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How many grafts are needed for a Norwood 5 to eliminate the bald look?



I was just wondering how many grafts I would need and what I could expect if I was to fill my head? My head is kinda small and the balding area is about a norwood 5 but not much lost in the crown. I was thinking about leaving the crown untreated and only fill the top. I think I could live with the crown thinning if the top was thick enough and got rid of the bald appearance. Could 4000 grafts give a satisfactory result or would I need more? I was thinking about getting a strip procedure because from what I`ve read it will maximize donor availability. After that, I could go for another strip or some FUE.
What do you guys estimate?


Valued member

Every individual really presents a unique situation in terms of graft requirements and to make any suggestions without images becomes even more open to interpretation.
The Norwood scale was updated by Mr. Norwood in the 70´s and although it does appear to have stood the test of time (at least in terms of the last 50 years), doctors agree that it is not always the most specific scale despite being universally known. Many patients often fall in-between stages of the scale, and as you mention head size, scale is not considered in terms of how this may relate to graft count.

Depending on how your lower crown and lateral humps (sides) may have dropped, also means that more surface area of scalp may have become exposed meaning higher graft demands, but the nature of further dropping adds restrictions to what may be deemed as your "safe" donor area, so there are many variables.

There is much artistry involved in achieving the "illusion of density" with as few grafts as possible. This is down to the quality and vision of the surgeon, but in terms of the visuals of fullness, we would associate this with specific data. Often spoken about is density, but equally important is follicular make up (how many hairs per graft), and the diameter (thickness) of the patients hair.

In terms of density, is understood that any area of thinning will become apparent to the naked eye once an individual has lost approximately 50% of his original density. This therefore suggests that restoring just over 50% of the density presented in a patients donor density should achieve the desired illusion.

On average, patients present 2.2 hairs per graft. Some patients may be lower and present nearer to 2 hairs per graft on average, whilst others may be fortunate enough to be closer to 2.4 hairs per graft. When considering a graft count of 4000 grafts as you mention, the difference in hair counts can be quite significant.
4000 grafts x average of 2.0 hairs per graft = 8,000 hairs
4000 grafts x average of 2.2 hairs per graft = 8,800 hairs
4000 grafts x average of 2.4 hairs per graft = 9,600 hairs

As you can see, the difference in hair count between the two extremes is 1,600 hairs despite using the same count of 4000 grafts. These 1,600 hairs will mean being able to achieve more coverage, or having more hairs and therefore a fuller visual result with the same surface area. Such careful and appropriate planning is what really achieves optimal efficiency for the patient and is the difference between standards of doctors.

The other factor mentioned was hair calibre. Thicker hair can logically achieve a much fuller result with less grafts than thinner hair can. If you double the diameter, you quadruple the volume.

Add to this that each patient presents a different level of contrast between hair colour and skin tone, this really highlights how 4000 grafts with one patient can be quite different to what can be achieved with 4000 grafts on another.


I would say that would totally depends upon the number of grafts that you want to transplant ...