Stigmata: Part I. Shame, guilt, and anger

The aesthetic surgeon may occasionally be consulted by a patient who wishes to discuss what can be done for the scars of self-inflicted wounds on the forearms. These scars are popularly referred to as "hesitation marks" or "s uicide gestures." Unlike patients suffering from factitial ulcers or Munchh ausen syndrome, these patients will admit to the physician that the scars a re the result of self-inflicted wounds. These scars often consist of multip le, parallel, white lines extending up and down the forearms (usually volar surface), with more on the nondominant side. Although the pattern of these scars is apparently what drives these patients to the aesthetic surgeon fo r relief (because even lay people identify these scars as self-inflicted su icide marks), the authors propose a new and deeper motivation for surgery. Recent experiences with three of these patients resulted in an epiphany tha t prompted this report. Once the symbolic meaning of these scars was broach ed, a torrent of thoughts and theories followed. This article will recount these three cases and present a central thesis for this type of self-inflic ted injury. A proposal for the proper surgical treatment of this condition will be offered. Uniquely, two of the patients will relate their own storie s and propose guidelines and warnings for the aesthetic surgeon.