6-7 scale patients are to recreate a natural-appearing hairline with appropriate age-related maturation and achieve cosmetically acceptable fullness throughout the remaining frontal scalp and mid scalp areas. This must be done without creating an abrupt transition between the transplanted and native hair. Designing the hairline to conform to aesthetic principles and the patient’s facial anatomy and drawing a high hairline is crucial for achieving a satisfying result.

Treatment of Norwood 6-7 hair loss is donor-dependent. In patients with hair loss extending beyond type 6-7, including thinning in the temple peaks or loss of the central forelock, additional hair loss stabilization therapy may be necessary before surgical restoration. Reclassifying these patients into higher Norwood types to account for frontal and crown loss has been proposed.

Although patients with Norwood 6-7 hair loss have not lost hair in the horseshoe distribution, ongoing hair loss can make them feel vulnerable. Complete hair loss significantly affects a patient’s perceived age and physical appearance.

Norwood 6-7 hair loss results from complete hairline recession and extensive scalp hair loss. Because traditional classification systems end at type 7, newer systems include both type 6 and 7 hair loss.

Why do people have severe hair loss?

Each man must be individually assessed to account for the pattern, extent, and expected progression of their hair loss when developing a treatment plan. There is no one-size-fits-all approach to managing Norwood 6-7 hair loss, as each man has unique circumstances and priorities. The assessment aims to determine the cause of the patient’s hair loss and formulate a treatment plan, considering their medical history, underlying disorders or risk factors, and setting realistic treatment goals and expectations. Patients should be asked about their current and past use of medications, including anabolic steroids and other hormone-altering substances, which can contribute to hair loss. If a medication is suspected to cause hair loss, the patient should be advised to cease its use if possible.

Managing Norwood 6-7 hair loss aims to restore the patient’s youthful appearance. Hair transplantation can help patients look 10-15 years younger. Another strategy is to slow the progression of hair loss using finasteride 1mg daily, optimized nutrition, and minoxidil 5%. This regimen may slow hair loss considerably, allowing patients to age gracefully without constantly changing their hairstyles to mask the loss.

Several factors contribute to Norwood 6-7 hair loss, primarily genetics. Sensitive receptor sites on hair follicles disrupt the normal hair growth cycle, causing hair to shed and stop growing. Hormones also play a significant role, and for some men, stress is a crucial factor. Stressful events can shock hair follicles into a resting phase, causing them to shed hair. Poor nutrition and crash dieting can also cause temporary hair loss and damage. Chemotherapy can cause hair loss since it effects fast growing cells.

Norwood 6-7 hair loss represents an advanced progression of male pattern baldness, usually affecting the back and sides of the scalp and extending from the forehead to the back. Men with this type of hair loss are generally good candidates for hair transplantation, provided it is performed in a reputable clinic with proper technique.

It is crucial to listen to the patient’s concerns and expectations. Managing and understanding the psychological influences contributing to excessive concern may be part of the help they seek. Excluding organic diseases is part of every consultation. Patients typically request that their hair loss be proportionate and compatible with their age. Various hormone levels are checked and corrected if abnormal. Prevention is the primary theme for every consultation. The androgens responsible for type VI-VII hair loss are raised in the body but are not of testicular or adrenal origin, so they cannot be surgically removed. The levels of testosterone have little bearing on the individual response to finasteride. Patients are started on finasteride and counseled about its action and side effects. Finasteride decreases testosterone metabolism, lowering dihydrotestosterone levels, which stops further hair loss if the patient responds to the drug. Patients are advised to wait and see the response. If finasteride is ineffective, minoxidil may be combined to enhance the effect.

The genetic factors responsible for Norwood 6-7 hair loss inheritance have not been identified but are assumed to be polygenic. Gene mapping studies involving many affected men must identify the genes involved. The high conversion rate of type V to VII in the Caucasian male population suggests that polymorphic genes are partially responsible. The 63% concordance of hair loss in monozygotic twins suggests that nongenetic factors are also involved. Genes on the X and Y chromosomes regulating or influencing hair loss have not been reported. The inheritance pattern is assumed to be autosomal with incomplete penetrance and variable expression among affected members. Knowledge of family history gives patients an idea of the risk and potential for the expression of hair loss in their male offspring.

