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Archive for the ‘arm lift’ Category

Case Study – Arm Lifts in Bariatric Surgery Patients

Sunday, June 14th, 2015

 

Extreme arm sagging after weight lossBackground: Large amounts of weight loss, whether from bariatric surgery or from other non-surgical methods, creates a lot of secondary body issues. The loss of subcutaneous fat causes deflation of the overlying skin, resulting in skin sagging and often interference with numerous normal bodily functions. The arms are a classic example of this expected phenomenon with large amounts of loose skin hanging off of the back of the arm creating the classic ‘batwing’ appearance. Besides its unsightly appearance it often causes problems in fitting into shirts and other upper body wear.

Removal of excessive arm skin is done by the well known arm lift or brachioplasty procedure. This arm reshaping procedure has been around for a long time and not much has changed in how it has been performed. It involves removing the loose skin and fat that hangs below the arm when one has their arm extended out at 90 degrees from their body. There are no vital structures in this skin segment, not even any major artery or veins. An armlift does create a prominent scar but this is always a better aesthetic tradeoff in the extreme weight loss patient with true batwings.

The relevant issues about surgically planning an arm lift is the scar location and whether it should cross past the armpit into the side of the chest. The latter is simply decided by whether a web of skin extends between the arm and the chest wall. But the scar location has been a matter of surgical and patient discussion for years. The final arm lift scar can end up being placed on the inside (medial), the back side (posterior) and an intermediate location between the two. (posteromedial)  This is purely a function of how the excision of excessive arm tissue is oriented.

Case Study: This 42 year-old female had bariatric surgery three years previously with a stable weight loss of 110lbs. Her primary body shape concerns were her arms and stomach. Her breasts and thighs were less important and were planned for a second stage procedure

Left Armlift result front view Dr Barry Eppley IndianapolisLeft Armlift result back view Dr Barry Eppley IndianapolisUnder general anesthesia , she underwent a fleur-de-lis extended tummy tuck and armlifts. The armlifts were performed by a posterior excision of tissue that was marked upright before surgery. During surgery her arms were elevated, crossed and attached to a padded metal bar which allowed direct access to the arm excisions. The excess tissue was excised down to the deep arm fascia and just past the lower portion of the armpit. It was closed into two layers and no drain was used.

Right Armlift result front view Dr Barry Eppley IndianapolisRight Armlift results back view Dr Barry Eppley IndianapolisArmlift Scars Dr Barry Eppley IndianapolisHer postoperative arms showed a typical bariatric arm lift patient result with a dramatic improvement in the size of her arms and elimination of hanging skin. The back of the arm scars were only seen when the arms were raised and at certain angles from the back. There were typical arm lift scars, not great by plastic surgery standards, but would go in to fade considerably with further healing. (two month healing result)

The arm lift procedure is the single most satisfying of all the bariatric plastic surgery procedures. It is easy for patients to undergo, produces very satisfying results and is associated with few complications. It is an excellent body contouring procedure to do as part of a first stage bariatric plastic surgery program.

Highlights:

1) Arm lifts are an important part of bariatric plastic surgery after extreme weight loss and is often part of the first surgical stage of the body contouring procedures.

2) Of all the body contouring procedures after weight loss, arm lifts have the easiest and least painful recovery.

3) The excision of loose hanging arm skin can be done from multiple locations on the arm but the posterior approach offers the best arm lift scar location.

Dr. Barry Eppley

Indianapolis, Indiana

Combining Liposuction and Arm Lifts – The Brachiolipoplasty Procedure

Thursday, February 6th, 2014

 

Arm Reshaping Surgery Indianapolis Dr Barry EppleyArm lift or brachioplasty surgery had become very popular in the past decade, largely due to the preponderence of bariatric and weight loss surgery. While many women would like to have smaller and more shapely arms, liposuction remains the only surgical technique of arm reshaping in most non-weight loss patients due to the scar from arm lift surgery.

Arm lifts fundamentally involve a simple excision of skin and fat with the only nuance of how to orient the excision and the final placement of the arm scar. While plastic surgeons have various locations of the final scar (medial arm, posterior arm and posteromedial arm), one scar location over the other has never been proven to offer a superior scar result or less wound healing complications.

