Q: Dr. Eppley, I would like to know if anything can be done to improve my arms scars. I have a history of being a ‘cutter’ but am now over that self-mutilating problem. I would like to put the reminders of this phase of my life behind me. I have sent you some pictures of the arm scars. The first picture is the left arm and the second is the right. I’ll look forward to hearing if there is anything that can be done to make these less noticeable. Thanks for your time.
A: Thank you for sending your pictures. Due to the large number of transverse scars on each arm, I see no significant improvement that could be obtained by any type of individual scar revision or laser resurfacing methods. Those approaches would be hopeless in your arm scar problem. In a few of these type extensive arm scar cases, I have done complete removal of the scarred forrearm segments and replacement it with a skin graft. This is a more radical approach, and replaces one scar problem for another, but at least the social stigmata of the visible scarred forearms is gone and may offer one a better social opportunity for explanation.That may be a satisfactory approach for the right patient.
Dr. Barry Eppley
Q: I self harmed for many years as a young person, I haven’t done so in almost a decade and I am a different person to the one I was back then. I find it almost unbearable to see the constant reminders on my arms and stomach. They are quite bad. I never go out in short sleeves and this has lead me to detest the summer as I am always covered up, miserable and uncomfortable. I wish I was like everybody else. Is surgery a good option for me to think about? I’m desperate to live a ‘normal’ life.
A: Self-mutilation leads to many linear and cross-hatched scars, often on the patient’s arms. They usually appear as fine white lines. They are white because of the unpigmented scar that is created from the often superficial lacerations. In general, the concept of simply wiping them away by laser resurfacing is not possible because the scar depth is too deep. At best, all one can do is trade-off a different type of scar for the self-mutilation scars. I have done deeper laser resurfacing to create a burned appearance as well as have even skin-grafted arm areas. The intent of this scar trade-off is that it can be more easily explained as part of a more socially accepted injury (e.g., burn) and not look like it was from self-mutilation or from someone who is a ‘cutter’. If one can accept this scar trade-off, such a scar revision approach may be reasonable.
Dr. Barry Eppley