Getting my head round the Norwood Scale

[jjones2908]

Hello all,


This is just to satisfy my geekiness / curiosity.

Am I right in thinking that the Norwood Scale is just the depiction of final baldness pattern and that even if you appeared to the naked eye to be, say, a '3a' and then proceeded to go through what appeared to be other patterns on the scale (again, only to the naked eye), you may actually in reality be a '5' if assessed properly by a doctor?

Furthermore, would your final pattern be detectable by a doctor from the very outset of the balding process due to the distribution of that miniaturisation, even if that miniaturisation was only very minor at that stage? Can miniaturisation on different parts of the scalp happen at different times / rates and therefore you do actually switch between patterns?

Cheers

[Gabe Zingaretti, PhD]

Look at your self through a mirror and find a picture that matches how you look. is that simple. it is also very subjective and while many will agree on your NW, just as many will disagree

[jjones2908]

Look at your self through a mirror and find a picture that matches how you look. is that simple. it is also very subjective and while many will agree on your NW, just as many will disagree

Perhaps this was a case of "ask a silly question, get a silly answer". Oh well!

[Ken Anderson, MD, FISHRS, ABHRS]

Hello all,


This is just to satisfy my geekiness / curiosity.

Am I right in thinking that the Norwood Scale is just the depiction of final baldness pattern and that even if you appeared to the naked eye to be, say, a '3a' and then proceeded to go through what appeared to be other patterns on the scale (again, only to the naked eye), you may actually in reality be a '5' if assessed properly by a doctor?

Furthermore, would your final pattern be detectable by a doctor from the very outset of the balding process due to the distribution of that miniaturisation, even if that miniaturisation was only very minor at that stage? Can miniaturisation on different parts of the scalp happen at different times / rates and therefore you do actually switch between patterns?

Cheers

[ATTACH=CONFIG]46744[/ATTACH]

Hello,

The Norwood Scale is mainly for communication purposes among doctors and for explaining the progression of hair loss to patients. Imagine being at a hair restoration meeting and there was no Norwood scale, and you wanted to talk to a colleague about a patient you had. Well, it'd be a rather drawn out process is we had to explain where the hair loss was and whether there was hair loss in the crown and so forth. With the Norwood scale, I can simply say to Dr. Whomever, "So I have this 34 year old male, Norwood 4A, and his goals include, ......." Immediately the listener is oriented to age, sex, and amount of hair loss inside of 5 words. Also it's important to remember that there are only 12 Norwood stages. The entire world does not fit exactly into 12 shoe sizes....there are infinite degrees and patterns of hair loss, and so usually patients are not exactly any Norwood diagram or number.

Also it's to help explain to patients what the future may hold. I use that exact diagram of the Norwood scale in consultation. A lot of times to help explain how I'm going to reconstruct their hair and looks when we do not have enough hair to cover the crown, bridge, frontal forelock and hairline in someone who is, say, a Norwood 6. If you look above Norwood 6 we can see the bridge has appeared on Norwood 5V. That's an important cosmetic sub unit of the anatomy of hair on the scalp, and so it helps me to explain the how's and why's of the surgical plan when discussing it with my patients.

Finally, no doctor can tell you where you're going to end up on the scale. Hair loss is not linear over the course of your life.....in that if you're destined to be a 5V, and you're a 3 now, you're not going to lose an even amount of hair each year until you're 80 and have reached the 5V pattern. Hair loss "stair-steps" over the course of one's life. One may have the same amount of hair for a few or several years, and then it may dip and loss may occur over a year and one can move an entire Norwood value down the chart in just one year. Then maybe the hair stays for a few years, then takes another step. Where you'll end up is pretty much an educated guess, and for that look to your mom's brothers and your dad...you're likely going to be somewhere in the middle. For today, however, Dr. Zingaretti is absolutely correct: it really is just a reflection of how you look currently. It isn't possible to determine your future Norwood scale with any certainty. What we do know for certain is that without intervention, your Norwood number goes up over time. The rate at which it goes up can be significantly delayed or even appear to halt with various non-surgical treatments such as finasteride therapy, low level laser therapy, platelet-rich plasma (PRP) with ACell procedures, etc.

[Ken Anderson, MD, FISHRS, ABHRS]

Finally, I wanted to mention that the Norwood scale is also very useful for conducting medical studies and for written communication between physicians in the medical literature. Suppose you wanted to design a study where only men with significant hair loss are going to be considered. You could write in the study design that only men who are Norwood 5 and above would fit the inclusion criteria. So for both written and oral communication, as well as medical research studies, the Norwood scale is a useful tool. I just finished a short ARTAS case and this point came to mind while operating my robot. I hope this information is helpful to you.