Norwood 3 Vertex (3V) combines temple recession at the front hairline with a separate area of thinning or baldness at the crown. This dual-zone pattern is what distinguishes 3V from standard Norwood 3, and it significantly changes treatment planning. At 3V, 2,000 to 2,800 grafts are typically required to address both zones surgically.
What Makes Norwood 3 Vertex Different from Norwood 3
The standard Norwood 3 shows deep temple recession forming an M-shape or U-shape, but the crown and mid-scalp remain dense. Norwood 3 Vertex adds a second zone of loss at the crown (vertex), while the area between the hairline and the crown, known as the mid-scalp bridge, usually retains reasonable density.
This two-island pattern is clinically important because:
- It affects more total scalp area, increasing graft requirements
- It signals a pattern of hair loss that is progressing simultaneously on two fronts
- It makes future progression planning more complex
- The crown responds differently to treatment than the hairline does
The "vertex" in the name refers to the anatomical vertex: the top-rear area of the skull. In androgenetic alopecia, crown loss typically begins as a small circular area of thinning and expands outward over time.
Visual Characteristics of Norwood 3 Vertex
Viewed from the Front
From the front, Norwood 3 Vertex may look identical to standard Norwood 3. Temple recession is the dominant visible feature: the hairline has pulled back to form a clear M or U shape, with deep recessions at both temples. The frontal forelock zone may still be dense.
Many men at Norwood 3 Vertex do not realize they have crown involvement until they see photographs taken from above or are told by a hairstylist or dermatologist.
Viewed from Above
The overhead view is where Norwood 3 Vertex becomes clearly distinct. You see:
- Temple recession at the front: the M-shape hairline with deep bilateral recessions
- Crown thinning or baldness: a circular or oval zone of reduced density at the vertex, typically 3 to 6 cm in diameter at this stage
- The mid-scalp bridge: the zone between the hairline recession and the crown loss. At 3V, this area typically retains density, creating a visible island of hair between two areas of loss
The size of the crown spot at 3V can vary. Some patients have only subtle diffuse thinning detectable under magnification; others have a clearly visible bald patch. The key classification criterion is that some vertex involvement is present alongside the temple recession.
Viewed from the Back
From the back, the crown spot is often visible as a circular zone with a whorl (the natural rotation point of crown hair) at its center. The hair around the spot may appear to thin outward from the whorl.
The Mid-Scalp Bridge: A Critical Structure at Norwood 3 Vertex
The mid-scalp bridge is the strip of hair connecting the frontal hairline zone to the crown. At Norwood 3 Vertex, this bridge is intact. If it were gone, the patient would be classified at Norwood 4 or higher.
The bridge is important for several reasons:
Visual framing: When hair is styled forward or to the side, the bridge creates the appearance of reasonably dense coverage over the top of the head.
Surgical planning: The bridge is often the zone surgeons prioritize with medication to prevent future loss, rather than transplanting into it at Norwood 3V. If the bridge thins and the hairline and crown grafts are already placed, they can look isolated.
Progression indicator: A thinning bridge is one of the first signs that a 3V patient is progressing toward Norwood 4. Monitoring this zone monthly with photos is useful.
How Norwood 3 Vertex Develops
Most men do not start at Norwood 3 Vertex. They typically arrive there from one of two directions:
Path 1: Norwood 3 with emerging crown loss. A patient who has been at standard Norwood 3 for several years begins to notice crown thinning. Finasteride may have been slowing this but not completely halting it.
Path 2: Norwood 3V with crown-first patterns. Some men begin losing hair at the crown before or simultaneously with the temples. These patients may reach 3V while still relatively young, often in their mid-20s.
Family history is the most reliable predictor of which pattern a patient will follow. Men whose fathers and maternal grandfathers both reached high Norwood stages are significantly more likely to experience crown-first or simultaneous dual-zone loss.
Measuring Norwood 3 Vertex: Key Dimensions
The following measurements are used during surgical planning at Norwood 3 Vertex:
| Zone | Typical Measurement at 3V |
|---|---|
| Temple recession depth | 2.5 to 4 cm beyond juvenile hairline |
| Crown spot diameter | 3 to 6 cm |
| Mid-scalp bridge width | 3 to 6 cm (intact) |
| Donor safe zone area | Approximately 90 to 110 cm2 |
| Total scalp area requiring coverage | 60 to 100 cm2 |
These measurements are typically taken at consultation using a transparent ruler and standardized photography.
Differentiating Norwood 3 Vertex from Adjacent Stages
It is possible to confuse 3V with adjacent stages. Here is how to differentiate:
| Stage | Temple Recession | Crown Loss | Mid-Scalp Bridge |
|---|---|---|---|
| Norwood 3 | Deep M-shape | None | Intact, dense |
| Norwood 3 Vertex (3V) | Deep M-shape | Present (thinning to bald spot) | Intact, some density |
| Norwood 4 | Deep M-shape | Moderate crown loss | Significantly thinned or absent |
| Norwood 5 | Extensive | Large crown loss | Very thin or gone |
The critical distinction between 3V and Norwood 4 is the state of the mid-scalp bridge. At 3V, the bridge remains. At Norwood 4, it has substantially thinned or disappeared, merging the hairline recession and crown loss into a single large bald zone.
