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 "suicide gestures." Unlike patients suffering from factitial ulcers or Münchhausen syndrome, these patients will admit to the physician that the scars are the result of self-inflicted wounds. These scars often consist of multiple, 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 for relief (because even lay people identify these scars as self-inflicted suicide marks), the authors propose a new and deeper motivation for surgery. Recent experiences with three of these patients resulted in an epiphany that prompted this report. Once the symbolic meaning of these scars was broached, a torrent of thoughts and theories followed. This article will recount these three cases and present a central thesis for this type of self-inflicted injury. A proposal for the proper surgical treatment of this condition will be offered. Uniquely, two of the patients will relate their own stories and propose guidelines and warnings for the aesthetic surgeon.
The synthesis and application of polymeric microspheres are of great importance from both academic and industrial points of view. As polymeric microspheres have been used in wider fields of conventional 1 and more sophisticated 2-6 areas, the development of a new process to prepare such materials has received much attention. Polymer microspheres of a particular size and uniformity are generally obtained with one of the heterogeneous polymerizations, including suspension, emulsion, dispersion, seeded, and precipitation polymerizations. Moreover, each polymerization is branched to several subsidiary methods, such as macroemulsion, miniemulsion, microemulsion, and soap-free emulsion polymerizations.Fully crosslinked monodisperse polymer microspheres have unique applications because of their superior strength, thermal and solvent resistance, and antislip properties.7 However, the synthesis of such microspheres is limited to a few techniques, such as seeded polymerization, [8][9][10][11] Shirasu porous glass (SPG) membrane emulsification followed by postpolymerization, 12,13 and precipitation polymerization.14 Precipitation polymerization, in particular, has advantages over the other techniques because crosslinked microspheres can be readily prepared in a single process without any auxiliary apparatus to make the size distribution of the particles narrow. Therefore, homoand copolymerization systems have been thoroughly investigated, including poly(divinylbenzene), 15 poly (methacrylic acid-co-polyethylene oxide methyl ether methacrylate), 16 poly(methacrylate-co-divinylbenzene), 17 poly(chloromethylstyrene-co-divinylbenzene), 18 poly(divinylbenzene-co-maleic anhydride) 19 , poly(methyl methacrylate-co-divinylbenzene)[poly(MMA-co-DVB)], [20][21][22] and poly(styrene-co-divinylbenzene) [poly(St-co-DVB)]. 23In addition, mechanistic studies to elucidate the formation of stable microspheres in the absence of any stabilizer have been reported 24,25 in which the absorption of oligomeric species onto the nuclei and the high degree of crosslinking are the primary reasons for the formation and stable growth of the microspheres.Several examples of the copolymerization of the partially water-soluble monomer acrylamide (AAm) and oil-soluble monomers such as methacrylic acid 26 and styrene 27,28 have been recently reported with precipitation polymerization, 26 inverse microemulsion polymerization, 27 and water/oil/water emulsion by SPG membrane emulsification and subsequent suspension polymerization. 28In our previous studies, poly(St-co-DVB) and poly (MMA-co-DVB) microspheres containing various concentrations of divinylbenzene (DVB), from 5 to 75 mol %, were synthesized by precipitation polymerization, and their unexpected thermal properties, superior to those of crosslinked polymers prepared by emulsion and
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