Can a Norwood 7 Get a Hair Transplant? All You Need to Know: All You Need to Know

Key Takeaways:

• What is the Norwood scale? The Norwood scale a classification system for male pattern hair loss.
  
• What does Norwood 7 mean? Norwood 7 is the most advanced form of male pattern hair loss, leaving the top part
  completely bare and the remaining hair forming a horseshoe-shaped pattern around the sides and back of the head. 
  
• How is it treated? Treatment involves careful assessment and strategic planning to give you the best natural look through a combination of cosmetic camouflage or strategic hair transplantation, including hair potentially taken from other areas of your body.
  
• What can I expect? You should set realistic expectations for the outcome you can achieve with your hair goals given the large area of hair loss that requires coverage.

Hair transplantation may be possible for selected patients with Norwood 7 hair loss. Full density coverage, however, is rarely achievable.

What is Norwood 7 hair?

Norwood 7 hair loss is the most advanced form of male pattern hair loss. The remaining hair forms a horseshoe-shaped band at the sides and the back of the head. The top is usually completely bald. Any remaining hair on top is usually sparse and thin.¹

If you have Norwood 7 hair loss, transplantation can prove to be a challenge because of the large area of the scalp that needs to be covered with hair, whilst only having a limited supply of hair grafts that can be used as a donor from the back and sides of the head.

Who Is a Suitable Candidate?

You will be a suitable candidate if your hair loss is stable and not advancing, and you don’t show signs of rashes, redness, or scaling of the scalp.

Further to this, the back of your head should have sufficient density that hairs may be removed and still maintain a good appearance, thereby avoiding the complication of over-harvesting in hair transplant surgery.^2,3

Hair transplantation is not recommended if you have Norwood 7 hair loss and active scalp disease, insufficient hair remaining to use as a donor, or if the back of your head(donor area) is also suffering from widespread thinning.

How Is the Available Donor Hair Assessed?

A safe donor area is mapped out on the back and sides of your head. This is where hair resides that is resistant to androgens and is therefore unaffected by male pattern hair loss.

The amount and thickness of hair available in your donor area helps in the planning of your surgery.^3. Your surgeon may try to examine your scalp and determine the density of your remaining hair as well as follicular unit composition using a densometer. 

A densometer is a specialised small digital camera that takes a look at an area of 1cm² at a time. The hairs in each area are then counted and their thickness considered to give a density estimate for that area.⁴

The donor area will be examined particularly for hair that shows thinning and shortening (miniaturisation), follicular unit composition and graft density. This is to ensure the safe donor area is calculated correctly to avoid transplanting impermanent hairs.⁵

How Many Grafts Does a Norwood 7 Patient Need?

A rough guide to the amount of grafts needed when you have Norwood 7 hair is as follows:³

• For full scalp coverage: minimum 6000-8000 grafts
• Front and mid-front coverage: 4500-5000 grafts
• Frontal coverage: 3000-3500 grafts
• Frontal forelock only: 1500-2000 grafts
• Crown coverage: 2500-3500 grafts

For comparison, a typical permanent donor zone may allow for the removal of 4000 to 6000 grafts. This can be augmented with hair taken from other parts of your body, such as your beard.

These numbers are an approximation, and there are variable factors which may change the amount of donor hairs available or required in your specific case.

What Results Can I Expect If My Hair Loss is Categorized as Norwood 7?

Can the Entire Bald Area Be Covered?

If you have Norwood 7 type hair, then it is not realistic to expect that your entire bald area can be covered with full density. If spread out over your entire scalp, hair coverage will be relatively thin.

With an advanced Norwood 7 pattern, the area of hair loss is often too large for the available donor supply to provide density at a natural density.

Which Areas Should Be Prioritised and What Density Is Realistically Achievable?

The frontal areas should be prioritised, as stronger frontal coverage will have more of a visual impact than spreading limited grafts over a wider area.

The density achievable will depend on which areas you wish to target with transplantation. The more area you want to cover, the less density that can be expected in the transplanted area.

The key is discussing with your surgeon to agree upon a realistic and achievable outcome, one that is visually appealing to you but still achievable based on your available donor area.

Norwood 7 Hair Transplant Before and After

At the Treatment Rooms London, we specialise in hair transplant surgery for all stages of hair loss, including patients with advanced Norwood 7 hair loss patterns. In our before-and-after gallery, you will see hundreds of cases.

Which Transplant Method Is Recommended?

FUE, FUT or a Combined Approach?

The two main types of hair transplant are:

Follicular unit excision (FUE)

This is a more modern approach where hair follicles are individually punched out from the back of the scalp. They are then placed into ready-made holes in the area of hair loss.

Follicular unit transplantation (FUT)

This is where a strip of hair is removed from the back of the head. Stitches are used to sew up the area where the hair was removed. The strip is then dissected into smaller follicular units, which are placed in the areas of hair loss.

For people with very advanced hair loss, an FUT procedure is recommended for most cases. This is because people with Norwood 7 hair loss have a thin and narrow donor area.

It is more likely to be successful when a thin strip of hair is taken, as the grafts are located more compactly in the safe donor area. FUE grafts are normally taken more spread out, and can be used in combination with an FUT procedure to maximise the amount of hair that can be harvested from the donor area. 

FUE is the preferred method for body hair graft harvest.⁴ If you will need additional hair from the rest of your body, including your beard, then a FUE may be suitable.

