Restore a Norwood 7 to a Norwood 3 or 4?

Dear Dr Rassman,
thanks for taking your time to help where you can with our balding problems. This has been discussed before, but wouldn’t it be better (and possible) to restore a Norwood 7 patient to a norwood 3-4 with a very high, feathery forelock (like Sting) IF he also wants coverage in the crown and has “only” normal density and calibre? I know that too much density is bad with high lying hairlines is bad (eg Nic Cage) whereas Sting does look good with his current hairline. Have you ever done that or would do it if a patient requested it?

We do what you are stating all the time! We focus on the frontal area first to frame the face. That almost always works and the hairline is put in the normal mature position. We negotiate with the patient where else to put the hair based upon how much he has available for transplantation. You can see our before and after photos here. Patients who are Norwood 7 may not get their entire head of hair back, but we can create a non-balding “frame” to their face and give them a hairline and a stronger forelock (if they choose).

I often show Patient ZU, who was a Class 7 with very advanced balding and had a remarkable hair transplant result. That patient had a very high hair density, so he was able to achieve such wonderful results. When we started to do his surgeries, I placed the first hairline in the normal mature position and initially we worked out that we might not have enough hair to fill in the crown. We were all surprised as his donor hair supply kept up with our desire for more hair.