Camouflage of Self-Inflicted Razor Blade Incision Scars with Carbon Dioxide Laser Resurfacing and Thin Skin Grafting

Abstract

Self-cutting using a razor blade is a type of self-mutilating behavior that leaves permanent and socially unacceptable scars with unique patterns, particularly on the upper extremities and anterior chest wall. These scars are easily recognized in the community and become a source of lifelong guilt, shame, and regret for the self-mutilators. In the presented clinical study, we aimed to investigate the effectiveness of carbon dioxide laser resurfacing and thin skin grafting in camouflaging self-inflicted razor blade incision scars. A total of 26 anatomical sites (11 upper arm, 11 forearm, and four anterior chest) of 16 white male patients, whose ages ranged from 20 to 41 years (mean, 23.8 years), were treated between February of 2001 and August of 2003. Detailed psychiatric evaluation preoperatively; informing the patient that the procedure is a "camouflage" operation; trimming hypertrophic scars down to intact skin level; intralesional corticosteroid injection to hypertrophic scars; carbon dioxide laser resurfacing as a single unit; thin (0.2 to 0.3 mm) skin grafting; compressive dressing for 15 days; use of tubular bandage; and protection from sunlight for at least 6 months constituted the key points of the procedure. The scars were successfully camouflaged and converted to a socially acceptable appearance similar to a burn scar. Partial graft loss in one case and hyperpigmentation in another case were the complications. No new hypertrophic scar developed. The carbon dioxide laser resurfacing and thin skin grafting method is effective in camouflaging self-inflicted razor blade incision scars.