Norwood 6: What It Looks Like

Norwood 6 is defined by a large, continuous bald area spanning the entire front, top, and crown of the scalp, with no remaining bridge of hair between the frontal and vertex zones. Treatment requires 4,000 to 6,000 grafts (typically across two sessions), with costs ranging from $4,000 in Turkey to $36,000 in the United States.

What Norwood 6 Looks Like: The Visual Markers

Norwood 6 represents one of the most advanced stages of androgenetic alopecia. The key visual characteristics are:

• Complete frontal-to-crown merger: The bald area extends uninterrupted from the frontal hairline all the way to the crown. There is no remaining bridge or island of hair connecting the front to the back
• Widened bald area: The bald zone is wider than at Norwood 5, extending laterally toward the ears. The temporal recession extends further than at previous stages
• Narrower horseshoe fringe: The permanent hair band along the sides and back is thinner (vertically narrower) than at Norwood 5. The superior border of the fringe sits lower on the head
• Possible nape thinning: Some Norwood 6 patients also show early thinning at the nape (retrograde alopecia), which further reduces the available donor zone
• Visible scalp throughout top: Under any lighting condition, the scalp is fully visible across the top of the head with no residual vellus or thin hair coverage

Norwood 6 vs. Norwood 5: The Key Differences

The transition from Norwood 5 to Norwood 6 typically takes 3 to 7 years without treatment. The primary changes are the complete loss of any residual bridge hair, widening of the bald area laterally, and narrowing of the donor fringe.

Norwood 6 vs. Norwood 7

Norwood 7 is the final stage of the Hamilton-Norwood scale. The difference between 6 and 7 is the extent of the remaining fringe: at Norwood 7, the horseshoe band is very narrow and sits close to the ears, with significant thinning even within the fringe itself. Norwood 6 retains a more substantial fringe that still has good density for donor harvesting.

How Norwood 6 Is Classified

The Hamilton-Norwood Scale, developed by James Hamilton in 1951 and revised by O'Tar Norwood in 1975, describes Norwood 6 as:

Norwood 6: The bridge of hair between the frontal and crown areas has been lost. Hair loss on the sides extends farther laterally, and the bald area expands in both depth and width. The remaining hair forms a horseshoe pattern that is narrower than at Stage 5.

There is no 6A variant in the standard classification. The 6A designation is sometimes used informally when the lateral recession is more pronounced than the crown expansion, but this is not part of the official system.

Who Reaches Norwood 6

Approximately 10-15% of men over age 50 are classified at Norwood 6 or beyond. The stage is most common in men aged 50 to 70, though aggressive genetic patterns can reach Norwood 6 as early as the late 40s.

Risk factors for progression to Norwood 6 include:

• Strong bilateral family history: Hair loss on both maternal and paternal sides
• Early onset: Men who reached Norwood 3 before age 30 are more likely to progress to Norwood 6
• High DHT sensitivity: Genetically determined follicle sensitivity to dihydrotestosterone
• No medical intervention: Men who never used finasteride or minoxidil progress through the stages faster than those who did

Self-Assessment: Are You Norwood 6?

Use these criteria to assess whether you are at Norwood 6 versus an adjacent stage:

You are likely Norwood 6 if:

• There is no hair (not even thin or vellus hair) connecting the front of your scalp to the back
• The bald area extends well beyond the crown, with lateral recession reaching toward the ears
• The donor fringe above your ears is narrower than a fist's width (roughly 6-10 cm)
• The bald area covers approximately 65-75% of the total scalp surface

You may still be Norwood 5 if:

• You can see any thin or miniaturized hair forming a bridge between the frontal and crown zones
• The lateral extent of the bald area has not yet reached toward the ears

You may be Norwood 7 if:

• The donor fringe is less than 5 cm high
• Visible thinning exists within the fringe itself
• The bald area covers more than 75% of the scalp

For a more precise assessment, upload a photo at myhairline.ai/analyze for an AI-powered Norwood classification.

