Q: Dr. Eppley, I had scar revision on my knee area. The surgery helped my scar to look thinner but there is still this image of a straight line cut. I had my operation last September 5, 2012. I am planning to undergo laser treatment for my scar. Can I have it done by December of same year?
A: While you certainly can treat your scar revision by laser resurfacing in the early months after a scar revision, I would not expect it to change how it looks. (like a residual straight line cut) Laser resurfacing is almost always perceived as if it is a ‘magic eraser’ but that is not how it works at all. Lasers do not have the capability to wipe away scars and often are overused and overhyped.
A scar, no matter how thin, is a full-thickness layer (most of the time) of abnormal tissue that is largely white and unpigmented tissue. Laser resurfacing removes a layer of the top of the scar but doing so will only reveal more of the scar. Only in the most superficial of scars can laser resurfacing reveal more normal underlying dermis which then can re-epithelize. Thus in full-thickness scars no improvement will be seen. And after surgical scar excision, your scar is most certainly full-thickness.
Dr. Barry Eppley
Q: Dr. Eppley, your discussion of laser use to somewhat camouflage the appearance of self-injury scars was the first I have been able to find on this subject. You seem to truly understand that removal may not be possible, but if they are changed to look like another type of scarring then the social stigma is reduced. I was hoping that you might be willing to provide more information. My daughter self-injured for years and has the scars you described. She has received treatment and is now pursuing a degree in the health field. Camouflaging clothes are not always an option.
A: Having seen many self-inflicted scars on the wrists, forearms and upper extremities, it is obvious in seeing almost all of them that removal is simply not possible. Many patients have a large number of these scars that usually are very fine and white. No amount of laser resurfacing will get rid of them because the white scar goes all the way through the skin. Laser resurfacing only continues to expose the scar as it gets deeper. Cutting them out is not an option because of both the large number and the amount of scar improvement by narrowing is negligible.
This only leaves the alternative of scar camouflage by trade-off. Can the scars become another scar that is more ‘explainable and socially acceptable’ to the patient. In that regard, I have used two approaches. One is deep laser resurfacing to essentially convert it into a burn scar or replacing the most severely scarred areas with a skin graft. This requires the right patient with a large number of visible scars to justify the appearance of a burn injury or as skin-grafted patch. But in the properly motivated patient, it can be a successful scar treatment strategy.
Dr. Barry Eppley
Q: I have 6 lines of self harm on my right wrist. They are white clear lines, which I would like them removed due to constantly being cautious to cover up when around people. I have recently found out that I am pregnant and would like them removed even more now, before the birth of my child. I’m so confused as to what I should do and which is the safest option. I’m so desperate to have them removed. I have had them for two years now and would like them removed by September of this year. What dio you recommend?
A: What you are referring to are many numerous fine white scar lines that often criss-cross each other on the volar aspect of the wrist. As self-mutilation/suicide attempt scars go, this pattern is fairly common and I have seen it numerous times in scar revision consultations. The reality is that there is no magic eraser and any technique for their removal. They are as narrow as scars can get due to their creation by a sharp instrument and their white color is unchangeable due to the scar in them. No form of laser resurfacing can ‘wipe them off’ or erase them, that simply is not going to work.
Since the stigmata of these scars are its classic pattern, an alternative approach is to create one larger scar which is more amorphous. A more confluent non-descript scar will at least not look like a pattern of knife cuts. In effect, this is creating a bigger burn scar which will look like a burn injury not a knife injury. Deep laser resurfacing can be done to create this effect. While this is not as desirous as erasing the scars, it is a more achievable goal.
Dr. Barry Eppley