Norwood 5 requires 3,000 to 4,500 grafts for a meaningful hair transplant, but full restoration to a pre-balding hairline is not achievable at this stage. Realistic expectations center on improved density and natural framing of the face rather than a return to your hair at age 20.
What Norwood 5 Actually Looks Like
At Norwood 5, the bald area across the frontal and crown zones has merged into one large region. The thin bridge of hair that separates these areas at Norwood 4 is nearly or fully gone. What remains is the classic horseshoe pattern: a band of permanent hair running from above the ears around the back of the head.
Key visual markers at Norwood 5 include:
- Total frontal hairline loss: No defined hairline remains across the top
- Crown and vertex fully exposed: The bald area extends from the forehead to the crown
- Thinning bridge nearly absent: The strip of hair that connected the front to the crown at Norwood 4 has receded significantly
- Donor fringe still intact: The sides and back retain good density in most patients
This level of hair loss affects approximately 15-20% of men over age 50 and roughly 5-8% of men in their 40s.
Honest Graft Numbers and Coverage Limits
The most important number at Norwood 5: you need 3,000 to 4,500 grafts for a single session. At an average of 2.2 hairs per graft, that translates to 6,600 to 9,900 transplanted hairs.
| Metric | Norwood 5 Range |
|---|---|
| Grafts needed | 3,000 - 4,500 |
| Hairs transplanted | 6,600 - 9,900 |
| Sessions typically required | 1 - 2 |
| Safe donor extraction limit | 45% of donor area |
| Graft survival rate | 90 - 95% |
The safe extraction limit of 45% of the donor area is the ceiling that determines what is achievable. Exceeding this limit risks visible thinning in the donor zone, which creates an unnatural appearance. Most patients at Norwood 5 have enough donor supply for one large session and potentially a second smaller session 12 to 18 months later.
What this means in practice: A skilled surgeon can create a natural-looking frontal hairline and provide moderate density across the mid-scalp, but the crown may receive lighter coverage or be left for a second procedure. Prioritizing the front gives the greatest visual impact because it frames the face.
What to Expect from Treatment Combinations
Hair Transplant Alone
A transplant at Norwood 5 can achieve 30 to 50% of the density you had before hair loss. The result is a visible, natural-looking improvement, not a return to full coverage. Surgeons typically design a conservative hairline positioned slightly higher than the original to ensure the graft count covers enough surface area.
Transplant Plus Medical Therapy
Combining surgery with finasteride (1mg daily, which halts loss in 80-90% of men) and minoxidil (5% topical, which supports 40-60% moderate regrowth over 4 to 6 months) preserves existing native hair and can boost the overall appearance of density. This combination is the standard of care at Norwood 5.
PRP as a Supplement
Platelet-rich plasma therapy ($500 to $2,000 per session) can increase hair density by 30 to 40% in treated areas. At Norwood 5, PRP works best as an adjunct to transplant and medication rather than a standalone treatment.
Setting Expectations Before Surgery
The patients who report the highest satisfaction at Norwood 5 are those who understood these realities going in:
- Full restoration is not the goal. The goal is natural-looking improvement that frames your face and allows flexible styling
- The crown is secondary. Most surgeons recommend prioritizing the frontal third and mid-scalp. Crown coverage can follow in a second session
- Medical therapy is not optional. Without finasteride or an equivalent, surrounding native hair continues to thin, making the transplant look increasingly isolated
- Results take 12 to 18 months. Transplanted follicles enter a shedding phase at weeks 2 to 4, then gradually regrow. Final density is not visible until month 12 at the earliest
How Long Do Results Last?
Transplanted hair is taken from the permanent donor zone and retains its resistance to DHT. The grafts themselves are permanent. However, native hair around the transplanted area will continue to thin without medical intervention, which is why ongoing finasteride or minoxidil use is strongly recommended.
Is Norwood 5 Too Late for a Transplant?
No. Norwood 5 is a common and well-suited stage for transplant surgery. The pattern of loss is typically stable enough to plan a long-term design, and the donor area usually has sufficient supply for 3,000 to 4,500 grafts. The key is working with a surgeon who specializes in advanced cases and designs a hairline that will look natural at any future stage.
Want to assess your current Norwood stage? Upload a photo at myhairline.ai/analyze for a free AI-powered analysis of your hair loss pattern, graft estimate, and treatment recommendations.