A two-session approach for Norwood 4 produces better density and preserves more donor flexibility than cramming everything into one procedure. Session one rebuilds the hairline and frontal zone. Session two fills the crown. Here is the complete plan, including graft allocation, timing, costs, and what to expect at each stage.
Why Two Sessions Beat One at Norwood 4
Norwood 4 requires 2,500-3,500 grafts. While a skilled surgeon can place this many grafts in a single FUE session, there are strong reasons to split the work:
Donor recovery. Extracting 3,000+ grafts in one sitting puts significant stress on the donor area. The safe extraction limit is 45% of donor follicles total, and pulling too many at once can leave visible thinning in the harvest zone. Two sessions allow the donor to recover between procedures.
Density optimization. Placing all grafts in one session means spreading them across a large area. Two sessions allow the surgeon to pack the frontal zone at higher density first, then address the crown with fresh precision.
Assessment opportunity. After session one, you see how your body responds to transplantation. Graft survival (expected 90-95%), growth pattern, and the effect of ongoing medication on non-transplanted hair can all inform the second session's strategy.
Future-proofing. If your loss progresses beyond Norwood 4 in the years following surgery, you still have uncommitted donor grafts available for future touch-ups.
Session 1: The Frontal Zone
Timing
Session one should happen after at least 12 months of hair loss stabilization on finasteride (1mg daily, 80-90% halt rate).
Graft Allocation
| Zone | Grafts | Density Target | Priority |
|---|---|---|---|
| Hairline (first 1cm) | 500-700 | 40-45 FU/cm2 | Highest |
| Frontal zone (behind hairline) | 800-1,000 | 30-35 FU/cm2 | High |
| Temporal points | 300-500 | 25-30 FU/cm2 | High |
| Session 1 total | 1,800-2,200 |
Hairline Design Principles
The surgeon designs the hairline to look natural now and in 20 years. For a Norwood 4 patient, this means:
- Setting the hairline at a mature position (not the juvenile line of a teenager)
- Creating slight irregularity (a perfectly straight hairline looks artificial)
- Building the temporal points to frame the face without appearing too aggressive
- Accounting for potential progression to Norwood 5 or 6
A well-designed Norwood 4 hairline sits approximately 7-8cm above the brow ridge at the center, with natural temple recession rather than a flat wall of hair.
Procedure Details
| Parameter | Session 1 |
|---|---|
| Technique | FUE (0.7-1.0mm punch) |
| Duration | 5-7 hours |
| Anesthesia | Local |
| Recovery | 7-10 days |
| Return to work | 5-7 days |
| Graft survival | 90-95% |
Post-Session 1 Protocol
- Continue finasteride (1mg daily) without interruption
- Apply minoxidil (5% topical) starting 2 weeks post-surgery to support growth
- Avoid strenuous exercise for 2 weeks
- Sleep elevated (45-degree angle) for the first 5 nights to reduce swelling
- Expect transplanted hairs to shed at weeks 3-4 (this is normal)
- New growth begins at months 3-4
- Assess results at month 10-12
The Waiting Period: Months 1-12
This period between sessions serves multiple purposes:
Growth Assessment
By month 10-12, approximately 80% of session one's final density is visible. You can evaluate:
- Whether the frontal zone has the coverage you wanted
- How your native hair in the mid-scalp and crown has responded to medication
- Whether the crown actually needs surgical intervention or can be managed with PRP and minoxidil
Medication Optimization
This is the time to fine-tune your pharmaceutical protocol:
- If finasteride alone is not maintaining native hair, add or adjust minoxidil
- Consider PRP ($500-2,000/session) to boost crown density before committing to session two
- Some patients find that the combination of finasteride, minoxidil, and PRP provides enough crown coverage to skip or reduce session two
Donor Area Recovery
The donor area needs 8-12 months to fully heal from FUE extraction. The tiny dot scars mature and become less visible. Hair in the donor zone regrows and fills in around the extraction sites. By 12 months, the surgeon can evaluate the donor's remaining capacity with precision.
Session 2: The Crown
Timing
Schedule session two at 10-14 months after session one, once first-session results are clearly visible.
Graft Allocation
| Zone | Grafts | Density Target | Priority |
|---|---|---|---|
| Crown center | 400-600 | 25-30 FU/cm2 | Medium |
| Crown periphery | 300-500 | 20-25 FU/cm2 | Medium |
| Mid-scalp blend | 200-300 | 20-25 FU/cm2 | Lower |
| Session 2 total | 800-1,300 |
Crown Strategy
Crown coverage requires a different approach than frontal work:
- Lower density is acceptable. The crown is viewed at a less critical angle (from above/behind) than the hairline (viewed straight-on).
- Whorl pattern matters. The surgeon must replicate the natural spiral growth pattern at the vertex for realistic results.
- PRP complement. Combining transplanted grafts with PRP therapy in the crown area maximizes the density-per-graft ratio.
Procedure Details
| Parameter | Session 2 |
|---|---|
| Technique | FUE (0.7-1.0mm punch) |
| Duration | 3-5 hours |
| Anesthesia | Local |
| Recovery | 7-10 days |
| Final results | 12-18 months post-session 2 |
Total Cost Breakdown
| Region | Session 1 (2,000 grafts) | Session 2 (1,000 grafts) | Total |
|---|---|---|---|
| Turkey | $2,000-4,000 | $1,000-2,000 | $3,000-6,000 |
| India | $1,000-3,000 | $500-1,500 | $1,500-4,500 |
| Europe | $5,000-9,000 | $2,500-4,500 | $7,500-13,500 |
| UK | $6,000-10,000 | $3,000-5,000 | $9,000-15,000 |
| USA | $8,000-12,000 | $4,000-6,000 | $12,000-18,000 |
Add ongoing medication costs: finasteride $10-30/month + minoxidil $15-40/month ($300-840/year).
Donor Budget for the Future
At Norwood 4, your total two-session graft usage is approximately 2,600-3,500. With a typical donor capacity of 6,000-8,000 FUE grafts (at 45% safe extraction), you retain 2,500-5,400 grafts for any future procedures. This reserve is critical if your loss progresses to Norwood 5 or 6.
If you suspect you may reach Norwood 6 or beyond, discuss this with your surgeon during the session one consultation. They may recommend a more conservative graft allocation to preserve long-term options.
Get Your Personalized Plan
Upload a photo at myhairline.ai/analyze to confirm your Norwood stage. Use the graft calculator by zone to see exactly how many grafts each area of your scalp needs. For a full overview of all stages, read the Norwood scale guide.