NHI Medical – World Renowned Hair Restoration Doctors

How Can I Assess My Hair Loss?

One of the easiest signs of hair loss to assess on your own is to compare your current hairline with the hairline of a photograph taken a few years prior. This comparison will give you an approximate idea of the amount of hair loss that has occurred and the speed at which the hair loss is taking place. The unknown factor for most men is the extent of hair loss at the top of the head. Looking in a mirror is one way to appraise the loss at the back of your head. The best way to access thinning hair in this area is take a picture of the back of your head. For an accurate reading, the picture should be taken in good lighting.

Does Hair Loss in Family History Matter?

Knowing your family history of hair loss patterns of your father, grandfather, and brothers will aid in assessing one’s own hair loss. Family patterns may not be hereditary, but it is a reasonable way to estimate what pattern you might develop. Take a look at the patterns of hair loss in the diagrams below to learn more.

A consultation with a physician who specializes in hair restoration is an important first step in assessing hair loss. An examination of the scalp in conjunction with the thorough family history may reveal the extent and trend of the hair loss process. A physician can accurately measure hair bulk and hair volume with a haircheck instrument called the Hair Densitometer.  

What is a Hair Densitometer?

NHI Medical’s very own Dr. William Rassman invented and patented a special magnifying apparatus, the Hair Densitometer. With this device, along with a special Haircheck instrument, the actual volume of hair can be measured. This allows the physician a way to measure the degree of hair loss and hair growth in various areas of the scalp.

This evaluation has the advantage of establishing a baseline from which the hair loss can be graded over time. If you decide to treat the process with a drug like Minoxidil, a repeat examination in 6-12 months may show the effectiveness of the treatment. This exam will reveal the effectiveness of this hair loss treatment.

Careful assessment of the hair loss process is critical to an accurate prediction of the rate and extent of hair loss. Many young men are convinced that they have thinning hair, however after the Hair Densitometer evaluation, there may be no evidence of any hair loss.  

The eye cannot tell a loss of as much as 30% or more of the hair in any particular area of the head. Using the Haircheck instrument can validate or reject this premise regardless of what is seen. Because hair loss causes loss of hair bulk over time, these tests show a general direction of your hair loss. A skilled doctor can project just what hair loss pattern you might develop.

What Other Ways Can I Determine Hair Loss?

The scientific way to assess degree of baldness is to compare your own pattern with the standard patterns described by Dr. O’Tar Norwood (detailed below). These diagrams depict the most common configurations of male pattern baldness. There are seven grades of hair loss in the main series and five grades of a variation called the “A” series. 

Comparing your pictures of the front and back of the head with these diagrams can provide evidence for an accurate evaluation. This will allow a knowledgeable physician to develop a specific Master Comprehensive Plan to address your receding hairline, both short and long term.

The Norwood Scale

Norwood Class 1
Norwood Class 2
Norwood Class 3
Norwood Class 3 Vertex
Norwood Class 4
Norwood Class 5
Norwood Class 6
Norwood Class 7

Norwood Classes Explained

Hair loss always progresses over the years, although the rate can vary dramatically from person to person, and the rate of loss can vary significantly. For example, a man may lose hair rapidly in his early 40s and then stabilize for many years, not showing significant hair loss until his 60s. People who become extensively bald usually show most of their hair loss in their 20s, but though not always. It is a doctor’s job to help you slow this progression down with the use of medications that often work well.

In 1975, Dr. O’Tar Norwood developed a classification of male pattern hair loss that is widely used today to identify hair loss patterns. He divided androgenetic hair loss in men into two common patterns: 1). The Regular Type, characterized by hair loss that begins in two different areas (at the hairline and the top of the head that may gradually merge into one. 2). Type “A” patterns, less common, are characterized by “front-to-back” hair loss. 

In men, 99% of hair loss is genetic. Hair loss that is not genetic usually does not conform to the patterns below. Some women also lose hair according to the patterns described by Norwood.  More commonly women will experience thinning all over, rather than patterned variety, as they lose estrogen. This occurs in almost 50% of women experiencing menopause. Pattern balding does occur in women but when women do not develop the same patterns described by Norwood.The Norwood patterns shown below do not progress from 2 to 7. If your biological father has a Class 7 pattern, it most probably developed before the age of 30, often never going though the other patterns shown below. The hairs that are actually lost in these male patterns form a gradual process. 

