- Best Results4-10 sessions
- Treatment Recovery1-7 days
- Procedure Time5-15 minutes
- Skin SpecialistDermatology nurse
- Duration of ResultsCan be permanent
- AnaestheticNumbing
- Back to Work0-3 days
- Cost$-$$
Self-Harm Scars - laser removal
Cutting or self-harm scars are common, occurring in over 10% of adolescents and young adults. Lasers can reduce the stigmata of cutting scars & can help blend these scars in with the surrounding skin. Lasers can target colour, mainly red, or help scars blend into the surrounding area.
FactsFacts on Lasers for Cutting/Self Harm Scars
- Lasers are best used on early cutting scars
- Vascular lasers are spaced 2-4 weeks apart
- Vascular lasers can reduce redness & help remodel collagen
- Fractional lasers can help with early & established cutting scars
- Examples of fractional devices include Fraxel, LaseMD, & CO2 devices
- The aim of laser is to treat both colour & contour of self-harm scars
What is the aim of treatment?
The aim of any scar treatment is to improve colour & contour. If both are achieved, the scar will be less visible. Lasers can achieve both, however there are specific clinical features that determine what is the best pathway.
In the context of self-harm – cutting scars, another unique aim is to remove the patterning of parallel cuts & scars associated with the perception of cutting scars. Read the section on surgical procedures to understand more about how I achieve this.
What can lasers achieve?
Lasers are great at treating colour changes, in particular red. White scars do not respond to lasers as the pigment cells (known as melanocytes) are reduced. White scars are more complex to treat. They may require surgical intervention (see the section on surgery).
Lasers can help bend in some scars by treating the surrounding skin. Additionally, lasers can help increase uptake of anti-inflammatory steroid drops & reduce the height of scars. This improves skin contours.
What can lasers not achieve?
Deep & wide scars are beyond the reach of lasers. Deep cuts that enter the bottom dermal layer of skin will not be improved with lasers. These scars are best treated with surgery & in some cases skin grafting.
As a guide, palpable scars, scars wider than 2.75 mm & depigmented scars will respond less to lasers. Exceptions do apply; however, it is impossible to tell who will get an excellent result.
What can be done about red self-harm scars?
Vascular lasers including V Beam Prima, Perfecta & Laser Genesis can help reduce redness. They are most effective for early scar management. Treatments are painless & not associated with any downtime. A series of 4 to 8 sessions is typically required, over a period of 4 to 8 months.
If scars are raised, vascular lasers can be combined with silicone sheeting or anti-inflammatory drops & injections.
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How do fractional lasers treat cutting scars?
Fractional lasers include Fraxel, Clear & Brilliant, LaseMD, Pico as well as CO2 & erbium lasers. My team & I choose a specific laser depending on the job. Lasers work by-
- Scar remodelling. This improves the quality of collagen. Examples include Fraxel, ablative lasers & picolasers.
- Increasing penetration of anti-inflammatories. Examples include thulium & CO2 fractional laser resurfacing.
- Blending in surrounding skin. Examples include Fraxel.
How many fractional laser sessions are required?
Between 4 to 6. It really depends on the location, scar depth, scar width, & skin type. More treatments for wide & deep scars. Fractional lasers are spaced 4 to 10 weeks apart.
Is laser treatment painful?
Nope. We use skin cooling to reduce pain. Additionally, my team uses high strength numbing gel to ensure patient comfort.
How long does it take to heal from fractional lasers?
About 3-9 days. It really depends on the type of laser used. As a guide-
- Pico lasers: 12-to-24-hour healing
- Fraxel / LaseMD/ Clear & Brilliant: 3-7 days
- Co2 Fractional: 4-9 days.
What can be done about white cutting scars?
Lasers can improve some white or hypopigmented scars. As a guide, expect 20-60% improvement after 3-5 sessions. Scars that are less than 1.5 mm wide do best. My preferred lasers for white scars include CO2, 1927, 1550, 1540 & 1440 wavelengths. In some cases, I combine lasers with pigment migrators such as Latiesse.
