Hairline design at Norwood 5 requires placing the new hairline 7 to 9 cm above the glabella (brow ridge), higher than the patient's original juvenile hairline, and distributing 3,000 to 4,500 grafts in a density gradient that prioritizes the frontal zone while providing meaningful coverage through the mid-scalp.
Why Hairline Placement Is Critical at Norwood 5
At Norwood 5, the area requiring coverage is large (typically 120-180 cm2 of bald scalp). The available graft supply (3,000-4,500 grafts) must cover this area at a density that looks natural. If the hairline is placed too low, grafts are consumed in the frontal zone and the mid-scalp and crown are left sparse. If it is placed too high, the result looks unnatural and ages poorly.
The fundamental principle: a well-placed hairline with moderate density looks better than a low hairline with thin density.
Step 1: Determine Hairline Height
The standard measurement reference is the distance from the glabella (the bony prominence between the eyebrows) to the new hairline.
| Patient Age | Recommended Height Above Glabella | Rationale |
|---|---|---|
| 30-39 | 7-8 cm | Slightly conservative, allows for long-term stability |
| 40-49 | 7.5-8.5 cm | Age-appropriate mature positioning |
| 50-59 | 8-9 cm | Higher placement preserves graft budget for density |
| 60+ | 8.5-9.5 cm | Conservative placement, maximizes natural appearance |
These are guidelines, not rigid rules. Individual facial proportions, forehead shape, and the patient's preferences all influence the final position. The surgeon typically draws the proposed hairline on the scalp with a marker and reviews it with the patient before proceeding.
The Rule of Thirds
A natural face divides roughly into three equal vertical zones: hairline to brows, brows to nose base, nose base to chin. At Norwood 5, the hairline should restore this proportion rather than recreate the patient's teenage hairline. Surgeons use this principle to determine a placement that looks balanced from the front.
Step 2: Design the Hairline Shape
A natural male hairline is not a straight line. It has specific contours:
Frontal Hairline Contour
- Central forelock zone: A slight forward projection at the midline (0.5-1 cm lower than the sides), creating a gentle rounded or peaked shape
- Temporal recession points: Natural bilateral recession at the temples. At Norwood 5, these are designed at a conservative angle to frame the face without consuming excessive grafts
- Irregular edge: The leading edge should be micro-irregular (not a clean line), achieved by staggering single-hair graft placement with 1-3mm variation in position
Lateral Boundaries
The hairline should not extend too far laterally. At Norwood 5, the lateral extent is typically aligned with the outer edge of the orbital rim (the bony ridge above the eye socket). Extending further laterally requires more grafts for minimal visual impact.
Step 3: Plan the Density Gradient
Not every zone receives the same number of grafts per square centimeter. Skilled surgeons distribute grafts in a gradient that mimics natural hair density patterns and maximizes visual impact.
Recommended Density Distribution at Norwood 5
| Zone | Grafts per cm2 | Purpose |
|---|---|---|
| Hairline edge (first 1-2 cm) | 40-50 | Creates the visual impression of thickness at the most visible point |
| Frontal zone (behind hairline) | 35-45 | Core density that provides styling options |
| Mid-scalp | 25-35 | Moderate coverage connecting front to crown |
| Crown | 20-30 | Lighter coverage radiating from the whorl |
Single Session vs. Two-Session Distribution
Single session (3,000-4,500 grafts):
- 60-70% to frontal and mid-scalp
- 30-40% to crown
- Result: moderate density throughout
Two-session approach:
- Session 1: 2,500-3,500 grafts to frontal and mid-scalp
- Session 2 (12-18 months later): 1,000-2,000 grafts to crown
- Result: higher density in the front (first session), dedicated crown coverage (second session)
The two-session approach often produces a better final result at Norwood 5 because it allows the surgeon to evaluate first-session growth before designing the crown strategy.
Step 4: Graft Type Placement
Each follicular unit contains 1 to 4 hairs (average 2.2). Surgeons sort extracted grafts by hair count and place them strategically:
Placement by Hair Count
- Single-hair grafts (1 hair): Placed exclusively along the hairline edge (first 1-2 rows). These create the soft, natural transition between bare skin and hair
- Two-hair grafts: Placed behind the single-hair zone in the frontal area. Provide the foundation of visible density
- Three and four-hair grafts: Placed in the mid-scalp and crown. These high-count units deliver maximum density per graft, which is important in zones where individual graft visibility is lower
This sorting and placement strategy is one of the factors that separates experienced hair transplant surgeons from less skilled practitioners. The visual difference at the hairline between a clinic that sorts grafts and one that places them randomly is significant.
Step 5: Angulation and Direction
Transplanted hair must follow the natural growth direction of the surrounding native hair. Incorrect angulation produces hair that sticks out at odd angles and looks unnatural regardless of density.
Natural Growth Patterns
- Frontal hairline: Forward and slightly downward, at 15-30 degrees from the scalp surface
- Mid-scalp: Gradually transitioning from forward to a more radial pattern
- Crown: Spiraling outward from the central whorl (clockwise in approximately 80% of men, counterclockwise in 20%)
- Temporal area: Following the direction of the existing temporal hair, typically forward and downward
The Choi implanter pen (used in DHI) allows precise control of angle during implantation. In standard FUE and FUT, the surgeon creates recipient sites at the correct angle first, then technicians insert grafts into these pre-made channels.
Common Design Mistakes at Norwood 5
Hairline Too Low
A hairline placed at 5-6 cm above the glabella (replicating a teenage hairline) consumes 30-40% more grafts in the frontal zone than a conservative placement. This leaves insufficient grafts for the mid-scalp, creating an abrupt transition from dense frontal hair to sparse or bare mid-scalp.
Symmetric, Straight Hairline
A perfectly straight, symmetric hairline looks artificial at any age. Natural hairlines have micro-irregularities and slight bilateral asymmetry. Surgeons who draw precise, geometric hairlines produce results that immediately read as transplants.
Ignoring the Crown Whorl
The crown has a natural rotation point (the whorl). Grafts placed without following this spiral pattern create an unnatural appearance. Some surgeons avoid the crown entirely in the first session rather than risk a poor design.
Over-Promising Density
At 3,000-4,500 grafts, you cannot achieve pre-balding density across the full Norwood 5 area. A surgeon who promises this is either planning to exceed safe donor extraction limits or has unrealistic expectations for graft yield. Expect 30-50% of original density distributed in a gradient.
Evaluating a Surgeon's Hairline Design Skills
When reviewing a surgeon's portfolio for Norwood 5 cases, assess:
- Hairline naturalness: Do the hairlines look soft and irregular, or geometric and harsh?
- Density consistency: Is the density even within zones, with smooth transitions between them?
- Age-appropriateness: Do 50-year-old patients have 50-year-old hairlines?
- Multiple angles: Are results shown from front, profile, and top views?
- 12+ month photos: Anything less than 12 months does not represent the final result
For a free AI analysis of your current Norwood stage and hairline design options, upload a photo at myhairline.ai/analyze.