Dublin clinical director: NHS refuses to pay for hair reconstruction
A private Dublin clinic says it has turned down burns victims from Northern Ireland who need hair reconstruction because the NHS refuses to pay for it.
A benefactor has paid for the treatment of east Belfast man David Haddock, who was disfigured in a house fire in 1981.
Dr Maurice Collins of the clinic said restoration was not always cosmetic.
"If you see some of the injuries they receive as a result of a fire, and if we can get them back into normal life, it's invaluable," he said.
Patients with skin loss in Northern Ireland are treated at the burns unit at the Royal Victoria Hospital (RVH), and the Belfast Health Trust says this often involves "multiple-staged treatments over a number of years".
Mr Haddock's hair reconstruction at the clinic in Blackrock began in November.
"If someone receives a bump on the nose or a scar to the face it can be addressed. Just as with hair restoration, we are trying to bring somebody back to where they should be - we are just trying to restore what was once originally there," he said.
Almost 70% of Mr Haddock's body was burned in a fire that destroyed his home in 1981.
His grandmother died in the blaze, and his mother passed away a short time later as a result of her injuries.
While Mr Haddock has undergone dozens of operations to his body, including plastic surgery at the RVH, surgery to his face, including hair transplantation, never went ahead.
Due to severe burns and scarring to his upper body, Mr Haddock, who is 36, is unable to grow a moustache or beard.Bullied
His hairline is damaged and he has no eyebrows. He has had to endure decades of bullying because of his appearance.
How are hair transplants done?
- While hair transplantation is a complex procedure, in simple terms it involves taking a strip of hair from where you have more than you need and putting it where you need it most
- Surgeons extract hair follicles normally from the back of the head and these are inserted into balding or thinning areas
- Under anaesthetic, a thin strip of skin containing the patient's hair is surgically removed and the area is stitched back together again
- In a laboratory, technicians then dissect the piece of skin separating the various follicles into slivers
- The resulting grafts, known as follicular units, are then inserted in the areas of scalp. Imagine a pin cushion, where multiple miniscule holes - almost invisible to the naked eye - are then filled with a separate hair follicle
- As the sebaceous gland is still intact, it keeps the follicle alive until it is re-implanted - if successful, the transplanted hair will continue to grow naturally
The BBC reported Mr Haddock's story last year, after appointments with the Belfast Health Trust were cancelled seven times in as many months.
Several hours after this was broadcast, the BBC was contacted by a private party who offered to pay for the treatment instead.
His case raises the question of what exactly should be diagnosed as cosmetic surgery.
While many burns victims will have plastic surgery to their bodies funded by the NHS, hair reconstruction is not.
According to the Dublin clinic, they have received eight applications from people in Northern Ireland.
However, only one person's treatment received NHS funding.
A spokesperson for the Belfast Health Trust said: "People who sustain injuries as a result of house fires constitute a small percentage of patients who are treated in the burns unit.
"They do however account for a significant proportion of the care provided by the expertise of the clinical team owing to the complex and life-threatening nature of these injuries.
"Many of these patients will go on to have a normal life expectancy and, with ongoing holistic support from the multidisciplinary team, hopefully return to full integration into society."
Hair reconstruction is used more often for cosmetic purposes. For instance, Louis Walsh and James Nesbitt both had their hair transplants carried out at the clinic where Mr Haddock is being treated.
Wayne Rooney's new locks are also testament to the procedure.Confidence boost
However, by allowing the BBC to film, Mr Haddock's benefactor hopes it will highlight the benefits if this treatment was available to burns victims on the NHS.
Dr Collins said by giving him back his hair, it's helping to restore not only his image, but also his confidence.
"By establishing somebody's eyebrows or hair line you can hide a lot of scarred tissue and give them a much better feeling about themselves. By restoring someone to what they should look like is not cosmetic, it's restoration," he said.
Mr Haddock's treatment at the Blackrock clinic began last year.
In November, the BBC was given exclusive access to the surgery. Among the team is Brendan Fogarty, who is a consultant plastic surgeon and lead clinician for burn surgery at the RVH.
Mr Fogarty said Mr Haddock was perfect for hair transplantation.
"If you look at the areas where David's scarring is still visible - the eyebrows, the moustache, the sideburns - all areas where there is a lot of scarred tissue, if we take hair from other areas and put it there, it will reduce the amount of scarred tissue and will give David a more natural appearance," he said.Patience
About 1,500 grafts were created from the strip of hair removed from Mr Haddock's head.
According to Mr Fogarty, Mr Haddock's quality of hair was a bonus.
"David has spectacular hair. On average people have 70 hairs per square centimetre. David has 160 hairs per square centimetre - he's a record breaker. It's a superb crop of hair, which makes our job a lot easier, as there is lots of hair to fill in the gaps," he said.
While the area is numbed throughout the process - which lasts several hours - Mr Haddock drifts in and out of sleep.
Mr Fogarty said the process requires patience.
"Because we have such good grafts of hair from David we are able to double up each incision, doubling the chances of growth for David," he said.
Mr Haddock's hairline will be restored, as will the sideburn and eyebrow region. All of this will cover scarred tissue giving him hair in places that a lot of us take for granted.
The procedure is expensive, but according to Dr Maurice Collins, while he understands the financial pressures, there is a mental and physical argument about why it should be provided by the NHS.
The Belfast Health Trust was unable to tell us how many patients have had their burn reconstructive surgery, including hair reconstruction provided in a private clinic under NHS funding.
The Dublin clinic carries out procedures on up to 250 patients every year.
To date, they have treated 96 people from Northern Ireland, five of whom had reconstruction resulting from scars and burns.
It is an expensive procedure. While every case is different, on its website the company quotes that the price per transplanted follicular unit graft is 10 euros.
In Mr Haddock's case there were 1,500 grafts.
In a cash-strapped health service there will be those who argue the money could be better spent.