Norwood-Hamilton Scale

What is the Hamilton and Norwood Scale?

The Hamilton and Norwood scale is a globally recognized classification system that charts the progression of male pattern baldness. Developed initially by Dr. James Hamilton and later modified and expanded by Dr. O’Tar Norwood, this scale is widely used by hair restoration experts, including the experienced team at Smile Hair Clinic in Turkey.

This scale consists of seven distinct stages, starting from Stage 1, where there is no significant hair loss, to Stage 7, which is characterized by severe hair loss. The Hamilton and Norwood scale enables both the patient and surgeon to identify the current degree of hair loss, predict future patterns, and decide the best course of action.

At Smile Hair Clinic, our skilled surgeons use the Hamilton and Norwood scale to tailor the hair transplant procedure to each individual’s needs. Understanding where a patient falls on this scale helps in determining the number of grafts required, the donor area’s suitability, and the overall strategy for restoring a natural-looking hairline.

The Hamilton and Norwood scale is not merely a tool for assessing hair loss. It’s a comprehensive guide that fosters clear communication between patient and surgeon. By pinpointing a patient’s exact stage of balding it ensures that every hair transplant performed at Smile Hair Clinic is precisely targeted to achieve optimal aesthetic results.

In conclusion, the Hamilton and Norwood scale is an indispensable part of modern hair restoration, providing a standardized language that leads to better patient understanding and more successful hair transplant outcomes. 

The History of the Norwood Scale

Dr. O’Tar Norwood’s pioneering work aimed to provide a standardized method for evaluating the progression of hair loss in men. The scale was created to facilitate communication between physicians, researchers, and patients and to aid in the development of appropriate treatment strategies.

Since its inception, the Norwood Scale has undergone some revisions and refinements, resulting in the Norwood-Hamilton Scale, which incorporates further stages and patterns of hair loss. However, the original Norwood Scale remains widely recognized and used in clinical practice to diagnose male pattern baldness.

The Norwood Scale is an essential tool for understanding and categorizing male pattern baldness. By identifying the stage on the Norwood Scale, individuals can better communicate with healthcare professionals, explore appropriate treatment options, and make informed decisions about addressing their hair loss concerns. Whether through medications, surgical procedures, or non-invasive therapies, there are effective treatments available for men at different stages of male pattern baldness, allowing them to regain their confidence and achieve a fuller head of hair.

How Norwood Scale Stages Affect Hair Transplants?

The Norwood Scale stages significantly influence the planning and success of hair transplant procedures:

1. Donor Hair Availability: The success of hair transplants relies on the availability of donor hair, typically from the back and sides of the head (the donor area). In stages 1 and 2, where hair loss is minimal, donor hair is abundant. However, as hair loss progresses to stages 3, 4, and beyond, the available donor hair may become limited.
2. Expectations and Coverage: Patients should have realistic expectations based on their Norwood Scale stage. Those in stages 3 and 4 can typically achieve satisfying coverage and natural-looking results. However, individuals in stages 5 and beyond may need to accept that complete restoration to a full head of hair may not be achievable in a single procedure.
3. Surgical Techniques: Surgeons may use different techniques based on the Norwood Scale stage. For stages 3 and 4, the Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE) methods are often suitable. However, in more advanced stages, advanced techniques like body hair transplantation or a combination of FUT and FUE may be necessary.
4. Number of Sessions: Advanced Norwood Scale stages may require multiple transplant sessions to achieve the desired coverage and density. Patients should be prepared for the possibility of several procedures over time.
5. Follow-up and Maintenance: Regardless of the stage, patients should understand that post-transplant maintenance is essential. Hair loss can continue in untreated areas, so ongoing treatments and preventive measures may be necessary.

The Norwood Scale is a valuable tool for assessing male pattern baldness and plays a crucial role in determining the suitability and planning of hair transplant surgery. While hair transplants can effectively address hair loss in various stages, the stage on the Norwood Scale significantly impacts the approach, expectations, and success of the procedure. Patients should consult with experienced surgeons who can provide personalized recommendations based on their Norwood Scale stage and goals. With the right guidance and realistic expectations, individuals can achieve natural-looking and satisfying results through hair transplant surgery, regardless of their stage of male pattern baldness.

 

 

What is a regular pattern? 

A regular pattern begins with a bald area on the crown and the temples of the head.

What is a Class A pattern? 

Class A baldness progresses differently, with the hairline receding from the front to the back; there is no bald spot on your crown area (vertex).

Let’s analyze the stage of your hair loss! 

 

Stages of the Norwood-Hamilton Scale

Stage 1:

There is nothing to worry about if you have stage 1. on Norwood Hamilton Scale. Stage 1, or the control stage, does not reveal any signs of hair receding. You may realize that there are only small recessions on your temporal sides. 

Stage 2:

In stage 2, you may get only slight evidence of hair receding, which comes up mostly around your temporal areas. If you feel that your temporal areas are moving back and sparse hair you are getting, you are most likely on stage 2.

Stage 3:

 

It can be claimed that Stage 3 is the very first stage of recession and is very obvious at the temples. So, hair loss becomes visible around Stage 3. Your hairline recedes backward from the temples in this stage, and “M” shapes hair forms. 

 

• Stage 3 Vertex:   

 In Norwood Stage 3 vertex, your hairline looks like stage 2, while your crown area, at the top of your scalp ( vertex), shows apparent hair loss.    

