Elton John in 2019.

Carmel Sparke

Dr Russell Knudsen was a GP in the 1980s when he became interested in hair loss treatments.

Here he talks about the emotional vulnerability of the men and women he sees, and why Shane Warne was wearing a hairpiece.

Australian Doctor: There are lots of jokes about male pattern baldness. Can you talk a little about the people you see. How traumatising can it be for them?

Dr Russell Knudsen: I see a lot of teenagers who come in with mum, he’ s wearing a hat, he won’ t look you in the eye, mum does all the talking. You see that he’ s devastated psychologically.

It does have a huge psychological impact on young men, and hair loss also has a psychological impact on every woman that I talk to.

Women are told their hair is their crowning glory, and it’ s part of their identity as a woman.

I keep tissues in my office because a lot of my female patients cry when they’ re talking to me.

With men, the big thing is that they can be cruel to each other about it.

Patients, especially younger ones, won’ t tell their friends they’ re having a transplant. I’ ve had people who don’ t want their wives to know, and professionals who want to minimise the initial impact for when they go back to work for face-to-face meetings.

I’ ve always joked, half seriously, that what I do is secret men’ s business, because people

don’ t want to look like they care or admit that they care to do something about it.

AD: Are the new treatments any good? Hair transplants don’ t have a great reputation.

Dr Knudsen: Before the 1980s, doctors did these large punch biopsy style hair transplants known as plugs that weren’ t very popular because they looked obvious.

‘ People don’ t want to look like they care.’

It wasn’ t until 1984 that the anatomy of hair on the scalp was even published in medical literature which showed hairs grow in natural groupings of anything between one and six hairs at a time.

In the late 1980s, doctors started doing grafts, taking the hair out from the back of the scalp, and dissecting it down under the microscope into the natural groupings and planting the natural groupings.

Suddenly it went from being cosmetically detectable to cosmetically undetectable.

That’ s called follicular unit transplantation( FUT).

But a lot of men were wary of the idea of having a linear scar on the back of the head, which occurs with FUT.

So around the year 2000, people thought we could go back to a punch biopsy technique, but use much smaller punches.

Back in the day when I started, the punches were 4mm.

Now we use these micro-punches, anything from 0.8mm to 1mm, to punch out the hair groupings.

This started the next revolution, which is called follicular unit excision( FUE), which is the dominant technique in the field today.

You take out these natural groupings one by one in a scatter zone, which leaves microdot scars, which aren’ t as noticeable.

So there’ s been an explosion of doctors coming into the field in the last 10 years to use the FUE technique exclusively.

AD: How many of each procedure do you do? And how many transplants are done across Australia each year?

Dr Knudsen: My practice is close to 50 / 50 but I’ m one of probably only three or four doctors in Australia that do both procedures. New doctors coming into the field only