49 do the FUE technique. This is the dominant technique in Australia and the world at the moment.
ausdoc. com. au 11 APRIL 2025
49 do the FUE technique. This is the dominant technique in Australia and the world at the moment.
Overall I do about 200 hair transplants a year, and I’ d do 2500 consults a year.
I do between four and six transplant cases a week roughly, so I’ m treating a lot more people medically than surgically.
Around Australia, doing the maths, I’ d say around 3000-plus hair transplants are done a year.
AD: Okay, speaking generally, what are the outcomes for people going through a hair transplant procedure?
Dr Knudsen: Part of the problem is that the marketing is about‘ more is better’.
They will say:‘ We can do 5000 grafts, we can do 7000 grafts.’
The point is, that might be the lifetime supply for that patient, being done in these guys in their 20s.
And they come back, now bald at the back of the head, rather than on the top of the head, because they’ ve been overharvested.
They’ ve had so much hair out of the back of the head, it’ s now see-through.
Once that happens, I’ ve got nothing to play with to deal with the problem. Balding unnaturally looks just wrong.
I probably see around a person a month for repair work, but that’ s more than I used to see.
I think we’ ll start to see a tsunami wave in the next 10 years of very unhappy patients that have been treated poorly because nobody thought through the consequences. Nobody gave them medical advice about how to preserve their future hair loss.
I’ ve been in the field for 40 years— I get to see what happens in 40 years over a patient’ s evolution.
AD: How do you avoid this happening?
Dr Knudsen: Long-term surgical planning is the key. You’ ve got to think about: What’ s the worst-case scenario? What if they’ re going to get more bald than I think, than they think, and faster than they think, and I think?
How do I deal with that, and how do I keep this looking natural?
When they walk away from medication, the worst thing that can happen is they bald naturally.
When they walk away from medication after surgery, the worst thing that can
GETTY IMAGES
‘ We do operate on some women, but it’ s about 85 % men.’
Shane Warne in 2019. happen is that they bald unnaturally.
For example, like the guys who have only got that little bit of recession at the front— the McDonald’ s hairline.
You put a triangle in on the left, and the triangle in on the right. What does that look like when the hair marches away from it? It looks like two horns.
Even with our medications, we don’ t have the ability to 100 % guarantee that we can stop people going bald. We may be just slowing it down rather than stopping it.
AD: You mentioned the rise of FUE. There have been reports of men travelling overseas for the procedure. The outcomes have not always been good, apparently.
Dr Knudsen: FUE has had several knock-on effects.
First of all, doctors think it doesn’ t take surgical skill to do it.
This is why we now have something like 50 doctors in Australia doing it, whereas we used to have 12.
The other thing that benefits practices with FUE is that they don’ t need as many staff to help.
When I’ m doing a strip procedure, for example, I use 6-7 staff. If they’ re doing FUE,
Dr Russell Knudsen.
AD: So what about megastars like Elton John, who, with all the money in the world, still seem to struggle to achieve natural-looking hair?
Dr Knudsen: His hair isn’ t a result of a hair transplant. He’ s wearing a wig. I spoke to the surgeon who did his hair transplant back in the 1980s. He said Elton John had very wispy, dark hair, and he tried it and didn’ t like the results, so he went back to wearing a wig. He had two transplants, I think. He was a French surgeon. I met him at a meeting once and we had a chat about it. they might only need two.
The next knock-on effect is on the business side of things. This has led people to think:‘ The work is laborious, it’ s boring. So we’ ll delegate it to a staff member.’
This has created what’ s called a‘ black market’ in these procedures, all around the world.
Turkey is the worst offender, where the doctor— if they’ re even on the premises— injects local anaesthetic into the scalp.
Then tech staff do the entire operation, which means [ they ] harvest at the back, using the punch and drilling out the grafts. They’ re making incisions in the top of the scalp, and then they’ re implanting the hairs as well.
Men have been told:‘ You can have a massive amount of hair for only $ 4299,’ so there’ s been a procession of people from around the world seeking cheap hair transplants.
AD: Is this happening in Australia?
Dr Knudsen: We have clinics that want to capture that overseas market, and have decided to do the same thing.
That is— they will have the doctor on the premises. Once he or she puts the anaesthetic in, that’ s the only time they’ ll touch the patient.
Tech staff then do the procedure.
AD: What about those cricketers and places like Advanced Hair Studio? What do they offer?
Dr Knudsen: Shane Warne had a hairpiece on the back of his head for his bald crown.
Many of the cricketers were wearing hairpieces, because Greg Matthews, an off-spinner for Australia, was employed by Advanced Hair Studio, so he got all his balding cricket mates to come on board.
Advanced Hair Studio is a hairpiece clinic. They just don’ t call them hairpieces. They call them“ natural units”. It’ s such an operation— and they sell you two expensive hairpieces, and you keep one in the drawer just in case you spill paint on or damage the other one. They glue it on— and they don’ t say“ glue”— they say they“ adhere” it to the scalp. And once they do that, you have to go back to them for haircuts every six weeks, for them to reattach the unit and to make sure the hair is trimmed.
AD: Can you explain the demographics of the people you see?
Dr Knudsen: In terms of patients, I see 70 % men, 30 % women. Men are aged anything from 16 through to 90.
With women, I have had a couple of teenagers, but it’ s usually a bit older, usually the late 20s to the 60s.
We do operate on some women, but the operating is 85 % men and 15 % women.
AD: But is there any counselling process? Isn’ t encouraging men to accept a natural process better than going through surgery?
Dr Knudsen: I counsel them, as the doctor taking charge of the process.
There is a thing that I would call premature balding, and that is a guy who says to me:‘ I’ m 25, I don’ t want to lose my hair now. But if I was 40 [ and ] married [ and ] I had three kids, by then I wouldn’ t care.’
My advice to him would be to take meds until you’ re 40, and then, when you don’ t care, stop taking the meds.
I would not advise him to have surgery, because once he has surgery, now he’ s got a commitment to make that look reasonable for the rest of his life.
If he sees it as a normal part of ageing,
SCIENCE PHOTO LIBRARY
‘ I’ ve had people who don’ t want their wives to know.’
A hair plug being inserted into a hole on the crown of a man’ s head during a hair transplant operation.
then we try to arrest it and do what we can medically until he becomes comfortable with it, and then he can stop taking the meds.
AD: You seem to have a good head of hair yourself.
Dr Knudsen: This is the irony, because my older brother— bald. My father— bald. My mother’ s father— bald.
I’ ve skipped it. My son has skipped it so far. It’ s just in the genetics of it, from either side of the family. It’ s just dumb good luck.
If you look on the internet, there are 1000 products for hair loss. The first thing that tells you is that 998 of them have no effect whatsoever.
It also tells you it is an issue.