Q: Dr. Eppley, I am interested in getting revision of my numerous arm scars. I have attached two photos of the scars on my left arm. The first one on my upper arm is an 8 year old scar. It is the largest of my scars. The second photo is of self inflicted wounds that are about 10 years old. These are the ones I am more insecure about. Let me know what you think of these.
A: Thank you for sending your pictures. I have seen many such scars as you have either from accidental or self-inflicted injury. The reality of your arm scar revisions is as follows:
1) The very large scar with the suture track marks can definitely be improved. But it would need to be done in two stages due to its width. First excise the inner scar portion, let it heal for six months and then go back in a second stage to include the area that has the suture track marks. This is the best way to get a much narrower scar. It is simply too wide the way it is now to get substantial narrowing in a complete one-stage excision. Staged serial scar excisions is the best approach in wide scars where the surrounding skin is not very lax. These are office procedures done under local anesthesia.
2) The ‘cutter’ scars are always problematic because there are so many and they go the whole way through the skin. That is why they appear white as they are a full-thickness skin jnjury/scar. This laser resurfacing will not simply ‘wipe’ them away. They really need to be cut out and reclosed which often does not make a real big improvement for what you are trying to achieve. (not to look like you cut yourself) I have done a few case of complete skin grafting but that is an extreme approach for those who seek another more palatable explanation for why they have a ‘patch’ of their arm.
Dr. Barry Eppley
Q: Dr. Eppley, I was looking at possibility of laser resurfacing for my arm scars. My left forearm arm is completely covered on the bottom side from about two inches from the wrist to my elbow. Many are not deep, but several are. There are more than I can count. All scars are at least 2 years old. Also I was wondering if you had an estimated cost for something like that. I don’t have much money, but will be saving for this because it would allow me greater freedom with work and life in general, but we need a target to save for.
A: The usual scar pattern for arm scars secondary to self-inflicted injury is fairly typical. A large number of horizontal scars are usually present, often between the elbow and the wrist. Some may be longer and more wide but most are more narrow and short. The large number of the scars makes the consideration of surgical excision to narrow them impractical. A few large ones can be excised but most of the smaller ones will not be improved by excision and re-closure. While laser resurfacing seems like it would be effective, it rarely is. The scars go full-thickness through the skin so thinning of the skin by burning off the top layer will only expose more of the scar not less. In some cases I have performed laser ablation to create the effect of a full-thickness burn. This creates a large scar which is easier to explain than the many small ones from knife wounds. I have also done a wide excision of the entire area of arm scars and then covered it with a split-thickness skin graft. This creates a skin-grafted arm appearance which again provides a visual appearance that is easier to explain. When considering this route, a skin graft would be preferable to creating a full-thickness burn.
To give you a quote for surgery, I would first need to see some pictures of your arm scars to determine the best approach.
Dr. Barry Eppley