Often for advanced Norwood 7 hair loss cases, our clinic advises a combination of  FUT and FUE approaches for best results.

“At our clinic, all patients are counselled about both FUT and FUE hair transplant techniques. Having both procedures as our skill set, we are able to perform advanced surgery for patients who have suffered severe hair loss, often at the stages of Norwood 7.”

Dr Roshan Vara, Co-Founder and Surgeon at The Treamtent Rooms London 

Can Beard or Body Hair Increase Coverage?

It can. If you have very advanced hair loss and you only have a limited supply of hair from the back of your head, the number of grafts can be supplemented from other areas of the body such as the beard. In most cases, around 1000-1500 additional grafts can be added this way.

For example, in a case where the donor scalp area provides 3000 grafts, it may be possible to increase this to 4000 grafts with hair taken from your beard, potentially making it possible to plan more area coverage.³

Will More Than One Procedure Be Necessary?

If you are a Norwood 7 patient who is seeking extensive coverage, it is common to have more than one procedure. 

The first operation will prioritise the hairline, frontal scalp, and, if possible, mid scalp. These areas provide the greatest cosmetic improvement. It may be possible to add density in a later procedure. 

There will usually be a waiting period of at least 9-12 months between procedures. This allows the surgeon to assess the graft survival, final density, and the remaining donor supply.

Using all the donor follicles in one surgery is not a good idea. A reserve will usually be left in case of future need.

“At our clinic, it is common for patients with Norwood 7 hair loss to have multiple hair transplants to achieve an outcome that provides density and naturalness. This requires careful planning and surgical skill to perform to a high level, as the margins for error are so small.”

Dr Roshan Vara, Co-Founder and Surgeon at The Treatment Rooms London 

What Are the Main Risks?

The main risks of hair transplantation in a Norwood 7 patient are:^4,6

• Overharvesting and donor thinning: Removing too many grafts, leaving a patchy “moth-eaten” look or not leaving enough grafts for future use.
  
• Scarring: Donor graft Scars may become visible if not planned with enough caution
  
• Insufficient density: Trying to cover the hairline, mid-scalp, and crown too thinly can produce a result you find unsatisfactory
  
• An unnatural hairline: A mature, age-appropriate hairline should be planned to avoid it from looking unnatural.
  
• Poor graft growth: Growth may be reduced by follicle transection, traumatic handling, dehydration, excessive time outside the body, infection, impaired blood supply, or poor technique.
  
• Grafts harvested outside the safe donor zone: Hairs may be transplanted that are not permanently resistant to androgen effects. This may lead to thinning of transplanted hair.

What Are the Alternatives If Donor Hair Is Insufficient?

If donor hair is not sufficient to cover your hair in a way you would like, these are some alternative options:

1. Scalp micropigmentation
   
   This is where small pigment deposits are placed on the scalp to imitate closely shaved hair follicles. It can create the appearance of a shaved look or make thin coverage look denser. 
   
2. Hairpiece
   
   A hairpiece such as a toupee can provide immediate coverage and greater apparent density. 
   
3. A shaved style
   
   Keeping your hair closely shaved can help hair look more uniform without needing a transplant, with some people even having the few remaining hairs undergo laser removal.

What Should You Ask the Surgeon?

Make sure to ask your surgeon questions such as the method they will use to transplant your hair, how many procedures they think it will take, and also to see a catalogue of previous work they have done on patients with a similar hairline to you.

Seeing a before-and-after montage can help you understand what is realistically achievable and whether that is something you would be happy to proceed with.

Conclusion

Norwood 7 doesn’t rule out transplantation. The goal, however, is cosmetic improvement without expecting restoration of your original density pre-hair loss. The next best step is to have a consultation to assess your suitability for the procedure and to learn more about what can be achieved with your hair. 

References:

1. Norwood OT. Male Pattern Baldness: Classification and Incidence. Southern Medical Journal. 1975;68(11):1359–1365. doi:10.1097/00007611-197511000-00009. PMID: 1188424.PubMed 
   
2. True RH. Is Every Patient of Hair Loss a Candidate for Hair Transplant?—Deciding Surgical Candidacy in Pattern Hair Loss. Indian Journal of Plastic Surgery. 2021;54(4):435–440. doi:10.1055/s-0041-1739247. PMID: 34984081. 
   
3. Chouhan K, Roga G, Kumar A, Gupta J. Approach to Hair Transplantation in Advanced Grade Baldness by Follicular Unit Extraction: A Retrospective Analysis of 820 Cases. Journal of Cutaneous and Aesthetic Surgery. 2019;12(4):215–222. doi:10.4103/JCAS.JCAS_173_18. PMID: 32001965. 
   
4. Crisóstomo M, Dua K, Gupta AK, Mohebi P, True RH, Williams KL Jr. FUE Clinical Practice Guidelines. Hair Transplant Forum International. 2019;29(4):139–150.ISHRS guideline PDF 
   
5. Khunkhet S, Chanprapaph K, Rutnin S, Suchonwanit P. Histopathological Evidence of Occipital Involvement in Male Androgenetic Alopecia. Frontiers in Medicine. 2021;8:790597. doi:10.3389/fmed.2021.790597. PMID: 34881276. 
   
6. Kumaresan M, Mysore V. Controversies in Hair Transplantation. Journal of Cutaneous and Aesthetic Surgery. 2018;11(4):173–181. doi:10.4103/JCAS.JCAS_118_18. PMID: 30886470.