Norwood 3 affects the temples only. Norwood 3 Vertex (3V) adds crown thinning to the same temple recession, creating two separate zones of loss that require different treatment strategies. The distinction matters because it changes your graft count, your surgical plan, and your medication priorities.
Side-by-Side Comparison
| Feature | Norwood 3 | Norwood 3V |
|---|---|---|
| Temple recession | Deep, M-shape | Deep, M-shape (same) |
| Crown involvement | None | Thinning or small bald spot |
| Zones affected | 1 (frontal) | 2 (frontal + vertex) |
| Grafts needed | 1,500-2,200 | 2,000-2,800 |
| Cost (US, FUE) | $6,000-$13,200 | $8,000-$16,800 |
| Cost (Turkey, FUE) | $1,500-$4,400 | $2,000-$5,600 |
| Medication priority | Moderate | High (crown responds well) |
| Progression risk | Moderate | Higher (two active zones) |
| Surgery complexity | Standard | Requires zone balancing |
Understanding Norwood 3
Standard Norwood 3 is defined by deep recession at both temples. The temple points have pulled back 2-4 centimeters from the original juvenile hairline position, creating a pronounced M-shape or U-shape. The key characteristic: the crown is unaffected.
Visual Markers of Norwood 3
- Clear M-shape visible without manipulating the hair
- Frontal forelock (hair in the center front) remains intact
- Crown density appears normal when viewed from above
- Recession is typically symmetrical, though minor asymmetry is common
- Hair density between the receded temples may be slightly reduced but not obviously thin
Who Gets Standard Norwood 3
Men who develop frontal-dominant hair loss typically progress through Norwood stages 1, 2, and 3 without significant crown involvement. This pattern is more common in men whose hair loss begins later (after 30) and those with certain genetic profiles that favor frontal recession over vertex thinning.
Understanding Norwood 3 Vertex
Norwood 3V has everything Norwood 3 has, plus visible thinning or an emerging bald spot at the crown (vertex). The crown component is what distinguishes it. Dr. O'Tar Norwood added this subtype in his 1975 revision specifically because crown involvement at this stage changes the clinical picture significantly.
Visual Markers of Norwood 3V
- Same temple recession as standard Norwood 3
- Visible scalp at the crown when viewed from directly above
- The crown thinning may appear as a small circular area or a diffuse region
- Hair miniaturization (thinner, lighter hairs) visible at the vertex
- A band of normal-density hair still separates the temple recession from the crown thinning
Why Crown Involvement Matters
The crown adds complexity in three ways:
More grafts needed. Addressing two zones requires 500-600 additional grafts compared to temples alone. The crown needs its own allocation, and surgeons must balance density distribution between the front and back.
Faster progression risk. Active loss in two zones suggests more aggressive androgenetic alopecia. Men with 3V are statistically more likely to progress to Norwood 4 and 5 than men who remain at standard Norwood 3 for the same duration.
Different medication response. Crown hair responds more favorably to finasteride and minoxidil than frontal hair. This creates a strategic opportunity: medication can often stabilize or reverse the crown thinning while surgery handles the temples.
Graft Distribution Strategy
How a surgeon distributes grafts differs substantially between these two stages.
Norwood 3: All Grafts to the Front
With 1,500-2,200 grafts and only one zone to cover, the surgical plan is straightforward. All grafts go to rebuilding the temple angles and reinforcing the frontal hairline. Surgeons can achieve higher density in a single zone because the graft supply is not split.
Typical Norwood 3 distribution:
- Temple points: 400-600 grafts per side
- Frontal hairline reinforcement: 300-600 grafts
- Transition zone behind hairline: 200-400 grafts
Norwood 3V: Splitting Between Two Zones
With 2,000-2,800 grafts split across two zones, the surgeon faces a distribution decision. The standard approach prioritizes the frontal hairline because it has the greatest visual impact (it is what you see in the mirror), then allocates remaining grafts to the crown.
