The first time I heard about the Norwood scale was when my dad was getting treatment for his baldness and the first time I heard about the Ludwig scale was when I went to a clinic to check on my own hair loss! Turns out when it’s in your genes, there’s not much that you can do about it, so you just have to get used to it, move on and try to find ways to deal with hair loss. 

Now the second time i heard about the Norwood and Ludwig scales was when i went in to get some counseling for SMP for hair loss.

As i said before, i had already decided to deal with my hair loss and one of the best treatments seemed to be scalp micropigmentation. However in order to see if you are fit for it, in other words if you want to make sure if a hair tattoo seems natural on your head, you can make great use of these two scales.

If you have been suffering from hair loss, you have probably heard of them, but if not don’t worry. We’ll learn all about the Norwood scale and the Ludwig scale in this blog post.

What is the Norwood scale?

About 85 % of men lose a great deal of their hair by the time they reach 50. Male pattern baldness is one of the main causes of hair loss in men. Dermatologists mostly use the Norwood scale (also known as Norwood-Hamilton scale) to identify the degree and stage of hair loss in men. Of course there are other references for hair loss classification but the Norwood scale is the most widely used one.

The Norwood scale classifies the extent of male hair loss in 7 stages. Based on the patient’s stage, they can choose treatment options and also measure how effective their current treatment is. 

the norwood scale
The Norwood-Hamilton scale was first introduced by James Hamilton in the 1950s and was later revised by O’Tar Norwood in the 1970s.

Stages of hair loss based on Norwood scale

  • Stage 1 hair loss: This is the first stage with practically no hair loss. In fact significant hair loss or recession of the hairline can not be seen in patients at this point. 
  • Stage 2 hair loss: The hairline begins to slightly recess. This recession usually occurs around the temples.
  • Stage 3 hair loss: In this stage patients usually start to feel the actual hair loss or baldness due to deep hairline recession in temples causing an M, U, or V shape.
  • Stage 4 hair loss: The hairline recession is more severe than in stage 2, and there is sparse hair or no hair on the vertex. The two areas of hair loss are separated by a band of hair that connects to the hair remaining on the sides of the scalp.
  • Stage 5 hair loss: The two areas of hair loss are larger than in stage 4. They are still separated, but the band of hair between them is narrower and sparser.
  • Stage 6 hair loss: The balding areas at the temples join with the balding area at the vertex. The band of hair across the top of the head can not be seen anymore or it’s too thin.
  • Stage 7 hair loss: This is the highest level of hair loss, and no hair will be left except a narrow band of hair around the head.
areas of the scalp
You can see areas of the scalp in this image to better understand the Norwood scale.

What is the Ludwig scale?

Women also suffer from patterned hair loss called female pattern baldness or Androgenetic alopecia. Just like the Norwood scale, the Ludwig scale is used to diagnose the level of pattern baldness only this one is used for females and has different stages.

The original Ludwig scale shows the progress of hair loss in women in 3 stages ranging from no hair loss to extreme hair loss.

the Ludwig scale
The Ludwig scale was developed in 1977 by Dr. Erich Ludwig. This scale classifies female pattern hair loss into only three stages, according to hair density.

Stages of female pattern baldness based on the Ludwig scale

  • Stage 1 hair loss: This stage portrays mild hair loss in women. The front hairline mostly remains healthy. Hair loss at the top is noticeable when the hair is parted in the middle.
  • Stage 2 hair loss: The second stage of the Ludwig scale shows moderate hair loss. This is where most women begin to notice their hair loss as a problem since they experience hair thinning, falling and volume decrease. At this stage hair loss occurs at the center of the scalp and reaches out to sides as the patient ages. 
  • Stage 3 hair loss: This is the severest extent of female hair loss. Hair loss is easily noticeable to any audience whether professional or not as the hair barely covers the scalp. Although there may be hair on both sides of the scalp, the best option here could be hair transplant as the middle part hair loss is so extreme.
The Ludwig scale
Since the original Ludwig scale is too broad and general, there have been other versions developed. This image is the revised and more complete version of the Ludwig scale.

How can I use these hair loss scales?

The Norwood and Ludwig scale are most importantly used by clinicians and dermatologists to diagnose the extent of pattern baldness in patients. You can also use it to see which hair loss treatment is best for you. Below you can see how it will be of use to you in getting a hair tattoo.

How to use the Norwood scale for scalp micropigmentation

If you are suffering from male pattern baldness, you have many options to treat it. One of the best and most practical options is scalp micropigmentation or a hair tattoo. This treatment is cost-effective, maintenance free and without any side effects.

If you are in stages 1 to 3 of the Norwood scale, then you can get a scalp micropigmentation for long hair, meaning you won’t have to shave the rest of your hair. You’ll just use SMP to cover the balding areas. However if you are in stages 4 to 7 then you probably have to shave your entire head and use SMP to create a clean and attractive shaved hair look. This is because your hair loss is so severe at these stages that SMP will look fake next to the remaining of your long hair.

How to use the Ludwig scale for scalp micropigmentation

If you are battling with female pattern baldness, one of your easiest ways to treat it is a female scalp micropigmentation. Now you might be surprised because you always thought that SMP is for men, but we must tell you that many of our clients are women who need help covering their hair loss.

If you are in stages 1 to 6 of the Ludwig scale above, then you can get a female scalp micropigmentation. It will cover the hairless areas and blend in perfectly with the rest of your hair. People won’t even notice it. 

However if you are in stages 7 to 9 of the scale, then SMP won’t be suitable for you, unless you want to shave your head entirely which is usually not preferred in women. In this case we recommend that you check out some surgical hair loss treatments or medical hair growth methods


As you read above, the Norwood and Ludwig scales are not just theoretical ones. They are indeed practical scales that show the stage of your pattern baldness (male and female). 

If you are looking for hair loss treatments, you can use these scales to choose the best treatments. For scalp micropigmentation if you are in an area of the scales in which the top or back of your head has partially lost hair, then SMP will probably look natural on you. 

We recommend that you try ELKA SMP’s free counseling session before booking an appointment for your hair tattoo. In this session we can work through the scales to make sure SMP is your best bet.