In the February 2014 issue of Plastic and Reconstructive Surgery, an article was published entitled ‘Avulsion Brachioplasty: Technique Overview and 5-Year Experience’. In this paper, 44 consecutive armlift patients over five years were reviewed based on a treatment combination of liposuction combined with skin resection. The average amount of liposuction aspirate was 340ml per arm and a skin resection average weight of 90 grams. Their results showed no after surgery complications of hematomas or infection. Only one patient had a seroma. Half of the patients needed dressing care for wound dehiscences. Nine (20%) of the patients had a scar revision within the first year after surgery.

Arm Lift Dr Barry Eppley IndianapolisThis article highlights to specific and distinct points about this arm lift technique. First, it demonstrates the value of doing liposuction to aid arm lift surgery. Besides helping to debulk the arm and making for a better reduction in its circumference, it also helps to better preserve the lymphatics and decrease after surgery swelling. With a lot of skin removal in the upper arm, a tight closure due to thick skin flaps can increase the risk of wound dehiscences.

The second important point is that armlift surgery is associated with a fairly high risk of minor wound dehiscences and scars that are unpredictable in their quality. This is due to the very thin skin of the upper arm which is unlike most other areas of trunk and extremity surgery. While all go on to heal without the need for surgical intervention, it it a process that can take up to 6 to 8 weeks after surgery to have complete incisional healing and the cessation of any suture extrusion. (spitters)

The location of the incision and the resultant scar in arm lifts, as this article as discussed, is best done in the posteromedial upper arm location. I have evolved to this location over the years as it offers the best aesthetic location between when one raises their arms or has them down at their sides. Being halfway between the side and the back of the upper arm, it offers the greatest amount of concealment in a location where the concept of a completely hidden scar is not realistic.

Dr. Barry Eppley

Indianapolis, Indiana

Preferences in Armlift Scar Location and Shapes

Thursday, September 26th, 2013

 

Armlifts, also known as a brachioplasty, is the most effective procedure to reduce the circumferential measurement of the upper for a profound tightening effect. Because it involves a scar, however, its use is usually restricted to the patient who has drooping ‘batwings’ which usually occurs after significant weight loss in women. But even in those patients who are usually more than willing to accept just about any scar over a very floppy upper arm,it is not clear where the best and most acceptable scar location is.

The excisional location and the resultant scar can have two variables, the location on the arm (inner or back) and the pattern of the scar. (straight or wavy) Plastic surgeons are mixed about where the scar should be placed and numerous surgeons any and all of these possible armlift scar locations and types. There are devout advocates for the different armlift scars, each position stating that it offers a superior scar result.

In the October 2013 issue of the Annals of Plastic Surgery, a paper was published entitled ‘Optimal Placement of a Brachioplasty Scar – Survey Results’. This study addresses the issue of where  and how to place the armlift scars based on a population survery. Using a model’s arm in different position, an armlift scar was photoshopped onto the inside and back of the arm as well as in a straight line and a sinusoidal pattern creating four possible armlift scar appearances. Online surveys were then conducted to assess the scar variables and rate them in their visual acceptability between the general public, plastic surgeons and actual patients who had undergone an armlift procedure.

Using approximately 135 survey responses, the straight line inner arm scar proved to be the most favorable while the inner arm scar that was sinusoidal was rated as the worst. Between these two extremes were the back of the arm scar in which a straight line was rated better than a wavy or sinusoidal one. Even with all other variables were considered (age group, gender) the inner arm straight line scar was preferred. In addition, the survey showed that a longer scar was viewed more favorably than leaving any residual hanging skin.

This armlift scar study is particularly interesting as it goes against what I evolved to over the years. Early in my Indianapolis plastic surgery practice, I always placed the armlift scar on the inner aspect of the arm. Because of protracted wound healing issues from the thinner skin present there and the appearance of the scar, I switched to a more back of the arm scar location where the incision heals better and with less problems due to the thicker skin. I presumed, although not proven by any scientific study, that the back of the arm resulted in better looking scars and that patient considered that scar location to be the best aesthetic choice for them.

This study conflicts my long held opinion on the armlift scar. In preoperative counseling on armlifts, I always ask the patient if they prefer the scar on the inside or the back of the arm..and they almost always universally choose the back of the arm. While this study suggests otherwise, the patient is the best judge of where they want the scar. What the study did not factor in is an intermediate choice of halfway between the inner and the very back of the arm which is my current armlift scar location preference.

