On a typical NW5 patient the amount of hair loss that has been experienced is roughly 50%. Half of all the hair on the patient’s scalp is gone. When you consider the safe donor zone only covers a portion of the back and sides of the scalp we are dealing with an overwhelming degree of demand for an underwhelming degree of supply. The challenge is to identify and prioritize the areas that the patient cares about most and in almost every case that area is the front. This includes the hairline, mid-scalp and to the vertex. On a NW5 the vertex still exists albeit in a lower than native density so fewer grafts can be used in this area for the sake of blending. The crown on a NW5 is prohibitively large to expect a similar degree of coverage but cosmetically appealing thin coverage can still be achieved. A patient with NW5 hair loss will need 5000 to 7000 grafts for a cosmetically acceptable result.
A patient with NW6 level hair loss obviously has a demand for higher numbers of grafts and a potentially smaller area to harvest from. The need for more hair beyond that of a NW5 lies in the lack of a vertex and an expanded crown region. NW6 patients can experience strong frontal reconstruction but they should expect even less coverage for a crown but they can still achieve a cosmetic improvement if expectations are realistic. Depending on characteristics a patient will need in the range of 6500 to 8500 grafts to achieve a cosmetically acceptable result.
Patients with NW7 stage hair loss are usually discouraged from having surgical hair restoration of any kind. The total area of demand outweighs the available supply by such a vast margin that it is many times considered to be a useless, expensive and even cosmetically detrimental endeavor regardless of the amount of care that is taken for the best result possible. Cases of NW7 loss should be HIGHLY scrutinized especially for the patient’s overall final expectations of the result. There are many cases of NW6 and NW7 patients receiving little to no surgical attention in the crown region and still having a natural and cosmetically improved appearance but these cases are the exception especially as we move higher on the hair loss chart. Regardless, NW7 patients can achieve a level of satisfaction from surgical hair restoration as long as their expectations are low and they have favorable surgical characteristics. A NW7 patient will typically need 7,000 to 12,000 grafts to achieve a cosmetically acceptable result.