Graft Requirements at Norwood 6

The bald area at Norwood 6 is substantially larger than at Norwood 5, requiring 4,000 to 6,000 grafts for meaningful coverage.

Why Two Sessions Are Usually Necessary

Most transplant techniques have per-session limits:

• FUE: Up to 5,000 grafts per session
• FUT: Up to 4,000 grafts per session
• DHI: Up to 3,500 grafts per session

A Norwood 6 patient needing 5,000+ grafts will typically exceed what can be comfortably extracted and implanted in a single sitting. The standard approach:

• Session 1: 3,000-4,000 grafts focused on the frontal hairline and mid-scalp
• Session 2 (12-18 months later): 1,500-2,500 grafts focused on the crown and density fill

Splitting across two sessions also allows the surgeon to evaluate first-session growth before planning the second, and gives the donor area time to recover between extractions.

Treatment Options at Norwood 6

Surgical: Hair Transplant

A hair transplant remains the only way to grow actual hair in areas where follicles have been permanently lost. At Norwood 6, the surgical approach requires careful planning to maximize the impact of the available donor supply.

FUE at Norwood 6:

• Punch size: 0.7-1.0mm
• Recovery: 7-10 days per session
• Per session: up to 5,000 grafts
• Graft survival: 90-95%
• Advantage: No linear scar, option to wear hair very short

FUT at Norwood 6:

• Strip excision from the donor area
• Recovery: 10-14 days per session
• Per session: up to 4,000 grafts
• Graft survival: 90-95%
• Advantage: Higher graft yield per session in some cases, donor area can still be used for FUE later

DHI at Norwood 6:

• Choi implanter pen for simultaneous site creation and graft insertion
• Recovery: 7-10 days per session
• Per session: up to 3,500 grafts
• Graft survival: 90-95%
• Advantage: Precise angle and depth control, ideal for the hairline edge

Combined FUT + FUE approach: Some surgeons recommend FUT for the first session (to maximize strip graft yield) followed by FUE for the second session (to extract additional grafts from the remaining donor area). This combination can maximize total lifetime graft availability, which is particularly valuable at Norwood 6 where every graft counts.

Realistic Surgical Expectations at Norwood 6

Full restoration to pre-balding density is not achievable at Norwood 6. The goal is a natural-looking result with:

• A defined frontal hairline appropriate for the patient's age (typically 8-10 cm above the glabella)
• Moderate density across the mid-scalp (25-35 FU/cm2)
• Lighter coverage at the crown (20-30 FU/cm2)
• Overall density of approximately 25-40% of original hair density

This level of coverage creates a significant cosmetic improvement and allows flexible hairstyling, but it does not replicate a full head of hair.

Medical Therapy

Medical therapy at Norwood 6 serves two functions: preserving remaining native hair and supporting transplanted graft growth.

Finasteride (1mg daily):

• Halts further loss in 80-90% of men
• Produces regrowth in 65% (modest at this stage, primarily in thinning zones rather than fully bald areas)
• Critical for protecting the donor area from potential thinning
• Sexual side effects in 2-4% of users
• Cost: $120-$360/year (generic)

Minoxidil (5% topical, twice daily):

• 40-60% of users experience moderate regrowth
• Onset at 4-6 months
• Works on miniaturized but still-living follicles
• Best applied to thinning zones at the periphery of the bald area
• Cost: $60-$180/year (generic)

PRP therapy:

• $500-$2,000 per session
• 30-40% density increase in treated zones
• Most effective as a post-transplant adjunct to boost graft growth and support native hair in the transition zone
• Protocol: 3 sessions in year 1, then 1-2 maintenance sessions per year

Non-Surgical Cosmetic Options

Scalp Micropigmentation (SMP): SMP creates the appearance of a closely shaved head by tattooing pigment dots into the scalp. At Norwood 6, SMP can:

• Define a hairline across the entire frontal zone
• Create the illusion of full scalp coverage when the patient shaves the remaining hair short
• Be combined with a transplant (transplant provides real hair in the front, SMP adds density appearance throughout)
• Cost: $2,000-$5,000, with touch-ups every 3-5 years

Hair Systems: Modern hair replacement systems provide immediate full coverage. At Norwood 6, the large bald area may require a larger system, but the technology handles this well. Annual cost: $600-$4,800 plus maintenance supplies.