Graft Requirements at Norwood 3 Vertex
Norwood 3 Vertex requires 2,000 to 2,800 grafts to address both the hairline and crown. The zone split used by most experienced surgeons follows a roughly three-zone distribution:
- Hairline and temples: approximately 40% of total grafts
- Mid-scalp and bridge: approximately 25% of total grafts (supportive density)
- Crown: approximately 35% of total grafts
This allocation is discussed in detail in the Norwood 3 Vertex graft requirements article.
Not all surgeons recommend addressing the crown at 3V. Some advise using medication alone for the crown while surgically restoring the hairline, reserving crown grafts for a later session when the full extent of crown loss is clearer.
Treatment Options at Norwood 3 Vertex
Medication First
Finasteride is particularly effective at the crown compared to the hairline. Clinical trials show that finasteride produces visible regrowth or halted loss in the vertex in approximately 83% of men, compared to approximately 66% for the hairline. This makes it especially valuable at 3V, where crown preservation has a significant impact on total graft requirements.
Minoxidil 5% applied directly to the crown twice daily is also beneficial. Some patients see meaningful regrowth in early vertex thinning with topical minoxidil, which can delay or reduce the need for surgical intervention.
A reasonable protocol at Norwood 3 Vertex:
- Start finasteride 1 mg daily
- Add minoxidil 5% topical twice daily (or 1-2.5 mg oral daily)
- Document crown size and hairline position with monthly photos
- Reassess at 12 months
- If crown loss has stabilized and hairline recession is the primary concern, consider hairline surgery
- If crown loss is still active, continue medication and reassess
Hair Transplant Surgery
When surgery is chosen at Norwood 3 Vertex, the operative plan is more complex than for standard Norwood 3. The surgeon must decide whether to address both zones simultaneously or stage the procedures.
Single-session dual-zone approach: Restore hairline and crown in one procedure. This requires 2,000 to 2,800 grafts and is feasible for most patients with adequate donor supply. The risk is that if the crown continues to lose ground, the transplanted patch may eventually be surrounded by new balding areas.
Staged approach: Restore the hairline now, then address the crown in a second session 12 to 24 months later after progression has stabilized. This conserves donor supply and avoids transplanting into a zone that may still be actively losing ground.
The choice depends on age, rate of progression, donor supply, and the surgeon's assessment of future loss risk.
Monitoring Norwood 3 Vertex Over Time
Norwood 3 Vertex is a dynamic stage. The two zones of loss can expand independently, and the bridge between them can thin. Monitoring is important for making well-timed treatment decisions.
Recommended monitoring approach:
- Take standardized photos every 4 weeks (front, top, back, left, right, overhead)
- Use the same lighting, distance, and camera settings for each session
- Track crown spot diameter using a ruler visible in the overhead photo
- Track temple recession using distance from a fixed facial landmark (e.g., the outer corner of the eye to the temporal hairline)
- Review your photo set every 6 months to assess rate of change
AI tools like myhairline.ai can analyze your photos, assess your Norwood stage, and track changes over time. Getting a baseline assessment today gives you a reference point for all future comparisons.
The Psychological Impact of Norwood 3 Vertex
Research consistently shows that hair loss has a disproportionate psychological impact compared to its physical severity. Men at Norwood 3 Vertex often report significantly higher distress than those at Norwood 3, because the dual-zone loss signals more aggressive future progression.
A 2011 study in the British Journal of Dermatology found that crown hair loss specifically had a greater negative impact on self-perception than frontal recession alone, possibly because the vertex is more visible to others (in normal conversation, people look down at seated or shorter individuals).
If you find that hair loss is affecting your quality of life, this is a valid medical consideration that your doctor should take seriously when discussing treatment options.
FAQ
What does Norwood 3 Vertex look like?
Norwood 3 Vertex shows two simultaneous areas of hair loss: temple recession creating an M-shape at the front hairline, plus a distinct area of thinning or baldness developing at the crown (vertex). When viewed from above, this creates a pattern with recession at both the front and the top of the head.
How many grafts do I need at Norwood 3 Vertex?
Norwood 3 Vertex typically requires 2,000 to 2,800 grafts to address both the hairline and the crown. This is more than standard Norwood 3 (1,500 to 2,200 grafts for hairline only) because the crown zone requires additional coverage. The exact count depends on the extent of crown thinning and the patient's hair characteristics.
What are the best treatments at Norwood 3 Vertex?
Finasteride is particularly important at Norwood 3 Vertex because it is most effective at protecting the crown from further DHT-related miniaturization. When combined with minoxidil, it slows progression in the majority of patients. Hair transplant surgery is an option when medications alone are insufficient, though surgeons often recommend stabilizing on medication for 12 months before surgery at this stage.