Dr. Barry Eppley

Indianapolis, Indiana

The Popularity of Excisional and Non-Excisional Armlifts

Friday, May 3rd, 2013

 

One of the more noteworthy items in the recent release of the annual 2012 statistics report from the American Society of Plastic Surgeons was in the number of armlifts that were performed. The greatest surge in all the body contouring procedures were arm lifts or brachioplasties with over 15,000 performed last year. While that pales in comparison to the millions of cosmetic surgeries performed during the year, this number represents a greater than a 4,000% increase in surgical arm reshaping since 2000 when just a few hundred were reported done.

Why this dramatic increase in armlift surgery? There are a variety of reasons which include new technologies and techniques to treat heavy and bigger upper arms as well as a societal trend towards more shapely upper arms. But a major factor has been the concomitant number of people who have undergo large amounts of weight loss as a result of bariatric surgery and other weight loss methods. The flappy arms that result from extreme weight loss can not be treated by any other method than surgery and the arms are always on the top three concerns of these patients.

The influence of weight loss on the rise of armlifts is reflected in the over 6,000 armlifts that were performed specifically after masssive weight loss, representing 42% of all armlifts done in 2012. The elasticity of arm skin between men and women is known to be different as very few  men ever get armlifts. Despite men who undergo large amounts of weight loss, they very rarely end up with flappy arms or ‘bat wings’. It is so uncommon that I in my Indianapolis plastic surgery practice have never even seen a weight loss male complain about their upper arms. This is corroborated by the scant few male armlifts reports with just over 300 done, representing a meager 0.02% of all armlifts done. The typical armlift patients is a female between the ages of 40 and 54.

Since nearly 60% of armlifts are done in non-weight loss patients, it is clear that there is a strong societal and fashion influence as well. While the female who is working out and getting their body toned may not be getting their desired result in their arms, the historic concept of a surgical armlift and its scar is not a worthwhile trade-off. The aesthetic standards of most more normal weight females is obviously quite different from that of the massive weight loss patient. And while improved suturing/wound closure techniques and scar treatments are available, it is just not a problem that most women want to acquire.

But the full or thick upper armed woman in the past who was not a good candidate for an armlift (brachioplasty) may now consider a variety of liposuction treatment methods. Upper arm fat can be removed using traditional, laser-assisted (Smartlipo) or power-assisted liposuction, to name a few, or even some non-surgical methods such as Cool Sculpting or Exilis. While none of these options will ever work as well as an armlift, they all avoid the need to end up with a long scar. And for the more normal weight female, some arm shape improvement is better even if it is not a dramatic circumferential reduction.

The coalescing of better methods of fat removal and the ability to create some degree of skin tightening, all with no to minimal scarring, has been a major impetus for the exponential increase in arm reshaping procedures. The concept of armlifts today no longer always mean that it requires a scar to achieve it.

Dr. Barry Eppley

Indianapolis, Indiana

The Outcomes of Armlift (Brachioplasty) Surgery

Friday, April 12th, 2013

 

Armlifts have a surprisingly long history dating back well over fifty years ago when it was initially described. While once only done as an occasional procedure for the diet-induced weight loss patient, the number of armlifts now done has virtually exploded since the increase in bariatric surgery procedures. While once done as an isolated procedure, armlifts are now more commonly done in conjunction with other body contouring procedures as part of a multiple-operation body contouring procedure.

While armlifts are very effective at reducing the circumferential size of the upper arm, they do place a scar in a disadvantageous location that is prone to wound breakdown, scar hypertrophy and prominent scar visibility. As a result, the desire for a revision of an armlift is not rare to improve the appearance of the scar or remove more arm tissue.

In addition, another change in armlift surgery has been the concomitant use of liposuction to get a better result. Removing fat from parts of the upper arm that are not affected by the tissue excision, as well as around the shoulder, helps produce a better upper arm contour. Whether concomitant liposuction increases the risk of armlift healing problems has not been well studied.

Since many armlifts today are done in conjunction with other body procedures, it would be relevant to know if this impacts their results, incidence of complications and need for revision. In the April 2013 issue of the journal of Plastic and Reconstructive Surgery, a review of armlift (brachioplasty) outcomes was reported. From a multipractice pool of 69 patients, half had an armlift done as part of a collection of body contouring procedures and half had arm liposuction done as part of their armlift. Major complications occurred in 18% of the patients and included hypertropic scarring and infection. Revisions of the armlifts were done in over 20% of the patients.

This study found that combining armlifts with other body contouring procedures did not increase the risk of complications. In addition, the use of liposuction in armlifts did not increase the risk of complications either. Higher complications rates were found, however, in patients who previously had bariatric surgery.

