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