Norwood & Ludwig Scale - A classification of hair loss
Article by Gemma Hutchings | Date Published 15th November 2024
Hair Loss Classification Scales
Norwood scale
The Norwood scale, or Hamilton-Norwood scale, is a classification system used to measure the extent and pattern of male pattern baldness (androgenetic alopecia). Developed by Dr. James Hamilton in the 1950s and later revised by Dr. O'Tar Norwood in the 1970s, the scale provides a standardised way for professionals to assess and communicate the stages of hair loss in men.
The Norwood scale also serves as a visual representation during SMP or Trichology consultations, enabling practitioners to discuss treatment planning based on current and future hair loss predicted patterns, with the aim of achieving results that are age-appropriate and in harmony with remaining natural hair.
Norwood Scale Stages
The Norwood scale categorizes male pattern baldness into seven stages, with each stage representing an increasing level of hair loss:
Stage 1: No significant/noticable hair loss or minimal hair recession at the front. Hairline is intact.
Stage 2: Early stages of hairline recession, typically forming an "M" shape as the hair recedes at the temples. This is often called a “mature hairline.”
Stage 3: The first stage of clinically significant baldness. The hairline recedes more deeply at the temples, creating a more pronounced M-shape. Some men also begin to experience thinning on the crown.
Stage 4: More advanced frontal hairline recession along with noticeable thinning or baldness on the crown. A thin band of hair may separate the hairline from the bald area on the crown.
Stage 5: The areas of hair loss at the temples and crown expand and approach each other. The hair between them thins out, creating a horseshoe shape.
Stage 6: The hair connecting the front and crown balding areas disappears, leaving only a ring of hair around the sides and back of the head.
Stage 7: The most advanced stage of hair loss. Only a thin band of hair remains around the sides and back of the head, with extensive baldness across the top.
Each Norwood stage depicts the different areas and densities of hair loss, which allows SMP practitioners to customise their treatment plan, taking in consideration the style of hairline and density required to help determine the timings and number of sessions, for the most realistic look. For example:
Early Stages (Norwood 1-3): These stages may only require subtle SMP density work to fill in sparse areas, around the temples for example, without drastic changes to the hairline.
Advanced Stages (Norwood 4-7): For clients with more extensive baldness, practitioners often need to create a full scalp micropigmentation, designing a new hairline and ensuring uniform coverage over larger bald areas.
It is worth noting that the scale is just a guide and every individual looking for SMP will need a full consultation to best determine their most suitable treatment plan. Early onset male pattern hair loss with no medical intervention to prevent further loss, for example, may need a 'combination SMP treatment plan' with both short- and long-lasting pigments to ensure the treatment it as 'future proofed' as possible. Blending into natural hair is also a prominent factor when using the scale as a consultation and treatment plan tool, natural hair density over all areas determining the level of SMP required to get a seamless result.
Choosing SMP over other hair restoration options
The Norwood scale allows clients to assess whether SMP is the best option for them based on their hair loss stage. For example:
Early Norwood Stages (1-3): Individuals may still have enough hair density for other treatments or interventions, like hair transplants or trichology treatments to stabilise and/or re-generate hair. SMP may still be the preferred option here and can serve as an enhancement or combining treatment with surgery or trichology, depending on personal circumstances and preferred outcomes.
Advanced Norwood Stages (5-7): SMP is often ideal for these stages, where hair transplantation might be challenging due to a lack of donor hair and trichology interventions unable to secure the required result, making SMP a practical and aesthetic solution.
The Ludwig scale is a classification system specifically designed to assess female pattern hair loss (FPHL) also referred to as androgenetic alopecia in women, and was developed by Dr. Erich Ludwig in the 1970s.
Female pattern hair loss often presents as diffuse thinning, where hair density decreases across the scalp, particularly along the part line and crown, rather than the receding hairline pattern commonly seen in men. The root cause of FPHL is a combination of genetics, aging and hormone inbalances.
The Ludwig scale categorises female pattern hair loss into three main stages, each representing a progressive level of hair thinning:
Stage 1: Mild thinning across the top of the scalp, usually without significant visible scalp exposure. Many women may not notice this stage as it often presents as general thinning rather than distinct patches.
Stage 2: Increased thinning, where the part line begins to widen, and more scalp becomes visible, especially at the crown.
Stage 3: Advanced thinning, where hair loss becomes very apparent, showing significant scalp exposure across the top. In this stage, thinning is more pronounced and may extend to the sides.
Densification as a solution for female pattern hair loss
Scalp Micropigmentation (SMP) is an effective solution for women experiencing hair thinning, especially those in the early-to-moderate stages of hair loss as classified by the Ludwig scale.
Blending pigment with existing hair: SMP is applied between existing hairs to create the illusion of increased density. This technique is designed to blend seamlessly with natural hair colour, especially when thinning is more concentrated around specific areas like the parting or crown.
Reducing visible scalp: By adding pigment/ink where hair density is low, SMP can minimise the appearance of scalp showing through the hair, which is often the main concern. The result is a fuller-looking head of hair and confidence restored.
Interested to find out more about of range of hair loss courses? - Click this link to find out more
