Grades and level of Baldness ( Norwood Scale )

The Norwood classification or Norwood scale is the most popular classification of grades of baldness worldwide. It was first put down on paper by Dr. O’tar Norwood in 1975.
In brief they are:
Grade 1/Type1: There is no hair loss. This is the adolescent hairline or the juvenile hairline which at times persists in adults. The hairlines sits on the uppermost brow crease. The frontotemporal expanse shows minimal hair loss which looks natural and pleasing because it is appropriate for age. I would say this is a normal hairline. Many would say genetic baldness begins at Grade 2.

Grade 2/Type 2: The hairline along the tuft is normally situated but s one fingertip breadth behind the upper brow crease of Type 1. The recession is appropriate for age and defines the masculinity of an individual. The mid coronal plane is the reference point. If you draw a line in the coronal plane 2 cms in front of the external auditory meatus (ear canal), the fronto-temporal recession should not touch it or go beyond. If it does, it enters Grade 3 territory. No hair transplant is advised if this is minimal but if the recession gets deeper (hairlines staying normal), hair transplant may be needed in selected patients.
In Grade 2 a/Type 2a: when the whole hairline recedes uniformly along forehead till mid-coronal point. (we shall discuss this in the individual video for grade 2)

Grade 3/Type 3: The recession happens beyond the coronal plane 2 cms ahead of the ear canal. This is the first clear cut grade where hair transplant is always recommended when the patient is keen.
Grade 3 (Vertex)/ Type 3 (Vertex) indicates baldness primarily of the crown area with or without features of recession along the hairline which can be of type 1-3 (but not exceeding features of type 3 ) on Norwood scale.
Type 3 a is like type 2 a but touching the MCL.

Grade 4/ Type 4: This denotes further balding and a bald crown larger than 3 inches in diameter. There is an intervening swathe of good quality hair between the fronto-temporal recession and the crown balding. If this region has thin hair or good quality hair but width less than or equal to 3 inches, it becomes grade 5 baldness.
Type 5 a denotes effacement of the frontal peninsula of hair till beyond the MCL

Grades 5 / Type 5: The hair loss has now reached an advanced stage around the temples and on the crown but there is a bridge (less than 3 inches) of hair thinning or otherwise separating the 2 zones areas of balding. It appears that this bridge is breaking up and effacing.

Grades 6 / Type 6: This is slick baldness. Horseshoe pattern of baldness. Hair remains but it is like a wreath around the back of the head. No bridge of hair separates the 2 bald areas of balding. Both zones have coalesced. The crown has expanded to the edge of the horizontal and vertical confluence of the shape of the skull.

Grade 7/ Type 7: Men with such advanced hair loss can be candidates for a hair transplant, but with such a restricted donor area the transplant may be limited to restoring the hairline while the crown remains bald.

There are 2 other patterns:

1. DPA- diffuse patterned alopecia
2. 2. DUPA- diffuse unpatterned alopecia

The lesser talked about grades of balding.
This is a challenge and especially during online consulation it can be actually missed out due to proper lighting issues. If missed in the young it can be disasterous if a hair transplant is done.
We shall talk about them later in an individual video but the essential difference is that DPA patients make good candidates for a hair transplant , whereas DUPA patients do not.
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