Norwood 3 Vertex requires 2,000 to 2,800 grafts when both the hairline and crown are treated in one session. The zone split used by experienced surgeons is approximately 40% to the hairline and temples, 25% to the mid-scalp bridge, and 35% to the crown. Understanding what drives this number helps you evaluate surgical plans and spot estimates that are out of range.
Why 3V Requires More Grafts than Standard Norwood 3
Standard Norwood 3 addresses only the hairline and temple recession, requiring 1,500 to 2,200 grafts. Norwood 3 Vertex adds a crown zone that must also be covered, increasing the total area requiring grafts by 30 to 50% depending on the size of the crown spot.
At 3V, the crown spot typically measures 3 to 6 cm in diameter. At a target density of 30 to 35 follicular units per square centimeter, this zone alone requires 700 to 1,000 grafts. Combined with the hairline and mid-scalp requirements, total graft count rises to the 2,000 to 2,800 range.
The ISHRS estimates that the average graft requirement across all procedures performed in 2023 was approximately 2,400 grafts, placing 3V patients squarely in the mid-range of complexity.
The Three-Zone Model for Graft Distribution
Zone 1: Hairline and Temples (40% of Total)
The frontal hairline and temporal recession form the most visible zone. At Norwood 3V, the hairline shows the same deep M-shape recession as standard Norwood 3.
For a 2,400-graft total session, Zone 1 receives approximately 960 grafts. These are distributed as:
- Transition zone (leading edge of hairline): Single-hair follicular units at 15 to 20 FU/cm2
- Hairline zone: Mix of 1 and 2-hair units at 25 to 35 FU/cm2
- Temple recession fill: Primarily single and 2-hair units at lower density
The hairline zone requires the finest and most precise graft placement because it frames the face. Any technical errors here are the most visible.
Zone 2: Mid-Scalp Bridge (25% of Total)
The mid-scalp bridge is the strip of hair between the hairline and the crown. At Norwood 3V, this area retains density but may show early miniaturization that is detectable under dermoscopy.
For a 2,400-graft session, Zone 2 receives approximately 600 grafts. These are placed at moderate density (30 to 35 FU/cm2) using 2 and 3-hair units. The goal is to reinforce the bridge against future thinning, not to fully restore it (since it is not yet bald).
Some surgeons choose to use medication to protect the mid-scalp bridge rather than grafting it at 3V, arguing that using grafts here before they are needed depletes donor supply unnecessarily. Both approaches are defensible and depend on the patient's projected progression rate.
Zone 3: Crown Vertex (35% of Total)
The crown zone at 3V is typically a circular or oval area of thinning ranging from early diffuse thinning to an established bald patch.
For a 2,400-graft session, Zone 3 receives approximately 840 grafts. Crown graft density targets are typically 20 to 30 FU/cm2, lower than the hairline, because:
- The crown's natural hair growth pattern (radiating outward from the whorl) means each hair covers more surface area when viewed from above
- Over-dense crown grafting at 3V risks looking unnatural if surrounding native hairs continue to thin
- Lower initial density preserves donor supply for future sessions if the crown spot expands
Factors That Shift the Graft Count
The 2,000 to 2,800 range is an estimate, not a fixed number. The following factors move the count up or down:
Factors That Increase Graft Count
| Factor | Effect on Count |
|---|---|
| Fine hair (below 50 microns shaft diameter) | +10 to +20% |
| Light hair color on light skin (low contrast) | +5 to +15% |
| Straight hair (no curl to expand coverage) | +5 to +10% |
| Large crown spot (above 5 cm diameter) | +200 to +400 grafts |
| Patient preference for maximum density | +200 to +500 grafts |
Factors That Decrease Graft Count
| Factor | Effect on Count |
|---|---|
| Coarse hair (above 70 microns shaft diameter) | -10 to -15% |
| High contrast (dark hair, light skin) | -5 to -10% |
| Curly or wavy hair | -10 to -15% |
| Small crown spot (under 3 cm diameter) | -200 to -400 grafts |
| Staged approach (crown addressed separately later) | -700 to -1,000 grafts |
Single Session vs. Staged Approach
Single Session (Full Coverage)
Treating both the hairline and crown in one session maximizes efficiency and avoids a second recovery period. For patients over 35 with a stable pattern, this is often the preferred approach.
