Norwood 7 is the most advanced stage of male pattern baldness on the Hamilton-Norwood scale. At this stage, only a narrow band of hair remains in a horseshoe pattern around the sides and back of the head, and the entire top of the scalp (frontal, mid-scalp, and crown) is completely bald.
This is the comprehensive hub page for Norwood 7. Below you will find a detailed breakdown of what this stage looks like, how it differs from earlier stages, what treatment options exist, expected graft requirements, costs by region, and realistic outcome expectations.
Understanding Norwood 7: The Clinical Picture
The Hamilton-Norwood classification system grades male pattern baldness across seven main stages (with several sub-stages). Norwood 7 sits at the far end of the spectrum. To understand what makes this stage distinct, it helps to see how it compares to the stages immediately before it.
How Norwood 7 Differs from Norwood 5 and 6
| Feature | Norwood 5 | Norwood 6 | Norwood 7 |
|---|---|---|---|
| Frontal hairline | Severely receded | Gone | Gone |
| Mid-scalp bridge | Thin bridge may remain | Bridge lost, areas merging | No bridge; fully bald |
| Crown | Large bald area | Merged with frontal loss | Merged, extends further |
| Remaining hair pattern | Wider horseshoe band | Moderate horseshoe band | Narrow, low-sitting horseshoe |
| Donor fringe width | 8-12 cm | 6-10 cm | 4-8 cm |
| Typical graft need | 3,000-5,000 | 4,000-6,000 | 5,500-7,500 |
At Norwood 5, a thin bridge of hair may still connect the frontal region to the back. At Norwood 6, that bridge is gone and the bald area extends across most of the top of the scalp, but the donor fringe is still reasonably wide. At Norwood 7, the bald area covers the maximum possible surface and the remaining donor fringe has narrowed, sometimes sitting only a few centimeters above the ears.
Physical Characteristics of Norwood 7
From the front: The forehead extends continuously into the bare scalp. There is no hairline or frontal fringe. The skin on top of the scalp may appear shiny or show sun damage from years of exposure.
From above: The entire top of the head is bare. Only a narrow rim of hair is visible around the perimeter when looking down.
From the back: The donor fringe (the band of DHT-resistant hair around the occipital and temporal regions) is narrow and sits lower on the skull than at earlier stages. In some Norwood 7 men, the donor fringe measures only 4 to 6 cm in vertical width.
Hair quality in the remaining fringe: At Norwood 7, the remaining hair may also show some miniaturization at its upper border (the transition zone). This is important because it affects how many grafts can safely be extracted. Not all hair in the fringe is equally robust.
Who Reaches Norwood 7?
Norwood 7 typically develops in men aged 50 and older, though some men with aggressive androgenetic alopecia reach this stage in their 40s. Genetics, DHT sensitivity, and time are the primary drivers. Roughly 5-7% of men with male pattern baldness eventually reach Norwood 7.
Men of European and Caucasian descent have higher rates of reaching advanced Norwood stages. Men of East Asian or African descent are less likely to progress to Norwood 7, though it does occur.
Graft Requirements at Norwood 7
Norwood 7 requires the highest graft count on the Norwood scale: 5,500 to 7,500 grafts for meaningful coverage of the entire bald area. At an average of 2.2 hairs per graft, this translates to approximately 12,100 to 16,500 transplanted hairs.
Why the Range Is So Wide
The exact graft count depends on several patient-specific factors:
- Surface area of baldness. Head size varies. A man with a smaller skull may need 5,500 grafts to cover the same proportional area that requires 7,000 on a larger head.
- Desired density. Full native density is approximately 80-100 follicular units per square centimeter. Transplant density typically targets 30-45 FU/cm2 because the donor supply cannot match native density across such a large area.
- Hair characteristics. Curly, coarse, or lighter-colored hair provides better visual coverage per graft than straight, fine, or dark hair on light skin. A man with thick, wavy hair may achieve satisfactory coverage with 5,500 grafts, while a man with fine, straight, dark hair on pale skin may need closer to 7,500.
- Coverage priorities. Some patients prioritize the frontal hairline over the crown. Others want even distribution. The allocation strategy affects the total count.
Session Planning
Extracting 5,500 to 7,500 grafts in a single session is not safe or practical. The safe extraction limit is approximately 45% of the donor area, and single-session FUE procedures typically cap at around 5,000 grafts. FUT can harvest up to 4,000 grafts per session.
