Norwood Class 7

[willhair]

Dear all.

I just turned into 31. I have always had very dense hair until my 25-26, then I started to loose hair on top and crown while preserving hairline (diffuse pattern hair loss). I had two transplantations of 1000 and 2000 grafts. At the time waiting for the results of the second operation. My question is about estimating my future norwood scale. First of all how can I measure if I am a class 6 or 7? Secondly my rim hair from front to back seems to go down more. Is this common or sign of bad news? I heard that rim hair of 3 inches or less is norwood 7. Is this true? because 3 inches looks like very high.

[willhair]

Dear all.

I just turned into 31. I have always had very dense hair until my 25-26, then I started to loose hair on top and crown while preserving hairline (diffuse pattern hair loss). I had two transplantations of 1000 and 2000 grafts. At the time waiting for the results of the second operation. My question is about estimating my future norwood scale. First of all how can I measure if I am a class 6 or 7? Secondly my rim hair from front to back seems to go down more. Is this common or sign of bad news? I heard that rim hair of 3 inches or less is norwood 7. Is this true? because 3 inches looks like very high.

[Al - Moderator]

If it helps any, I just measured mine. At my ears the side rim hair is about 2 inches. In the back of my head it's about 2.25 inches. I'm 41 years old and consider myself a NW 7 if I didn't have a HT. It's actually now sort of a NW 7, but with some very thin hair in a combover trying to cover the large area and scars. I wish I could just cut it short, but it's really not an option unless you're willing to show your scars.

 

I think a lot of guys who are getting megasessions are going to be in real hair trouble in a few years especially as the megasessions get larger and larger the last few years.

 

I think there's a lot more NW 6 and 7s than some people want to believe and they are a lot younger than you think. I keep hearing here how it won't matter once you're in your 70's, but don't think all those NW 7s are that old. They just look much older than they are because they are NW 7s. It's the same reason most NW 3s want a HT... they think they look much older than they are. Think about it. The NW 7s look much older too. I was a NW 7 at 25, but nobody would have ever guessed I was that age and a lot of people thought I was in the 50 year old range.

[mmhce]

It's the same reason most NW 3s want a HT... they think they look much older than they are.

 

This is so true! I feel I look much older with my NW3.

 

Some people say I look older and some not.

 

It's just that different people have different opinions and the off-colour comments hurt us all.

[Dr. Michael Beehner]

If you even suspect that you might end up a Norwood VII class of hair loss (side fringe borders partway down the side of the head with a narrow fringe of donor hair), you shouldn't even be thinking about "filling in" the bald area. Rather, you should be thinking in terms of using the little donor hair you have to frame the face along with some natural blurring with sparse hair in the alleys between the forelock density of hair and the side fringes. The downhill vertex (crown) in back should almost always be excluded from transplanting if you are to use the donor hair available wisely.

Rather than thinking in terms of uniform density over a large area, the goal is to create GRADIENTS of hair density, with the maximal density being created in the front-central region, which we term the "frontal core." Then the density gradually tails off to each side and toward the back. Sometimes "tacking hairs" are placed in the rear vertex in line with the planned styling pattern of the patient, so the hairs swept back have some other hairs to help "fix" them in position. Needless to say, a styling pattern that sweeps the hair back either straight or, better yet, toward one of the corners, is the ideal one for a man with this much baldness. A good example of a little bit going a long way is Joe Biden. He doesn't have all that much hair up in front, but the way he sweeps it back makes him look from most vantage points as if he has a lot more hair than he actually does. When you see a back view of Biden, you realize how much bald, shiny skin is still there.

If a man is young (20's or early 30's) and there is reason to suspect that he might be heading for a Norwood VII pattern, then it is very foolish to embark on any kind of transplant plan that tries to fill in the bald area.

Mike Beehner, M.D.

[willhair]

downhill

Thank you very much for the reply. Actually my investigation is about whether to suspect I might end up in NW-7 or not. 2 of my uncles are bald but it is like NW-6 definitely not NW-7. http://www.hairtransplantnetwo...PatientID=610&DrID=5 this before photo of your patient looks like the current height of my rim hair. I have more hair on top (because I suffer from diffuse pattern). I cannot see the vertex of the picture so I cannot compare mine with that.

 

As a matter of fact my doctor told me that I am between NW-5 and NW-6 but from the pictures and NW scale labels I can see that this field is open to conflicts. My questions are,

 

1) How can I measure my NW class?

2) What are the signs of going towards NW-7?

3) Are NW-7 people usually people who have diffuse pattern hair loss or loosing from front towards backward?

4) Is there a correlation between progressing towards NW-7 and age?

5) I thought having a higher rim in the front and a little bit lower in the backwards is a sign of NW-7 but the patient in the photo above looks like having exactly this type?

6) Do you agree with the comment that 3 inches and below is NW-7?

 

Thanks in advance

[Dr. Michael Beehner]

Willhair,

There are no numerical measurements or guidelines that I know of related to which Norwood category you fall into, although, as a general rule in my experience, if your width of baldness on top measures across greater than 15cm in distance, you are probably close to or in fact a Norwood VII. One good way to determine a Norwood VII is to look at a photo taken from straight above the head. If you see only bald scalp and don't see the fringe, that patient is a Norwood VII for certain.

If a young man is in his 20's or early 30's and is wondering if he will possibly become a Norwood VII, there are several clues that can help: One is family history, particularly older brothers, father, and maternal grandfather. Another one, at least for the man in his 30's, is the quality of the side fringe. If it has any miniaturization, which is seen by the layman's eye as very early thinning, then you can be fairly certain that the fringe is going to drop further as that man ages. A hair surgeon can tell that by using strong magnification. Anything over 5% miniaturization should arouse suspicion that the area may clear out some day.

As for the men in his 20's, I am on the conservative side and feel that all of these candidates should be transplanted as if they were going to progress to a Norwood VII. The worst errors of judgement are filling in the rear crown and filling in the fronto-temporal recessions aggressively. Some of these 20-ish transplant patients who are transplanted in this manner are someday going to have a very abnormal, freakish appearance.

In two large studies performed around 25-30 years ago, Norwood found that 10% of men in their 60's became Norwood VII's, and Walter Unger found that 20% of men in their late 60's became Class VII's.

Mike Beehner, M.D.

[Take a chance]

Doctor Beehner

 

What about the guys who are in their late 20's early 30's and are already a Norwood 5 or 6. Will they eventually be NW7's? The reason I ask is I'm in my late 20's a NW6 and having a HT soon. I have a lot of work to do but what advice can you give the younger patients. The last thing we want is to be 50 and look like a freak or worse off than before the procedure.

[Dr. Michael Beehner]

Take a Chance,

If you are up near 29 or so, AND your side fringe where it defines you as a Norwood VI is fairly "strong," meaning that on magnification hardly any miniaturization is seen among those hairs, then you are pretty safe having the front 2/3-3/4 of your balding area filled in. The side areas, if they recede a little more over the years, which they probably will, can usually be blurred in with some FU's as you get older, providing you have a reasonable amount of donor hair. This whole matter is a judgement thing and your hair surgeon is in the best position to make this decision and advise you.

Mike Beehner, M.D.