Cost Breakdown by Country

Norwood 6 requires 4,000 to 6,000 grafts, making cost differences between countries even more pronounced than at earlier stages.

Total Surgical Cost by Region

Total First-Year Treatment Cost

Medical Tourism Considerations

For Norwood 6 patients requiring two sessions, the travel logistics are more complex. Options include:

• Two trips: Return to the same clinic 12-18 months later for session 2. Doubles travel costs but allows evaluation of first-session growth
• Mega-session in one trip: Some clinics offer extended multi-day procedures (2-3 days) to maximize graft count in a single trip. This reduces travel cost but may push against safe per-session limits
• Combination clinic: FUT on day 1, FUE on day 2, at clinics that offer combined approaches. This can yield 5,000-7,000 grafts across two consecutive days

Donor Area Considerations at Norwood 6

The donor area is under more pressure at Norwood 6 than at any previous stage. The safe extraction limit (45% of follicular units) becomes the hard ceiling that determines what is achievable.

Typical Donor Supply Calculation

For a Norwood 6 patient with average donor characteristics:

• Usable donor area: 120-160 cm2 (smaller than Norwood 5 due to narrower fringe)
• Average density: 65-90 FU/cm2
• Total follicular units: 7,800-14,400
• Safe extraction (45%): 3,510-6,480 grafts

Patients at the lower end of this range may not have enough supply for the full 6,000 grafts. In these cases, the surgeon must prioritize: the frontal hairline and mid-scalp receive the bulk of the grafts, and the crown receives lighter coverage or is addressed with SMP instead.

Body Hair as a Supplement

When scalp donor supply is insufficient, beard and chest hair can provide supplemental grafts:

• Beard: 1,000-2,000 additional grafts, survival rate 70-80%
• Chest: 500-1,000 additional grafts, survival rate 70-80%
• These are secondary options with lower survival rates than scalp grafts (90-95%)

Long-Term Management at Norwood 6

Preventing Progression to Norwood 7

Without treatment, Norwood 6 progresses to Norwood 7 over 5 to 10+ years. The primary change is further narrowing and thinning of the donor fringe. Finasteride (1mg daily) is the most effective way to slow this progression and protect the donor area for potential future procedures.

Maintaining Transplant Results

Transplanted grafts come from the permanent donor zone and are inherently DHT-resistant. The grafts themselves are permanent. However:

• Native hair in the transition zones continues to thin without medication
• The contrast between transplanted and native hair increases over time if medications are not used
• A second touch-up session may be desired 5-10 years post-transplant as native hair continues to recede

The standard maintenance protocol: finasteride (1mg daily) plus minoxidil (5% topical, twice daily). Annual cost: $180-$540 for generic medications.

Psychological Considerations

Norwood 6 is an advanced stage that can significantly affect self-image and confidence. Research consistently shows that hair loss at Norwood 5-7 has a measurable impact on self-reported quality of life. Seeking treatment (surgical, medical, or cosmetic) is a valid and common response.

When evaluating treatment options, prioritize approaches that align with your lifestyle, budget, and long-term goals. There is no single correct answer. A transplant, medical therapy, SMP, a hair system, or embracing the bald look are all legitimate choices.

Next Steps

1. Confirm your Norwood stage: Upload a photo at myhairline.ai/analyze for a free AI-powered classification
2. Understand your donor supply: Read the complete Norwood scale guide for context on how your stage fits within the broader progression
3. Get consultations: Schedule evaluations with 2-3 surgeons who have documented experience with Norwood 6 cases
4. Start medical therapy: If you have not yet started finasteride and minoxidil, discuss these with your physician. Early medication use protects existing hair and preserves surgical options
5. Review costs: See the Norwood 6 cost breakdown for a detailed financial analysis by country and technique