Most Norwood 7 patients require:
- Two FUE sessions (2,500-4,000 grafts each, spaced 8-12 months apart)
- One FUT plus one FUE session (a combined approach that maximizes total graft yield)
- Two FUT sessions (less common, leaves a wider linear scar)
The first session typically addresses the frontal zone and hairline, while the second session fills the crown and mid-scalp. This approach lets the surgeon evaluate the first session's growth (which takes 8-12 months to mature) before finalizing the second session's plan.
For a detailed breakdown, read our guide on Norwood 7 graft requirements.
Treatment Options at Norwood 7
Treatment at Norwood 7 falls into three categories: surgical restoration, non-surgical medical therapy, and cosmetic solutions. Most men at this stage benefit from a combination.
Surgical Options
FUE (Follicular Unit Extraction) FUE uses a 0.7 to 1.0 mm micro-punch to extract individual follicular units from the donor area. Recovery takes 7 to 10 days. Graft survival rates are 90-95% with an experienced surgeon. FUE can harvest up to 5,000 grafts per session and leaves no linear scar, though it does create small dot scars throughout the donor area.
FUT (Follicular Unit Transplantation) FUT removes a strip of scalp from the donor area, from which individual follicular units are dissected under magnification. This method can harvest up to 4,000 grafts per session with 90-95% survival rates. Recovery takes 10 to 14 days. The primary tradeoff is a linear scar across the back of the head, which is typically concealable with hair at a length of 2 cm or longer.
DHI (Direct Hair Implantation) DHI uses a Choi implanter pen to simultaneously create the recipient site and place the graft. It offers precise angle and depth control. Recovery is 7 to 10 days with 90-95% survival rates. The limitation is capacity: DHI typically maxes out at 3,500 grafts per session, making it less efficient for the high graft counts Norwood 7 demands.
Combined FUT + FUE For Norwood 7, many surgeons recommend combining FUT in the first session (to maximize strip harvest) with FUE in the second session (to extract additional grafts from around the strip scar). This approach can yield the highest total graft count from a finite donor area.
Non-Surgical Medical Options
Even at Norwood 7, medical therapy plays a role. The goal is not to reverse the baldness (medication cannot do that at this stage) but to protect the remaining donor hair and stabilize the transition zone.
Finasteride (1 mg daily): Blocks DHT conversion. Halts further loss in 80-90% of men. Produces regrowth in approximately 65% of users, though at Norwood 7 the regrowth is minimal in bald areas and more relevant to protecting the donor fringe. Side effects (sexual) occur in 2-4% of users.
Minoxidil (5% topical or low-dose oral): Extends the growth phase and may improve blood flow to follicles. Produces moderate regrowth in 40-60% of users. At Norwood 7, it is primarily used to support donor area density and any remaining transitional hair.
PRP (Platelet-Rich Plasma): Costs $500 to $2,000 per session. Can increase density by 30-40% in areas with miniaturized but living follicles. At Norwood 7, PRP is most useful in the donor fringe and transition zones rather than the bald scalp.
For a full rundown, see our guide to Norwood 7 treatment options.
Cosmetic and Non-Surgical Alternatives
Scalp Micropigmentation (SMP): Tiny deposits of pigment are tattooed into the scalp to simulate the appearance of short hair stubble or a closely shaved head. SMP works well at Norwood 7 because it does not depend on existing hair. Cost is typically $2,000 to $4,000 for a full course. It can also be combined with a transplant to create the illusion of greater density between transplanted hairs.
Hair Systems (Toupees and Hairpieces): Modern hair systems use thin polyurethane or lace bases with natural hair. When fitted properly, they are difficult to detect visually. Monthly maintenance costs are $100 to $300. They provide immediate, full coverage that a transplant cannot match at Norwood 7, where donor supply limits transplant density.
Cranial Prostheses: Medical-grade hair systems prescribed for alopecia. In some regions, insurance may cover part of the cost.
Cost at Norwood 7
The financial commitment at Norwood 7 is the highest on the Norwood scale because of the graft volume required. Here is a regional cost comparison for a typical 6,000-graft procedure:
| Region | Cost Per Graft | Total for 6,000 Grafts |
|---|---|---|
| Turkey | $1-$2 | $6,000-$12,000 |
| India | $0.50-$1.50 | $3,000-$9,000 |
| Europe | $2.50-$4.50 | $15,000-$27,000 |
| UK | $3-$5 | $18,000-$30,000 |
| USA | $4-$6 | $24,000-$36,000 |
These figures assume a single course of treatment. If two sessions are needed (which is typical at Norwood 7), the total doubles, though many clinics offer multi-session pricing. Travel costs, accommodation, and medication expenses add $1,000 to $3,000 depending on the destination.
For a detailed cost analysis, see Norwood 7 transplant costs.
