The sagging skin that results from extreme weight loss does not spare the upper body, particularly the arms. Flabby upper arm skin, often referred to as ‘bat wings’, is a very troubling problem that makes many affected women wear long sleeves, even in warmer weather. It limits their clothing options and is a frequent source of embarrassment. In my experience it is always in the top two concerns of most extreme weight female patients.
Such an arm problem is a good candidate for an arm contouring procedure known as an arm lift or brachioplasty.This operation removes a large amount of excessive skin and fat from the upper arm. This is a fairly simple operation that causes little to no pain afterwards. The biggest decision for any one considering this procedure is whether they can handle the scar that results from the procedure. Unlike most body contouring plastic surgery procedures where the scars may be fairly well-hidden under clothes, this is a scar which will be visible. For this reason, the decision for some patients can be a difficult one. Is it better to have a flabby arm with no scar or a more tightened arm with a scar? While the temptation is to always assume that the scar may be better, it is important to know that the scars in the arm (in my opinion) are never great. They frequently end up after healing and time to be wider and more raised than we like. While some arm scars can look quite good, many will be simply acceptable in the vast majority of patients. Scars are the arm simply do not do as well, for example, as scars from a tummy tuck or a breast lift. Scar revisions after an arm lift can really make a big difference is problematic arm scars…but that is another operation as well.
There are two types of arm lifts or brachioplasties. A full (extended) and a limited (short scar) arm lift. The difference is in the amount of skin removed and the resultant length of the final scar. In every extreme weight loss patient that I have seen, they all need an extended or the full arm lift due to the amount of skin. While I usually never cross the scar past the elbow, it is almost always necessary to carry the upper part down into the armpit if not further down into the chest wall and back. The arm lift scar can be placed either on the inside of the arm or on the back of the arm. There are arguments to be made for either scar placement,. neither approach is necessarily better than the other. Both locations of skin and fat removal will do the job. I leave the scar location decision up to the patient since they are the one who has to live with the final result.
While arm lifts cause very little pain afterwards, they do create some temporary swelling in the hands and forearms. The combination of upper arm skin tightening and circumferential dressings (loosely applied) causes some temporary lymphatic obstruction which resolves in less than a week after surgery. Healing of the incision is sometimes slow in the armpit area and it is not rare to have to drain a seroma in the elbow in the few few weeks after surgery. Beyond these short-term troublesome issues, arm lifts produce good results with a relatively uncomplicated postoperative course.
Dr. Barry Eppley