International Standards For Treatment Planning

International Standards For Treatment Planning

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When it comes to a hair transplant, a major part of your procedure will be the treatment planning, to help determine the number of required grafts and the technique which is best suited to your requirements. While there are some non-reputable surgeons who may make-up the number of grafts required, there is an international standard for both male and female patients in order to determine the treatment that is required and the number of grafts, meaning treatment plans should not vary from surgeon to surgeon. These scales, Norwood-Hamilton scale for men and Ludwig-Savin scale for women, are used to help categorise the level of balding that a patient may be experiencing, and therefore the required number of grafts in order to achieve natural coverage and density. Here, we’re taking a closer look at these scales in order to give you an idea of where you may rank.

Norwood-Hamilton Scale

Designed specifically for male patients, the Norwood-Hamilton Scale, allows surgeons to accurately classify patients into groups depending on the severity of their hair loss. This scale was originally determined in the 1950’s by Dr. James Hamilton, and was later updated by Dr. O’Tar Norwood in the 1970’s. Typically, men will lose their hair in different patterns and stages – some may suffer from a receding hairline, whereas others may lose the hair at the vertex of the head. Others may lose hair from all over the head.

Norwood Scale

The Norwood-Hamilton scale helps to break down hair loss into a series of stages, in order to determine the most appropriate treatment and when it is required to have a hair transplant or begin to use other forms of treatment.

Stage 1 – Minimal amount of hair loss on the hairline. There is no need for treatment at this stage.

Stage 2/2A – Hair loss at the front temporal sides, creating a triangular shape. Hair loss may also begin to appear in the middle of the front of the hair. At this stage, diagnosis is important to determine whether hair loss is a result of male pattern baldness or lifestyle choices.

Stage 3/3A/3V – This is where baldness is scaled from small to moderate. Baldness on the crown area may occur at this stage and baldness on the temples will be clearly visible.

Stage 4/4A – This stage is a stage of moderate hair loss, mainly in the front temporal sides and receding hairline, as well as hair loss on the vertex area.

Stage 5/5A/5V – In this stage, a moderate to large amount of hair loss is visible, particularly at the back and front of the scalp (although these will still be connected with natural hair).

Stage 6 – Here is when surgeons will begin talking about a considerable amount of hair loss, starting from the hairline to the crown. Hair loss on the sides of the head will have also increased during this stage and a large number of grafts will be required if the patient opts for a hair transplant.

Stage 7 – This is the highest stage on the baldness scale, and hair is likely to only be present at the back of the head from one side to the other. A hair transplant at this scale will not be able to cover the full level of baldness in one sitting and more than one hair transplantation may be required to achieve the best results.  

The stages will determine how many grafts are likely to be required. For example, if the patient is experiencing stage 2A, then they may require 1000-1500 grafts. If they are experiencing stage 6 however, then they will require 4500-5000 grafts.

Ludwig-Savin Scale

In a similar way to how men’s hair loss is measured, women’s hair loss also has a scale to accurately measure the extent of the balding. However, due to the fact that women typically bald in a different way to men, they required their own scale. The Ludwig-Savin scale was originally two separate scales, with the Savin scale also measuring overall thinning as well as the density of the hair on the scalp, but this was then integrated into a single scale by many surgeons to help ensure that the right hair transplant technique was used.

Stage I-1 – The first stage of the scale is when the central parting of the scalp showed no hair loss.

Stage I-2 – There is a small amount of hair loss which can be seen on the central parting of the scalp.

Stage I-3 – A much larger amount of hair loss is visible on the scalp.

Stage I-4 – The parting is showing prominent signs of hair loss and is the widest parting indication on the scale showing that the hair is becoming much thinner on the scalp.

Stage II-1 – The hair is not only thinning around the parting but it is also diffusing over the top of the scalp.

Stage II-2 – The thinning on the scalp is very prominent.

Stage III – This stage is where the woman showcases extensive and diffuse hair loss on the scalp, although some hair will survive this.

Advanced – This is a very advanced stage of hair loss and typically the hair on the scalp will be non-existent, with some hair still visible on the side.

Frontal – This is where the hairline is beginning to thin, which is far less common in female patients than male patients.

Similar to the Norwood-Hamilton scale, the Ludwig-Savin scale is used to determine the number of grafts required. For example, if the patient is experiencing stage I-2, then they will require 250-750 grafts. However, if they are experiencing the most advanced stage of hair loss, then they will require 3500-4500 grafts.

At Longevita, surgeons closely follow these two scales to ensure that our patients are receiving the right amount of grafts in order to achieve the best possible results in terms of natural coverage and density. To find out where on the scale your hair loss sits, contact us or call 020 3409 1947. Whatsapp