Typical Norwood 3V distribution:
- Temples and frontal hairline: 1,200-1,800 grafts (60-65% of total)
- Crown: 800-1,000 grafts (35-40% of total)
The crown typically receives fewer grafts because:
- Medication (finasteride + minoxidil) can handle early crown thinning effectively
- Crown hair grows in a circular pattern, requiring fewer grafts for visual coverage
- If progression continues, the crown will need more grafts later anyway
When to Prioritize the Crown Instead
Some patients care more about the crown than the hairline, particularly those who:
- Wear their hair forward, covering temple recession
- Work in environments where others frequently see the top of their head
- Have minimal temple recession but noticeable crown thinning
In these cases, a surgeon may shift the allocation to favor the crown, or recommend medication only for the temples while transplanting the crown.
Medication Response Differences
Finasteride and minoxidil work differently depending on the zone.
Crown (Vertex) Response
The crown is the most medication-responsive area of the scalp. Finasteride (1mg daily) halts vertex hair loss in 80-90% of men and produces visible regrowth in approximately 65%. Minoxidil (5% topical) adds another 40-60% regrowth response. Combined therapy at the crown can sometimes restore enough density that surgical grafting becomes unnecessary.
Temple (Frontal) Response
Temples are less responsive to medication. Finasteride still halts progression in most men, but regrowth of lost temple hair is less common and less dramatic than at the crown. Minoxidil has a modest effect on frontal hair but does not rebuild a receded temple point.
Strategic Medication Approach for 3V
| Zone | Medication | Expected Outcome |
|---|---|---|
| Temples | Finasteride + minoxidil | Halt progression, minimal regrowth |
| Crown | Finasteride + minoxidil | Halt progression, significant regrowth possible |
This difference is why many surgeons recommend that Norwood 3V patients start finasteride 6-12 months before surgery. If the crown responds well to medication, the patient may only need temple grafts (reducing cost and donor usage). If it does not respond, both zones are planned for transplantation.
Cost Implications
The additional 500-600 grafts for Norwood 3V over standard Norwood 3 add to the total cost.
| Region | Norwood 3 Cost | Norwood 3V Cost | Difference |
|---|---|---|---|
| USA ($4-$6/graft) | $6,000-$13,200 | $8,000-$16,800 | $2,000-$3,600 |
| UK ($3-$5/graft) | $4,500-$11,000 | $6,000-$14,000 | $1,500-$3,000 |
| Turkey ($1-$2/graft) | $1,500-$4,400 | $2,000-$5,600 | $500-$1,200 |
| India ($0.50-$1.50/graft) | $750-$3,300 | $1,000-$4,200 | $250-$900 |
The percentage increase is 25-35% more for 3V than for standard 3. For patients considering treatment abroad, the absolute dollar difference is smaller but the proportional increase remains similar.
Progression Outlook
Norwood 3 Progression
Without treatment, standard Norwood 3 progresses to Norwood 4 in 2-5 years on average. Some men stabilize at Norwood 3 for decades, particularly those whose hair loss began after age 35. With finasteride, 80-90% of men halt progression regardless of stage.
Norwood 3V Progression
Norwood 3V tends to progress faster than standard Norwood 3 because two zones of active loss indicate higher androgen sensitivity or more aggressive genetic programming. Without treatment, progression to Norwood 4 or 5 typically takes 2-4 years. The crown component often accelerates, potentially merging with frontal recession sooner.
This faster progression makes medication more urgent for 3V patients. Starting finasteride at the 3V stage can prevent the need for larger (and more expensive) transplant sessions later.
How to Tell Which Stage You Are
The distinction between Norwood 3 and 3V comes down to one question: is your crown thinning?
Check your crown:
- Stand in front of a mirror and hold a second mirror behind your head
- Part your hair at the crown and look for visible scalp
- Compare crown density to the density on the sides of your head
- Check old photos for comparison. Crown thinning often happens gradually
If your temples are receded but your crown looks the same as it did five years ago, you are likely a standard Norwood 3. If the crown is thinning, you are a 3V.
For a more precise assessment, upload a photo at myhairline.ai/analyze. The AI analysis evaluates both the frontal and vertex zones independently, identifying whether crown involvement changes your staging from Norwood 3 to Norwood 3V and adjusting graft recommendations accordingly.