The hairline recession is more severe than in Stage 2, and there is sparse hair or no hair on the vertex. The two areas of hair loss are separated by a band of hair that connects to the hair remaining on the sides of the scalp. This band is a key distinguishing feature of Stage 4.
Critical to protect the band of hair and prevent progression to Stage 5-6. Start immediately.
Apply to both areas twice daily. Crown area typically responds better than temples.
1,800-2,500 grafts. May require two procedures — hairline first, crown later. Cost: $8,000-$20,000.
Can improve density of existing hair and boost transplant results.
Norwood Stage 4 typically requires 1,800-2,500 grafts for a hair transplant covering both the hairline and crown areas. The exact number depends on your desired density, donor supply, and hair characteristics. Some surgeons may suggest two sessions for optimal results.
Medication (finasteride + minoxidil) can slow or stop further loss and may regrow some hair, but at Stage 4, significant cosmetic restoration usually requires a hair transplant. Medication is still essential to protect remaining hair and transplanted grafts from future loss.
Without treatment, progression is likely — the band of hair separating the front and crown areas will narrow and eventually disappear (Stage 5-6). Finasteride can significantly slow this progression. With treatment, many men stabilize at Stage 4 for years or decades.
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