One rare but significant form of thinning hair is a condition called Diffuse Un-Patterned Alopecia (DUPA) which will impact the entire scalp. This type of condition may be associated with one of the patterns of hair loss. If this diagnosis is made, the hair should never be transplanted. A doctor will be able to diagnose DUPA by using a hand microscope on the hair in the donor area (the hair around the back and sides of the head). DUPA will show miniaturized hairs in excess of 20% of the hairs in these areas. Unfortunately, this diagnosis is rarely made by hair transplant doctors. These patients receive hair transplants that eventually result in hair loss deformities and hair transplant failures.

A review of the following diagrams will enable one to recognize the pattern of hair loss of any male member in your family tree. While the patterns seen in older relatives may become your pattern, since heredity plays an important role in androgenetic baldness, it is important to know the age at which the family member reached a specific pattern. For example, if your father is totally bald but lost all of his hair in his 20s, and you are 35 with only a Class 4a pattern, his extensive hair loss pattern has little relevance to predicting your future loss.

Regular Norwood Classes

Norwood Class 1

Type I • No recession

  • “Adolescent” or “Juvenile” hairline
Norwood Class 2

Type II • Temporal recession (less than an inch)

  • “Mature” hairline which can be identified by lifting your eyebrows, allowing your forehead to crease, and then placing your finger on the highest crease. The mature hairline is one finger breadth above the highest crease and takes on a gentle V shape.
Norwood Class 3

Type III • Further frontal recession

  • Deeper recession at corners
  • Earliest stage of balding
Norwood Class 3 Vertex

Type IIIv • Hairloss predominantly in vertex (crown)

  • Frontal hairline recession may or may not be present
Norwood Class 4

Type IV • Further frontal hair loss and temporal recession

  • Enlargement of vertex (crown)
  • Solid band of hair across top separating front from vertex (generally ear-to-ear)
Norwood Class 5

Type V • Frontal and temporal areas enlarge further

  • Band separating the two areas becomes narrower and sparser, often disappearing. The fringe area above the ears may remain high.
Norwood Class 6

Type VI • Frontal and vertex balding areas merge into one and increase in size, and the fringe area may lower.

Norwood Class 7

Type VII • Narrow horseshoe band of hair

  • Low hairline in the back and sides (about a 3-inch-high band of hair)
  • This hair is considered permanent lifetime hair, and the zone is called the permanent zone. This is also the area we consider the good donor area for hair transplants since these hairs almost always last the lifetime of the person.

Type A Variant Norwood Classes

  • Frontal recession keeps advancing backwards
  • Single area of balding
  • Eventual extent of balding tends to be more limited than in Regular classes

Type IIa • Entire frontal hairline recedes

Type IIIa • Entire frontal hairline recedes further

Type IVa • Hair loss moves past this “mid-coronal” line

Type Va • Hair loss extends towards the vertex

  • Back part of bald area is narrower than in the regular Norwood VI

How much hair do I need?

NORWOOD CLASSFOLLICULAR UNITSTOTAL UNITS WITH CROWN*
III1000-1500+** –(depends upon extent of recession and thickness of hair shafts)
IIIv1500-2500+1000-1500+ (depends upon extent of recession and thickness of hair shafts)
IIIa1300-1600+
IV1100-2000+1500-2000+ (depends upon extent of recession and thickness of hair shafts)
IVa1500-2500+– (depends upon extent of recession and thickness of hair shafts)
V2000-3000+1900-2500+
Va2200-3000+
VI2000-4000+2800-6000+ (depends upon extent of recession and thickness of hair shafts)
VII4000-8000+– (depends upon extent of recession and thickness of hair shafts)

Over the past few years, we have tried to put a number on the amount of hair and grafts any given person might need. We have found that our patients want more hair than we initially believed. At NHI Medical, patient procedures are planned to ensure natural-looking results after each session. However, some of our patients elect to undergo further sessions to enhance their appearance. A recurring question is how much hair does NHI Medical recommend? The number of grafts recommended is highly dependent on information our doctors gather during a private consultation with you, as well as your hair’s texture and coarseness. Your expectations are also factored in.

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