The revelance of this study supports what I counsel my Indianapolis armlifts patients in regards to what they can expect after surgery. Armlifts are easy to go through and are extremely effective…but at the price of a scar that can be problematic and may require a scar revision later if one is seeking the best apppearance of it as possible. The incisional closure is also prone to minor wound healing problems most commonly seen up near the armpit area. The change that I have done in my armlift surgery technique was to place the excision and scar on the back of the arm rather than on the inside of the arm where the skin is thinner.

Dr. Barry Eppley

Indianapolis, Indiana

Postoperative Instructions for Armlift Surgery

Tuesday, January 22nd, 2013

Armlifts, also known as brachioplasties, removes loose and hanging skin from the back of the arms and into and across the armpit if necessary. No muscle, fascia or any significant blood vessels or nerves are removed in the process. This will leave a straight line scar from just below the elbow and into or across the armpit in some cases. This will tighten the arms by reducing its circumferential measurement.

The following postoperative instructions for armlifts are as follows:

1. Arm lifts usually have a minimal amount of postoperative discomfort. After the first 24 hours, most patients no longer require pain medication.

2. Your arms will be wrapped in ace wraps after the operation. These are to be left in place for the first 48 hours. As your arms will swell after surgery, the ace wraps may feel too tight. You may loosen them or unwrap them and reapply them in a looser fashion. If your hands get tingly or numb, they are too tight.

3. After 48 hours, take off the ace wraps and take a shower. The incisions will be taped but do not worry about getting them wet. Reapply the ace wraps again after showering. Do not take a bath or submerge the arm incisions under water for two weeks after surgery.

4. Your forearms and hands will swell during the first week after surgery. This is normal and will return to normal within 10 -14 days after surgery. This is due to the new tightness of the upper arms and the mildly constrictive nature of the ace wraps. This temporarily obstructs lymphatic outflow and causes the swelling of the forearms and hands.

5. The tapes that are on your arm incisions will be removed by Dr. Eppley at your first follow-up visit. Should they come off before your first visit, do not be concerned. It is not necessary to reapply them. They can be left untapped and covered by the ace wraps.

6. You are to continue wearing the ace wraps on the arms for up to two weeks after surgery.

7. Numbness of the upper arm around the incisions is normal. Feeling will eventually return but it may take up to three months after surgery for it to feel normal.

8. Avoid exercise and strenuous use of your arms for four weeks after surgery so breakdown of the incisions can be prevented.

9. You may drive when you feel comfortable and can react normally and are off pain medication.

10. If any redness, tenderness, or drainage develops after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Consent for Plastic Surgery: Armlifts

Wednesday, January 16th, 2013

 

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the armlift procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

The alternatives to arm lift surgery are liposuction to remove fat only (and hope the skin tightens) and non-surgical devices to shrink fat and tighten skin.

GOALS

The goal of armlift surgery is to reshape the circumference of the arms, making them smaller and less flabby on the triceps or backside of the arm area.. This is done cutting out loose skin and fat on the back of the arms from below the elbow to the armpit and, in some cases, below the armpit area as well.

LIMITATIONS

The upper arms can only be downsized so much, which is limited by how much skin and fat can be removed and getting the excised area closed without too much tension.

EXPECTED OUTCOMES

The following are all likely to occur: temporary pain, swelling, and bruising of the arms, possible need for several days to a week of drain tubes after surgery, permanent scars along the inside or back of the arms, temporary or permanent numbness of the skin of the arms, and up to one month after surgery for complete healing.

RISKS

Complications may include bleeding, infection, fluid accumulation (seroma) after drain removal, skin irregularities, poor scarring, incision separation after surgery (particularly close to the armpit), spitting of sutures for months after surgery, tightness of the arms, scar banding across the armpits and residual loose skin that may need further surgery to remove.

ADDITIONAL SURGERY

Additional or revisional surgery may needed to close open wounds or improve undesired scarring. These risks are not rare in armlifts with the risk of the need for scar revision as most likely with a 5% to 10% likelihood. This may generate additional costs.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Long-Term Scar Outcome From Armlifts

Tuesday, November 6th, 2012

 

Background: The armlift, known technically as a brachioplasty, is the only skin tightening procedure that is done on the arm. Because of its long scar, it is an excisional procedure used almost exclusively in patients who have had a large amount of weight loss. Whether through bariatric surgery or by diet and exercise alone, weight loss that exceeds 75 to 100lbs will result in considerable loose upper arm skin that hangs down from the back of the arm. (most commonly in women but not men) There are no non-surgical skin tightening treatments that will reduce this amount of loose skin other than surgery.