Advantages:
- One recovery period
- Hairline and crown restored simultaneously
- Cost-effective per graft if clinic pricing is per-graft
Disadvantages:
- Higher total graft count depletes donor supply faster
- Crown grafts may be placed into an active loss zone, requiring future touch-up
Staged Approach
Treating the hairline now and the crown in a second session 12 to 24 months later allows crown loss to stabilize before committing grafts to that zone.
Advantages:
- Crown extent is clearer at session two, allowing more precise placement
- Smaller first session reduces immediate cost and recovery
- Medication has time to work on the crown before the surgical decision is made
Disadvantages:
- Two separate recovery periods
- May be more expensive total if clinic charges fixed fees rather than per-graft
For patients under 30, most ISHRS surgeons recommend the staged approach at 3V, particularly if finasteride has not yet been tried or has only been used for less than 12 months.
Graft Quality: Not All Grafts Are Equal
The 2,000 to 2,800 graft count assumes standard follicular unit grafts averaging 2.0 to 2.2 hairs per graft. Some variation in graft quality affects the effective hair count delivered:
- A session of 2,400 grafts averaging 2.0 hairs per graft delivers 4,800 hairs
- A session of 2,400 grafts averaging 2.4 hairs per graft delivers 5,760 hairs
Surgeons who selectively place single-hair grafts at the hairline and 2-3 hair grafts in the mid-scalp will produce a more natural result than those who place grafts uniformly.
Ask your surgeon what the average hairs-per-graft is in their typical session for patients at your stage. A figure below 1.8 may indicate poor graft selection or harvesting practices.
How Donor Supply Limits Graft Count at 3V
At Norwood 3 Vertex, the graft requirement of 2,000 to 2,800 is well within the safe extraction capacity of most patients. A typical donor zone of 100 cm2 at average density (75 FU/cm2) contains approximately 7,500 follicular units, of which 40% (3,000 units) can be safely extracted without visible thinning.
For the first procedure at 3V, this means donor supply is generally not a limiting factor. However, if the patient progresses to Norwood 5 or 6, future procedures may require an additional 3,000 to 5,000 grafts. Responsible planning at 3V accounts for this entire projected need, not just the immediate session.
Use myhairline.ai for a free AI-based assessment of your current Norwood stage and a preliminary estimate of the graft range appropriate for your pattern.
FAQ
How many grafts does Norwood 3 Vertex require?
Norwood 3 Vertex typically requires 2,000 to 2,800 grafts when both the hairline and crown are addressed in a single session. The standard zone split is approximately 40% to the hairline, 25% to the mid-scalp, and 35% to the crown. Patients who address only the hairline at this stage may require 1,500 to 2,200 grafts, reserving crown coverage for a later procedure.
What is the zone split for grafts at Norwood 3 Vertex?
The recommended graft allocation at Norwood 3 Vertex is: 40% to the hairline and temples (800 to 1,100 grafts), 25% to the mid-scalp bridge (500 to 700 grafts), and 35% to the crown vertex zone (700 to 980 grafts). This distribution addresses all three zones while maintaining sufficient density in each area.
Does hair type affect graft requirements at Norwood 3 Vertex?
Yes, significantly. Patients with coarse or curly hair require fewer grafts than those with fine straight hair to achieve equivalent visual density. Coarse hair can cover a given area with 10 to 15% fewer grafts, while fine hair may require 10 to 20% more grafts. Hair color contrast with skin tone also affects perceived density.