The Role of Hormones

Norwood 6-7 hair loss is associated with androgenic changes, primarily hormonal imbalances. This type of hair loss is described as a negative aesthetic sign, making the person appear old and tired. Norwood 6-7 hair loss affects facial perception and changes the head proportions. People with this type of hair loss may also suffer from psychological issues. Therefore, addressing hair loss from all angles, not just the hair is essential.

Not to have balanced hormones is one of the biggest causes of hair loss in both male and female patterns. An increase in dihydrotestosterone or androgen receptor activity causes hair loss in genetically predisposed individuals. Humans produce male hormones (androgens) and female hormones (estrogens) regardless if they are female or male. An alteration in the estrogen-androgen ratio is the main reason why women suffer from this type of hair loss, along with other signs of masculinization. Women with hormonal imbalance-related hair loss often have different symptoms, such as irregular periods, acne, and hirsutism. Therefore, managing hormonal imbalance-related hair loss requires treating the patient as a whole.

Effect of Baldness on physical appearance

The most severe form of Norwood-type male pattern hair loss is Type VII. In some cases, hair loss is so extensive that the band around the head is denuded, leaving only hair in the occipital scalp. Despite extensive hair loss, patients with advanced hair loss are still good candidates for hair restoration surgery. The only way to meet the objectives of this group entirely is through hair transplantation surgery, typically using follicular unit grafts. The goals of surgery for Norwood Types VI-VII are the same as for less severe hair loss patterns, but the number of grafts required is commensurately higher.

Advanced Type VII is the most extensive form of hair loss. A narrow, fringe-like band of hair nearly encircles the head anteriorly. The bitemporal regions join the baldness “at the hip,” becoming confluent with loss over the vertex (crown). In some cases, the area becomes completely denuded, achieving the most severe patterning of hair loss. Despite its severity, Type VII loss is relatively asymptomatic. Like other forms of androgenetic alopecia, the skin underneath the bald scalp is smooth, showing no signs of inflammation or scarring. For this reason, even patients with advanced hair loss are amenable to hair restoration.

Ludwig Classification for Female Hair Loss

A separate classification system, the Ludwig Classification, describes female hair loss similarly. Women typically have diffuse thinning throughout the top of the scalp, often sparing the frontal hairline. However, a significant number of women may experience hereditary hair loss. A specialist should evaluate women, as there can be many reasons for hair thinning. In some cases, women may present with male pattern hair loss and would be evaluated similarly to men using the Norwood classification.

Understanding the progression of pattern hair loss is crucial for individuals consulting a hair restoration surgeon. Pattern hair loss follows a somewhat predictable course. The Norwood Classifications help us understand the progression of hair loss in male pattern baldness. It is essential because it helps understand the current state of hair loss in a patient and predict the future extent of hair loss. Regardless of race, the Norwood classification works for all men. It starts with the adolescent maturing from a Norwood 1 (the most minor hair loss) to a Norwood 7 (the most hair loss). Most patients will reach their final adult pattern of hair loss by age 50. Family history, including fathers, grandfathers, and uncles on both the maternal and paternal sides, can provide clues to one’s final pattern of hair loss.

How should you treat hair loss?

Hair Transplantation

The only elective and definitive treatments for Norwood 6-7 hair loss are surgical. Hair transplants are basically taking hair follicles from the donor growth zone (usually the back and sides of the scalp) and moving them to the bald scalp regions. There are two main extraction types for hair transplantation: Follicular Unit Transplantation (FUT) or strip surgery and Follicular Unit Extraction (FUE). Surgeons take a strip of skin with hair follicles from the donor area and  transplans the hair follicles into the recipient’s bald area in FUT surgeries. FUE involves individually extracting hair follicles from the donor area and transplanting them into the bald area. Patients with Norwood 6-7 hair loss may not have enough donor hair to cover large bald areas, but beard and body hair can be viable options for restoration. No hair transplant can guarantee full natural coverage in such extensive balding cases. People with this much hair loss must remember they will need one or two more sessions with one-year intervals.

