If you are at Norwood 3 Vertex, you are likely a good candidate for hair transplant surgery. The dual-zone pattern (temple recession plus crown thinning) typically requires 2,000 to 2,800 grafts and benefits from a combined surgical and medical approach.
What Makes Norwood 3V Different From Standard Norwood 3
Standard Norwood 3 involves only frontal recession at the temples, requiring 1,500 to 2,200 grafts concentrated in one zone. Norwood 3V adds vertex thinning to the equation, increasing the total graft requirement to 2,000 to 2,800 and introducing the need for dual-zone planning.
This distinction matters for candidacy because your surgeon must consider how to distribute a finite donor supply across two separate areas. The frontal hairline and the crown each have different aesthetic goals, hair direction patterns, and density thresholds for a natural appearance.
For the full breakdown of how Norwood stages progress, see our Norwood scale complete guide.
Candidacy Criteria for Norwood 3V Surgery
Age and Pattern Stability
Most surgeons recommend waiting until at least age 25 before proceeding with transplant surgery. This is particularly important at Norwood 3V because the vertex component suggests your hair loss may be progressing more aggressively than standard frontal-only patterns.
Your loss pattern should show signs of stabilization. If vertex thinning has accelerated recently, your surgeon may recommend 6 to 12 months of medical therapy (finasteride 1mg daily) before surgery. This serves two purposes: it can partially reverse vertex thinning on its own, and it demonstrates how your pattern responds to treatment, improving surgical planning.
Donor Area Requirements
Norwood 3V's 2,000 to 2,800 graft requirement draws more from the donor area than a standard Norwood 3 procedure. Your consultation should include a detailed donor assessment covering:
- Density measurement: The surgeon will count follicular units per square centimeter in several donor zones. A density of 80+ FU/cm2 is considered good.
- Total available supply: Even with 2,800 grafts for this session, you need enough reserve for a potential future procedure if loss progresses.
- Hair caliber: Thicker hair provides greater coverage per graft, potentially allowing a lower total count.
- Donor health: Any miniaturization in the donor area (a sign of diffuse thinning rather than pattern baldness) can disqualify patients or alter the surgical plan.
Medical Suitability
Standard health requirements apply: no uncontrolled bleeding disorders, no active scalp infections, and no conditions that significantly impair wound healing. Smokers should plan to quit at least 2 weeks before and after the procedure to protect graft survival rates (expected at 90-95% under normal conditions).
If you are already on finasteride and tolerating it well (2-4% of men experience sexual side effects), that works in your favor. Surgeons view ongoing medical therapy as a sign of commitment to long-term results.
Strategic Planning: Hairline vs. Crown
One of the most important decisions at Norwood 3V is how to split your grafts between the two zones. Most surgeons recommend prioritizing the frontal hairline because:
- The hairline frames the face and has the most impact on appearance from the front
- Crown thinning often responds well to medication alone (minoxidil 5% twice daily produces 40-60% moderate regrowth at the vertex)
- If future loss continues, the hairline is harder to restore later than the crown
A common allocation is 1,500 to 1,800 grafts for the frontal zone and 500 to 1,000 for the vertex, but this varies based on your priorities and your surgeon's assessment.
Choosing a Procedure Type
All three major techniques work well at Norwood 3V:
- FUE: 0.7 to 1.0mm punch, 7 to 10 day recovery, up to 5,000 grafts per session. No linear scar. Well-suited for patients who want to keep their hair short.
- FUT: Strip method, 10 to 14 day recovery, up to 4,000 grafts per session. Leaves a linear scar but often yields excellent graft integrity.
- DHI: Choi implanter pen, 7 to 10 day recovery, up to 3,500 grafts per session. Offers precise angle control, which is beneficial for recreating the natural whorl pattern at the crown.
For pricing details at this stage, see our guide on Norwood 3V transplant costs.
Next Steps for Evaluating Your Candidacy
The most reliable candidacy assessment comes from an in-person consultation with a board-certified hair restoration surgeon. However, you can start the process now by documenting your current pattern with photographs (front, both temples, and top-down crown view) and beginning a conversation about medical therapy with your doctor.
For a preliminary assessment of your Norwood stage and treatment options, try the free AI evaluation at myhairline.ai. It can help you prepare informed questions for your surgical consultation.
Frequently Asked Questions
What does Norwood 3 Vertex look like?
Norwood 3 Vertex shows deep temple recession forming an M-shape (identical to standard Norwood 3) alongside noticeable thinning or early balding at the crown. You will typically see the scalp through the vertex area, especially under direct light. These two zones of loss occurring simultaneously define the 3V classification and distinguish it from the frontal-only pattern of standard Norwood 3.
How many grafts at 3V?
Norwood 3V patients typically need 2,000 to 2,800 grafts. This range is higher than the 1,500 to 2,200 required for standard Norwood 3 because grafts must cover both the receding temples and the thinning crown. The exact count depends on hair caliber, desired density, and how much vertex work the surgeon recommends versus managing with medication.
Best treatments at 3V?
The optimal strategy at Norwood 3V combines surgery with ongoing medical therapy. A transplant of 2,000 to 2,800 grafts addresses visible loss, while finasteride 1mg daily halts further progression in 80-90% of men (with about 65% seeing regrowth). Minoxidil 5% twice daily is especially effective on vertex thinning, producing 40-60% moderate regrowth. Many surgeons prioritize surgical grafts for the hairline while relying on medication to manage the crown.