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