FDA-approved medications for hair loss:

Oral finasteride is the primary medical intervention that has successfully stopped hair loss. Finasteride is a 5-alpha reductase inhibitor approved by Health Canada and the US FDA for treating men with prostate enlargement. Researchers discovered that finasteride can stop hair loss and help hair regrow. A smaller dose (1 mg) is used for treating hair loss. Surgical techniques like hair transplantation relocate permanent hair follicles from the back and sides of the scalp to the thinning and balding areas. The results, when done well, can be pretty impressive. Some surgical transplant clinics cater almost exclusively to the hair transplant needs of high-profile individuals.

Surgical intervention is the only permanent option for managing hair loss. The two most common surgical procedures in hair restoration are FUT (strip surgery) and FUE. Both procedures typically involve transplanting hair from the back and sides of the scalp to the bald areas on the top. The decision to have a hair transplant is personal, and the patient’s feelings should be the final arbiter. It is essential for the physician to educate the patient and set realistic outcomes to increase the chances of satisfaction post-operatively.

How to manage stress caused by baldness

Finding coping strategies to manage feelings and emotions is essential. Talking to others who have experienced significant hair loss can be helpful. Support groups exist for those dealing with various types of alopecia. Some people find that covering the loss helps boost their confidence. Hats and scarves are simple, comfortable options for casual covering. Customized wigs are available and may be the most helpful choice for many. When exploring wig options, consider that some materials can be itchy and uncomfortable for long periods. Lightweight, breathable wigs that fit the head are often the most comfortable. Some people may choose not to cover their hair loss and embrace the natural look. This choice is entirely personal. Improving overall health indirectly affects hair regrowth. A good diet rich in proteins, healthy carbohydrates, omega acids, and various fruits and vegetables is essential. Vitamins and minerals like biotin, iron, vitamins C and E, and omega-3 fatty acids are key for hair health.  Exercise done at least 3 times a week, adequate sleep, and decreasing stress contribute to overall well-being.

Change your unhealty lifestyle and make home remedies for your hair health

As the management of MPHL evolves from merely covering it up to preventing and treating the problem, more attention will be paid to education and advice concerning diet, nutrition, lifestyle, and stress management. Men with rapid hair loss associated with MPHL should be assessed for underlying health conditions that affect hair growth due to poor health and nutrition. Physicians or related health specialists should provide advice on promoting hair growth and discussing the implications of hair loss on overall health. Hair loss can be an early warning of poor health and upcoming bigger diseases.

Good nutrition is the foundation for good health and good-looking hair. While the literature on the relationship between nutrition and hair loss is limited, it is logical to conclude that a diet deficient in biotin, proteins, or other essential vitamins could be a factor in rapid hair loss associated with advanced MPHL. Men concerned with ‘going bald’ can help prevent accelerated MPHL by improving their dietary intake. A diet with the appropriate balance of essential fatty acids, proteins, vitamins, and minerals will be necessary for men taking TMPID drugs to promote hair growth over a prolonged period.

Norwood 6-7 classes describe extensive hair loss in the front, top, and crown areas. Patients in these classes are usually over 50 years old and have an established, stable pattern of hair loss. It is crucial to assess the patient’s expectations for surgical and medical management and determine their suitability for non-surgical options, such as a hairpiece or tactile/growth factor program. Many Norwood 6-7 patients are satisfied with their current appearance and choose not to pursue surgical restoration. Achieving reasonable density in these extensive areas often requires multiple surgical procedures, and compassionate patient counseling is essential in discussing potential future loss and realistic expectations for hair restoration.

Norwood 6 or 7 classification represents extensive hair loss and balding. Hair restoration in these patients is challenging and generally requires many grafts to cover the balding areas. Setting realistic patient expectations and informing them about the extent of the surgical sessions, the variability of outcomes, and potential future hair loss is essential. Combining non-surgical medical management with surgical restoration can significantly reduce visible balding and improve patient satisfaction. Only patients with extensive donor reserves and laxity should consider undergoing a procedure to lower the hairline and restore the entire Norwood 6-7 area. Autologous programs evaluating the effects of platelet-rich plasma, Acell, and other modalities can enhance graft survival and expedite wound healing for high-tier patients.