Stage 4:    

The hairline recession is more severe in this stage. On your crown area, you may have sparse or no hair; recession on your front is more profound, and your hair forms a “U” shape. 

Stage 5:      

In Norwood Stage 5, hair loss occurs prominently in the forehead line and the crown area. This pattern has a certain amount of hair between the front and crown area. However, besides the previous stage, the hair is thinner, while the line becomes narrower. There is horseshoe-shaped hair on the head. 

Stage 6: 

 In the 6th stage of hair loss, the distinction between the crown and the front has almost disappeared. The sides of the head may still have hair. However, hair loss extends to both sides, most of the hair is lost, and the rest appears to be scattering. 

Stage 7:   

Norwood Stage 7, which is the last stage of hair loss, the level of baldness is severe and extreme. Hair loss begins to severely damage the side of the head; it leaves no hair on the ears and nape. The hair that does grow will most likely be thin and fragile.

What Causes Male Pattern Hair Loss?

AGA (Androgenetic Alopecia) is men’s most common cause of hair loss. It is colloquially called male pattern hair loss, usual baldness, and masculine hair loss. This type of shedding occurs with the conversion of testosterone, the most dominant androgenic hormone, to dihydrotestosterone by the 5-alpha-reductase enzyme in our hair follicles and by the effective response of our hair follicles, starts on both sides of the head (bitemporal). Spills follow it in the mid-front line. In this process, the hair becomes thinner and weak, transforming from thick and solid roots to barely visible baby hair, and this thinning is called miniaturization. If it is not intervened through treatment during this period, permanent loss will occur.

How is Hair Loss Treated?

Early treatment for hair loss is the most effective, and there are a lot of solutions if you are experiencing hair loss. Let’s look at some of the solutions that you can benefit from. 

Hair Transplantation

Hair transplant has developed over the years and has become one of the most common medical aesthetic procedures in recent years. Many people travel to other countries every year and have a hair transplant operation. The most significant advantage is that it offers permanent solutions to people suffering from hair loss. The result varies according to the person’s suitability for the treatment, expectation, experience of the clinic, and the surgeon performing the procedure. Hair transplantation, which requires personal planning and is performed in experienced clinics, gives good results.

Minoxidil

The active ingredient of Minoxidil was initially used to regulate blood pressure in patients with blood pressure disease. Although it is still not fully understood how it stimulates hair growth, it has received FDA  (U.S. Food and Drug Administration) approval for the treatment of androgenetic hair loss. It has been determined that the hair loss has stopped in around 60% of the patients using it topically. Most patients using Minoxidil experience more intense hair loss than before when they stop taking the drug. For this reason, continuous use of the drug is recommended.

Finasteride

Finasteride (Propecia) is another effective medication for those who deal with male pattern baldness. Does Finasteride stop hair loss? Yes, it does! It helps regrow hair around the temples and crown area of the scalp. 

FAQ

Is Norwood-Hamilton Scale Accurate?

The stages of male pattern baldness are classified using the Hamilton–Norwood scale. The steps are defined by a number ranging from 1 to 7. 

Where Should My Hairline Start?

Naturalness is our main aim as part of the Smile Hair Clinic family. Therefore, during your planning, we follow your natural hairline; stay away from the muscles on your forehead! We advise the natural look. Besides, we give importance to the expectation of our patients. So, do not worry! We will guide you to the best hair transplantation that matches your expectations!

Is Norwood Stage 1 Considered Balding? Do I Need Hair Transplant Operation in Stage 1? 

Norwood Stage 1 is the control stage, so there is no hair loss; we don’t recommend a hair transplant operation for someone in the Norwood 1 stage of hair loss because your existing hair can be damaged.

Is Norwood 2 Considered Balding? 

Norwood 2 is considered the first stage of baldness. It is not precisely balding. But the beginning of the transition from a teenage to an adult male hairline. Hair loss around your temples comes out. 

Can you recover from Norwood 2?

You are lucky if you are in Norwood 2 stage, the “mature” hairline stage. Before your hair loss progresses, you have an excellent chance to stop the upcoming dreadful situation and get back healthy hair.

Does Norwood 3 Mean Balding? 

Stage 3 is the very first stage of recession and is very obvious at the temples. So, hair loss becomes visible around Stage 3. Your hairline recedes backward from the temples in this stage. So, yes, it does mean balding! 

How many grafts for Norwood Scale stage 4?

Norwood Scale fourth stage requires a minimum of 3000 grafts for full coverage. If the donor region is strong and hair loss is entrenched to 4000 hair grafts can be implanted to obtain a dense look.

Can Norwood 5 Get a Hair Transplant?

Yes! Without a doubt, the most effective treatment at this time. You should be aware that the faster you act, the less hair balding you will experience. 

Can a Norwood 6 Get a Hair Transplant?

Hair transplant operations can be carried out during all stages of hair loss. So, a Norwood 6 in an advanced stage of hair loss can also get a hair transplant. 
 

 

Can a Norwood 7 Get a Hair Transplant?

Do not worry if you are in Norwood 7 stage. You still have the chance to have a hair transplant operation. Your doctor will need to take hair from your head and beard to improve hair density in the crown and restore a natural-looking hairline.

According to your expectations and your doctor’s recommendation, a new hairline, temple, and crown design will be redesigned.

Norwood 7 is a severe stage that needs to be fixed initially. Therefore, it takes a little more time, and you may need 2nd operation.