Norwood 4 at age 45 means significant frontal recession combined with thinning or balding at the crown. A narrow band of hair still separates the two areas, but the overall coverage has noticeably decreased. At 45, this pattern is well-established, and your treatment options are clear and effective.
What Norwood 4 Looks Like at 45
Norwood 4 is a transitional stage where hair loss is no longer limited to the temples. The frontal hairline has receded further, and the vertex (crown) area shows visible thinning or a bald spot.
| Feature | Norwood 4 at 45 |
|---|---|
| Frontal recession | Severe, deep M-shape |
| Crown thinning | Moderate to significant |
| Bridge between areas | Still present but narrowing |
| Grafts if surgery chosen | 2,500 to 3,500 |
| Progression risk | Moderate |
Is This Normal at 45?
Norwood 4 at 45 is well within the normal range. Roughly half of men experience visible hair loss by this age, and Norwood 4 is one of the most common stages observed in mid-40s patients. Many men progress to Norwood 4 between ages 35 and 50.
By 45, progression tends to slow. If you have been at Norwood 4 for a few years without dramatic change, your loss rate is likely manageable with treatment. Rapid progression from Norwood 4 to 6 within a few years is uncommon at this age.
Treatment Strategy for Norwood 4 at 45
Medication: Protect What Remains
Medication is critical at Norwood 4, whether or not you pursue surgery.
Finasteride (1mg daily)
- Halts further loss in 80 to 90% of men
- Regrowth in 65% of users (most visible in crown area)
- Side effects in 2 to 4%, reversible
- Essential for protecting native hair around transplanted grafts
Minoxidil (5% topical, twice daily)
- 40 to 60% moderate regrowth
- Particularly effective on the crown
- Complements finasteride for stronger results
Hair Transplant: Restore Coverage
Norwood 4 at 45 is a prime transplant scenario. Here is the breakdown:
| Procedure | FUE | FUT |
|---|---|---|
| Max grafts per session | 5,000 | 4,000 |
| Grafts needed (Norwood 4) | 2,500 to 3,500 | 2,500 to 3,500 |
| Sessions required | 1 | 1 |
| Recovery | 7 to 10 days | 10 to 14 days |
| Graft survival | 90 to 95% | 90 to 95% |
At 2,500 to 3,500 grafts, both FUE and FUT can handle the job in a single session. FUE is more popular for this range, but FUT preserves more donor capacity if you anticipate needing a second procedure later.
Cost Breakdown by Region
| Region | Cost for 2,500 to 3,500 Grafts |
|---|---|
| Turkey | $2,500 to $7,000 |
| USA | $10,000 to $21,000 |
| UK | $7,500 to $17,500 |
| Europe | $6,250 to $15,750 |
Where to Distribute Grafts
A surgeon will prioritize graft placement based on visual impact:
| Zone | Priority | Graft Allocation |
|---|---|---|
| Frontal hairline | High | 40 to 50% of grafts |
| Mid-scalp | Medium | 20 to 30% of grafts |
| Crown | Lower | 20 to 30% of grafts |
The frontal zone creates the most visible improvement and frames your face. Crown coverage is important but secondary because it is less visible in daily interactions.
Non-Surgical Alternatives
For men who prefer to avoid surgery or need to supplement limited donor supply:
- PRP therapy: $500 to $2,000 per session, 3 to 4 sessions initially, 30 to 40% density improvement
- Scalp micropigmentation (SMP): $2,000 to $5,000, creates the appearance of density
- Low-level laser therapy (LLLT): FDA-cleared devices for modest density improvement
- Hair systems: Immediate full coverage, $150 to $400 monthly maintenance
Timeline for Action
| Phase | Timeline | Action |
|---|---|---|
| Assessment | Week 1 | AI analysis, dermatologist consultation |
| Medication start | Month 1 | Begin finasteride and minoxidil |
| Monitoring | Months 1 to 6 | Track response with monthly photos |
| Surgical consult | Month 6 | Evaluate candidacy, plan graft distribution |
| Procedure | Month 8 to 12 | Transplant if desired |
| Full results | Month 20 to 24 | Final transplant growth visible |
Next Steps
Norwood 4 at 45 offers a clear treatment path with predictable results. The combination of stable pattern, adequate donor supply, and proven techniques means you can expect meaningful improvement.
Get your free AI Norwood assessment to confirm your stage and see graft estimates for your specific case. Review the complete Norwood scale guide for context on progression, or check the hair transplant candidacy guide to assess your surgical options.
Medical disclaimer: This article is for informational purposes only and does not replace professional medical advice. Consult a board-certified dermatologist or hair restoration surgeon before starting any treatment.
FAQ
Is Norwood 4 hair loss normal at 45?
Yes. Norwood 4 is a common stage for men in their mid-40s. By age 45, about 50% of men show visible hair loss, and Norwood 4, which features deep frontal recession plus crown thinning, is a frequent presentation. This stage represents moderate-to-advanced loss that typically progresses slowly from this point.
What treatments work best for Norwood 4 at age 45?
A combined approach of medication and surgery is most effective. Finasteride halts further loss in 80 to 90% of men, and a transplant of 2,500 to 3,500 grafts can restore both the frontal zone and crown. Starting medication before or alongside surgery protects native hair and maximizes long-term results.
Should I get a hair transplant at age 45 with Norwood 4?
Yes, Norwood 4 at 45 is a strong candidate profile for transplant surgery. Your pattern is stable, the graft count (2,500 to 3,500) is achievable in one session with FUE, and donor supply at this stage is typically sufficient. Age 45 allows surgeons to design a hairline that looks natural well into your 60s and beyond.