Hypopigmented/white scars greater than 2.25-2.5 mm are best treated with surgery.
What is the best treatment for raised self-harm scars?
The three ways to manage raised self-harm scars are as follows-
- Silicone gel or sheets; including Dermatix, Strataderm
- Vascular lasers (performed by my clinical team)
- Steroid injections or via laser/microneedling infusion
As a guide it can take up to 12 months to reduce the height of hypertrophic scars. Risk factors for raised hypertrophic – keloid scars include young age, females, ethnicity, & location- shoulders & outer arms.
How does microneedling compare to lasers?
Microneedling can be a useful adjunct to lasers. Lasers give more scar remodelling & are specific when it comes to reducing redness & raised scars. Microneedling is best used for white scars. I also use microneedling to assist in delivery of corticosteroids in the dermis.
What factors should be taken into consideration before treatment?
The most important factor to consider prior to revision is to ensure that you are emotionally stable prior to treatment. We can gain the most ground if your cutting has stopped. This way my team & I can work with you to gain more ground. We can work with your GP, psychiatrist, or psychologist.
Prevention is the key, there after it is early management & wound care. If your scars are less than 6 to 8 weeks, we have a narrow window to remodel scars early. This can markedly reduce the effects of permanent scarring. Early scars are best treated with silicone tape, Dermatix or Stratamark silicone gel, as well as vascular lasers.
What are the risks of lasers?
Minimal in the context of how we apply them to treat cutting scars. An accurate guide is as follows-
- Infection. Less than 3% of cases.
- Skin color changes. Higher in darker skin types. Seen in 3-5%, temporary.
- Patterning. Related to above. More common in CO2 lasers, reduces over 1-3 months.
- Blistering. With vascular lasers, seen in less than 1% of cases.
- Scarring. Extremely rare, less than 0.1% of laser procedures.
How do I employ lasers?
I use lasers in a different modus operandi for the management of cutting scars. In the context of more invasive surgical techniques, I use an erbium laser to completely resurface scars (often in conjunction with excision). This type of laser resurfacing prepares a recipient bed for skin grafting. This procedure is complex as it transfers skin cells, including pigment cells from a donor site to the recipient wound bed. The majority of cutting scars will not require this form of treatment.
How much are treatments?
It depends on the extent & complexity of laser treatments. As a guide-
Pico & vascular lasers (red scars): $240 to $390 per session.
Fractional lasers (LaseMD, Fraxel, CO2): $390 to $690 per session.
To keep costs down, lasers are performed by my clinical staff. My skill sets are in the revision of complex scars – objectively severe scarring via surgical & high-powered lasers.
*There is no Medicare rebate for laser treatment. Surgical procedures carry a partial rebate.
When do I employ surgical methods to treat self-harm scars?
The decision to operate or not is complex, as there are both surgical & physical algorithms as well as emotional ones. A guide as to how I think is as follows-
- Early scars (red, narrow scars), best treated with vascular lasers & topicals.
- Narrow white scars with good blend, best treated with lasers.
- Self-harm/ cutting not in remission, best treated conservatively.
- Wide >2.4 mm scars, best treated with excision then laser.
- Multiple wide scars, best treated surgically; excision & grafting
Davin’s Viewpoint on the use of lasers for cutting scars
Lasers are useful for-
- Treating redness in early self-harm scars. They can also reduce the palpability & soften hypertrophic & keloid scars. In this situation, early scar remodelling can reduce the need for more invasive procedures such as surgery.
- Lasers are also useful for blending in surrounding skin. Fractional lasers including thulium & CO2 are best.
- Lasers can also reduce the width & improve colour for scars that are less than 2.75 to 2.5 mm in width.
The rate limiting factor of lasers is the depth of scars. It is impossible to gauge the actual depth of the cut, in the future imaging maybe useful (think high resolution ultrasound). Lasers, though useful, are not effective in all cases of cutting scars.
Unfortunately, Medicare does not recognise self-harm – cutting scars as a medical condition, hence laser treatments are not subsidized (however can subside scaly patches on the knees and elbows for up to $7500 per annum). The mind boggles.