According to the Norwood scale, Norwood 7 is the most advanced stage of male pattern baldness, which accounts for around 95% of hair loss in men [1].
By this stage of hair loss, the hairline recedes enough so that there may only be a band of hair around the back of the head while the top of the head is completely bald. As male pattern hair loss progresses, there is a chance that you will reach stage 7 on the Norwood scale, however, progression time can differ from man to man.
In this article, we will explore:
Norwood 7 is classed as the most advanced form of hair loss, as there is little to no remaining hair left. At this stage, there is a narrow band of hair around the sides and back of the head.
The temples and hairline have completely receded by Norwood 7. The remaining mid-scalp hair of Norwood 6 has now receded, too, leaving a horseshoe-shaped band of hair.
At this point, crown hair loss is extremely advanced, leaving a large bald spot on the crown. There may be very fine hair or sparse hair across the crown, or it may be completely bald, but any hair present is usually very thin [2].
Larry David and Jason Alexander, both of Seinfeld fame, both have stage Norwood 7 hair loss.
It is difficult to tell exactly how long it takes to progress to stage Norwood 7 as progression can happen at different rates. It’s determined by factors such as genetic predisposition and levels of dihydrotestosterone, or DHT (the male hormone that causes hair loss) [3].
Some men find that they reach Norwood 5 or 6, but never reach Norwood 7. Other men reach Norwood 7 very quickly.
Research indicates that the prevalence of Norwood 7 increases with age, from 31% at age 40-55, to 53% at age 65-69, which shows that age plays a role in the progression of hair loss [4].
Individuals who have reached this stage of significant hair loss can still undergo hair transplantation. Even at Norwood 7 you can get a hair transplant, and while you won’t immediately receive a sweeping head of hair, you should at least have a natural-looking hairline restored.
If you have no harvestable hair follicles on your scalp, your surgeon may look to harvest follicles from alternate donor sites to perform a body hair transplant. According to the ISHRS, alternate places such as the beard, chest, back, or pubis are often used as alternative donor sites, with the beard being the most common among these [6].
A good hair transplant surgeon will be sure to assess the safe donor area before harvesting follicles. The safe donor area constitutes how many grafts a surgeon can safely extract in order to avoid hair transplant overharvesting and other hair transplant complications.
Performing a hair transplant procedure for Norwood 7 can be tricky due to the lack of donor hair available on the head. However, a completely bald hair transplant is possible in some instances if there is enough hair remaining that is available to be harvested.
Most hair transplants that require a large number of grafts are carried out using the FUT method. FUT is less arduous and time-consuming than FUE, and the grafts are more likely to survive when extracted using the FUT technique [5].
You may also be able to have an FUE/FUT combination hair transplant. An FUE hair transplant allows for hairs outside of the typical donor site (scalp) to be harvested (for example, from the back, chest, or beard).
This man had an FUE for Norwood 6-7. In the picture on the right, it seems that he now has thick hair across the scalp, with just some light thinning on the crown.
This man was at Norwood 7 in the picture on the left, and is almost completely bald on the crown. After undergoing an FUE transplant he is now at Norwood 4. This is a significant improvement, with hair now visible on the mid-scalp.
When hair loss is at Norwood 7, a fuller hair transplant becomes difficult to perform due to the limited number of grafts.
If there are sufficient harvestable follicles in the donor area, then a hair transplant can usually be performed. However, at Norwood 7, the scalp donor site may provide a sparse supply of follicles.
An experienced hair restoration surgeon may harvest a combination of body and scalp hair follicles for the hair transplant, which would create more grafts and allow more hair growth on the scalp.
A hair transplant at Norwood 7 aims to restore the hairline, temples, mid-scalp, and crown. A fair amount of grafts are needed to cover these areas.
A 4,500 graft to 5,000 graft hair transplant may be needed for Norwood 7 hair loss. This includes the front of the head (hairline and temples) which would need around 2,500 grafts, and the crown, which would need around 1,700 grafts.
To create the illusion of density with a Norwood 7 hair transplant, graft harvesting can be combined with a technique called scalp micropigmentation (SMP) [7].
SMP uses the tattooing method to place a pattern of dots on the scalp. This creates an illusion of hair where no hair exists. This method can be used to build depth and density underneath thin hair, or create the illusion of hair on a bald head [7-8].
This man experienced alopecia totalis (a type of severe hair loss) which had made him completely bald. Figure A shows the effect of the condition, while Figure B shows his scalp after scalp micropigmentation. SMP has created a ‘close shave’ hairline.
It may not be too late to get treatment for male pattern baldness, even if you have extensive hair loss across your head. The team at the Wimpole Clinic is here to support you throughout your hair restoration journey and help prevent further hair loss.
We can explore your treatment options, which for a Norwood 7 will most likely involve a combination of hair restoration surgery using FUT, Finasteride or Minoxidil, as well as SMP to bridge the gap required for those who are completely bald.
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