Realistic Expectations at Norwood 7
Honesty about outcomes is essential at this stage. Here is what a Norwood 7 patient should realistically expect:
What a transplant can achieve:
- A visible hairline that frames the face
- Moderate density across the frontal zone (30-40 FU/cm2 versus 80-100 FU/cm2 native density)
- Partial crown coverage, though density will be lower than the front
- A natural appearance at conversational distance
What a transplant cannot achieve at Norwood 7:
- Full native density across the entire scalp
- A thick, youthful head of hair
- A result that looks identical to someone who never experienced hair loss
- Complete crown coverage at high density
The most realistic outcome is a significant improvement over complete baldness, not a return to a full head of hair. Men who understand this going in report the highest satisfaction rates. Those who expect a Norwood 2 result from a Norwood 7 starting point are consistently disappointed.
Timeline of Results
| Milestone | Timeframe |
|---|---|
| Surgery day | Day 0 |
| Initial recovery complete | 7-14 days |
| Transplanted hair sheds (shock loss) | Weeks 2-6 |
| New growth begins | Months 3-4 |
| 50% of final density visible | Month 6 |
| 80-90% of final density visible | Months 10-12 |
| Final result | Months 12-18 |
If a second session is planned, it is typically scheduled 8 to 12 months after the first, once initial growth is established. This means the full treatment timeline from first surgery to final result can span 2 to 3 years.
The Donor Area Challenge at Norwood 7
The central limitation at Norwood 7 is donor supply. The donor fringe is narrower than at any other stage, and the total available follicular units may be insufficient to cover the entire bald area at satisfactory density.
Donor Density Assessment
A healthy donor area contains 70 to 100 follicular units per square centimeter. At Norwood 7, the usable donor area (factoring in the 45% safe extraction limit) typically provides:
- High-density donor (90+ FU/cm2): 6,000-7,500 extractable grafts total
- Average-density donor (70-90 FU/cm2): 4,500-6,000 extractable grafts total
- Low-density donor (<70 FU/cm2): Below 4,500 extractable grafts total
Men with low donor density at Norwood 7 face difficult choices. They may need to prioritize the frontal zone only, accept lower overall density, supplement with SMP, or consider alternatives to transplant surgery entirely.
Body Hair Transplant (BHT)
When scalp donor supply is exhausted, some surgeons harvest follicles from the chest, beard, or legs. Body hair has different growth characteristics (shorter growth cycle, finer caliber, different curl pattern), so it is typically used to add density between scalp grafts rather than as a primary source. BHT adds 1,000 to 2,000 usable grafts in selected patients.
Psychological Considerations
By Norwood 7, most men have lived with significant hair loss for years. Many have already adapted psychologically. However, pursuing treatment at this stage raises its own emotional challenges:
- Managing expectations is critical. The gap between hoped-for and achievable results is widest at Norwood 7.
- Financial commitment is substantial, and the return on investment (in terms of coverage) is lower per graft than at earlier stages.
- Social pressure and unsolicited opinions from family or friends can complicate decision-making.
Speaking with other Norwood 7 patients who have undergone treatment (through forums or clinic-arranged conversations) provides the most practical perspective on what to expect.
Next Steps: Get Your Assessment
If you think you are at Norwood 7 (or are unsure whether you are at Norwood 6 or 7), start with an objective classification. Upload your photo at myhairline.ai/analyze for a free AI-powered Norwood assessment. The tool identifies your stage and maps your pattern of loss, giving you a clear baseline before you consult with surgeons.
For a full understanding of all seven stages, read our complete Norwood scale guide.
FAQ
What does Norwood 7 look like?
Norwood 7 is the most advanced stage on the Hamilton-Norwood scale. Only a narrow horseshoe band of hair remains around the sides and back of the head. The top of the scalp is completely bald from the frontal hairline through the crown, with no remaining island of hair or bridge connecting front to back.
How many grafts do I need at Norwood 7?
Norwood 7 typically requires 5,500 to 7,500 grafts for substantial coverage. At an average of 2.2 hairs per graft, that equals 12,100 to 16,500 hairs. This almost always requires two or more surgical sessions spaced 8 to 12 months apart, as extracting this volume safely from a single donor area in one session is not feasible.
What are the best treatments at Norwood 7?
At Norwood 7, treatment options include hair transplant surgery (FUE or FUT, requiring 5,500 to 7,500 grafts over multiple sessions), scalp micropigmentation for the appearance of a cropped buzz cut, hair systems for immediate full coverage, and combination medical therapy (finasteride plus minoxidil) to protect remaining donor hair. The best approach depends on donor density, budget, and personal goals.