Norwood 4 is a treatable stage of hair loss where a transplant of 2,500 to 3,500 grafts can produce visible, natural-looking restoration, but it will not return you to a full adolescent hairline. Setting accurate expectations before treatment is critical for satisfaction.
This article is for informational purposes only and does not constitute medical advice. Consult a qualified hair loss specialist before making any treatment decisions.
What Norwood 4 Actually Looks Like
Norwood 4 represents a clear progression beyond early hair loss. The frontal hairline has receded past the temples, and the vertex area has enlarged with visible thinning. A bridge of hair still connects the frontal and crown zones, but this bridge is narrowing. Scalp visibility is obvious under overhead lighting and in photographs taken from above.
At this stage, most men find it difficult to disguise hair loss with hairstyling alone. The cosmetic impact is significant enough that both the patient and those around them can see the loss clearly.
How Norwood 4 Differs From Norwood 3
Norwood 3 shows primarily temple recession with relatively preserved crown density. At Norwood 4, the frontal recession has deepened substantially and crown thinning is no longer subtle. The total area requiring coverage is roughly 30-50% larger than Norwood 3, which directly affects graft requirements and treatment strategy.
The Bridge of Hair
The strip of hair between frontal and crown loss zones is clinically important. When this bridge is thick, a surgeon can focus grafts on the hairline and crown separately. When it is thinning (as it often is at Norwood 4), the surgeon may need to allocate grafts across a larger continuous zone, which reduces density per area.
What Treatment Can Achieve
A well-planned transplant at Norwood 4 can deliver meaningful cosmetic improvement. With 2,500 to 3,500 grafts at an average of 2.2 hairs per graft, you receive approximately 5,500 to 7,700 transplanted hairs. With a graft survival rate of 90-95% (achievable with FUE, FUT, or DHI), the final growing hair count reaches 4,950 to 7,315 hairs.
Achievable Density
Transplanted density at Norwood 4 typically reaches 35 to 50 follicular units per square centimeter in prioritized zones, compared to native density of 80 to 100 FU/cm2. At conversational distance, this looks like natural, moderately thick hair. Under bright lighting or close inspection, density differences may be noticeable.
Timeline for Results
- Weeks 1-6: Transplanted hairs shed (shock loss), a normal part of the process
- Months 3-4: New growth begins emerging
- Month 6: Approximately 50% of final density visible
- Month 12-18: Full results mature, with 80-90% density achieved by month 12
What Treatment Cannot Achieve
No transplant can recreate the density of a person who has never experienced hair loss. At Norwood 4, the goal is an age-appropriate, natural-looking result rather than a return to teenage fullness.
Limitations to Understand
- Crown density will be lower than the frontal zone because grafts are typically prioritized toward the hairline
- Without finasteride (which halts loss in 80-90% of men), native hair behind the transplant zone may continue thinning, creating a contrast with the transplanted area
- The safe extraction limit of 45% of the donor area means graft supply is finite, and future sessions must be planned conservatively
- A single session may not fully address both the frontal zone and crown. Some patients at Norwood 4 benefit from a staged approach
The Role of Medication
Finasteride at 1mg daily is the most effective medical complement to surgery at Norwood 4. It halts further loss in 80-90% of men and produces regrowth in approximately 65%. Minoxidil at 5% twice daily provides 40-60% moderate regrowth and supports both transplanted and native hair.
Starting medication before surgery helps stabilize the loss pattern, giving the surgeon a clearer picture of the final treatment area. For a more detailed overview of all options, see our complete Norwood scale guide.
Getting an Accurate Assessment
Every Norwood 4 presentation is different. Hair caliber, donor density, skin-to-hair color contrast, and the exact pattern of loss all influence what is achievable. A consultation with an experienced surgeon, combined with tools like myhairline.ai's free AI assessment, can help you understand your specific situation before committing to a treatment plan.
For cost estimates, see our Norwood 4 cost breakdown.
Frequently Asked Questions
What does Norwood 4 look like?
Norwood 4 features significant frontal recession that has moved well past the temples, with an enlarged vertex (crown) thinning zone. A narrowing bridge of hair typically still separates the frontal and crown loss areas, but it is visibly thin. From above, scalp exposure is noticeable across both the frontal and crown regions.
How many grafts do I need at Norwood 4?
Norwood 4 typically requires 2,500 to 3,500 grafts for comprehensive restoration. The exact count depends on your hair caliber, donor density, scalp laxity, and whether you want to prioritize the frontal hairline, the crown, or both. At an average of 2.2 hairs per graft, this delivers approximately 5,500 to 7,700 transplanted hairs.
What are the best treatments at Norwood 4?
A hair transplant (FUE, FUT, or DHI) paired with finasteride (1mg daily) offers the strongest outcome at Norwood 4. Finasteride halts further loss in 80-90% of men and produces regrowth in about 65%. Minoxidil (5% twice daily) adds 40-60% moderate regrowth. Surgery addresses the visible deficit while medication protects hair behind the transplant zone.