Thank you for sharing your photo and for your question. I appreciate your courage to share such sensitive photos and I understand the desires to correct these scars.
The reticular dermis is the lower layer of the dermis, found under the papillary dermis, composed of dense irregular connective tissue featuring densely packed collagen fibers. Cuts to the skin above this layer usually heal without scars.
Once you have scars that remain permanent, it would mean that the cuts from self-harm are significantly deep and past the reticular dermis to cause permanent fine scars (like the ones in the photo). Whilst it may be possible to lighten the scars, unfortunately it is difficult to completely remove it. As pointed out by Dr. Chin, the treatment of these scars are very challenging and most treatments are not able to offer significant improvement.
I echo his comments concerning skin grafting. Let me elaborate further. The procedure of skin grafting would involve taking skin from a part of your body (usually from an area that is easily concealed, such as the groin grease, along the inner thigh or from the buttocks) and applying that to the area with the fine scars once that skin has been removed. As a result there will be a patch of skin graft over the forearm. That patch of skin would take time to fade and would not be unnoticeable.
However, there is another surgical option, which is known as tissue expansion. This is a staged procedure that involves placing a small balloon under the skin that is next to the scars. The balloon is gradually inflated and expanded to "grow" new skin to resurface the area of fine scars. After weeks of tissue expansion when sufficient amounts of skin has been expanded, the scarred skin is excised and the new skin is used to resurface the arm (see below). Whilst the method is not without scar, we can convert the area of fine scars to a single linear scar (which is the entry wound that is required to insert the balloon.
The expander flap method for forearm scars. a. Design of the first operation, where an expander was implanted. b. View during the first operation. c. View immediately before the second operation. d. Eighteen months after the second operation. Healthy skin was expanded for 3 months after the first operation. In the second operation, the entire scar area was excised and closed primarily with z-plasties. (Reference: Surgery for scar revision and reduction: from primary closure to flap surgery. Ogawa R. Burns Trauma. 2019 Mar 1;7:7.)
Many patients have scars as such as most cope with using creams and clothing to camouflage the scars. Over time, the scars would also remodel and become less obvious.
Hope this answers your question.
Have a great week ahead!
Dr. Terence Goh
Plastic Surgeon | AZATACA Plastic Surgery
