Transplanting Very Bald Patients

how much “coverage and density” can a norwood 6 patient actually achieve? All your photos of men with 6 or 7 norwood, all have “comb over” type hair styles? How come u never show any pics of the back of the finished product(or crown)?

A person with a Norwood Class 6 pattern will have lost 50-60% of his natural hair. A person with a Class 7 pattern will have lost between 70-80% of his natural hair. If you move half of the permanent zone of an average man, the most you can yield would be about 15,000-20,000 hairs (or 7,500/10,000 grafts in a series of about 3-4 surgeries). That would mean the coverage mathematics, of let’s say 60% of the total area of originally hairy scalp, can only receive maximally 20,000 hairs in an area that originally had 60,000. This is at best 1/3rd of the original density. In actuality, one rarely ge’s out that much and more likely 12,000-15,000 hairs is maximal. In the person with a Class 7 pattern and 80% hair loss by count, the maximum overall density in the recipient area is 80/12 or 15% of the total original density. We usually weight it to the front so that there is a comb-back effect, moving more density to the place where the greatest impact will occur. We could weight it to the front and sides, with a good comb-over produced (front to back or side to side). Either approach works. The crown is often sacrificed with the lowest densities placed there favoring the front or the sides, as the case may be. So you are correct, the densities in the less favored areas are ‘covered’ with some type of comb-over.

I posted these photos a few months ago here, but it is worth displaying them again to show that the results of weighting the frontal hairline can be very good, even though the crown is not as dense. Patient ZU is in his mid 60’s and had multiple procedures totalling 6,036 follicular unit grafts transplanted. “Before” is on the left, “after” is on the right. Click the photos to enlarge.

You can see more of his before and after photos on the NHI site: Patient ZU