An armlift is an extremely effective procedure that produces an extreme amount of arm tightening. But its use is restricted to severe excess skin on the upper arm because of the residual scar that is created. A long scar that runs the length of the upper arm from the armpit to the elbow is the trade-off that one must accept for the reduction of the arm circumference. This is why it is not casually used for lesser degrees  of arm sagging.

While an armlift creates a scar, where is the best location on the arm to place it? When I first started performing arm lifts, I used the traditional inner or medial part of the arm where it is supposedly well hidden.  This was historically taught to be the best location for the scar. But the inner arm skin is very thin and delayed wound healing and wide very noticeable scarring was a common outcome in my experience.

Case Study: A 35 year-old female came in who had lost nearly 100lbs on her own by diet and exercise. She was a firm believer in exercise and a teacher of Zumba. While she had reshaped many parts of her body with the weight loss, there was little she could do about her floppy arms. Given her daily Zumba, the flapping arm skin was a real bother and a source of embarrassment. In discussing her armlift, it was decided to put the armlift scar on the back of her arms which would be less noticeable to her.

During surgery, her arms were placed on a crossbar so that they crossed high above her face. This allowed the back part of the upper arms to be positioned in a completely vertical plane with the backs easily exposed for surgery. A long and wide ellipse of skin and fat was removed from just behind the back of the elbow down to and across the armpit into the lateral chest wall. The excision as closed as a straight line.

Her postoperative course was marked by typical forearm swelling during the first week which resolved quickly. Her incision went on to heal without incident. She was back teaching Zumba one month after surgery.

Seeing her scars at one year after surgery, they were well healed. But they could not be considered fine line scars as they had a moderate amount of scar widening. In looking at numerous armlift scars over the years, I do consider the location on the back of the arm produces the best scars. But even the best armlift scars can never be considered great-looking scars in most cases.

Case Highlights:

1)      An armlift is the only effective treatment for loose flabby skin on the upper arms, particularly after a large amount of weight loss.

2)      The best location for excision of saggy upper arm skin is near the back of the arm where the skin is thicker and heals better.

3)      The long-term results of the scar from posterior armlifts is acceptable and not seen from the front or when the arms are raised.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: The Extended Armlift in the Bariatric Surgery Patient

Sunday, October 30th, 2011

Background:  The shape of the upper arm is primarily determined by the front (biceps) and the back (triceps) sides of it. While men are notoriously concerned about the biceps region, women are much more concerned about the opposing triceps region, particularly as they age. Loose and floppy skin on the back of the arm affects many women and a desire to undergo some treatment for it is common.

For minor amounts of upper arm fullness or loose skin, liposuction or non-surgical skin tightening can be effective. While armlifts create the most dramatic change in the shape of the arm, it should only be employed in the most severe sagging arm cases. The  scar of an armlift is simply not acceptable to most women, short of those who have had a lot of weight loss. This makes the bariatric surgery female the most likely to accept an arm scar as a better aesthetic problem than that of a low hanging skin on the back of the upper arm.

The severe sagging of many bariatric or extreme weight loss patients also presents another aesthetic problem. The amount of excess rarely stops in the arm or at the armpit. Rather it extends past the armpit down into the lateral chest wall to the side of the breasts. When planning an armlift in most bariatric patients, this excess skin outside of the arm must be factored into the excision pattern. Having a scar cross the armpit poses risks of tightening and restriction or painful abduction of the arm when lifted above shoulder level.

Case Study: This 40 year-old female had bariatric surgery (bypass) two years previously. She had lost over 120lbs. Besides her abdomen and waistline, her next most important concern was her arms. She was embarrassed by the floppy skin and how it swung back and forth with arm movement. She agreed to multiple body contouring procedures performed simultaneously including armlifts, an extended tummy tuck, and breast implants with nipple lifts.  

During her multiple bariatric plastic surgery procedures, an extended armlift was planned that had a cutout pattern that run from her elbow up to her armpit and then down to the side of her breasts. This was marked out just slightly in from the very backside of her arms toward the inner side of the arms. Skin and fat was excised down to the muscle fascia of the upper arm and into the subcutaneous fat of the armpit and the lateral chest wall. Closure of the long incision was done with subcuticular sutures without any z-plasty or break-up of the incision as it crossed the armpit. Drains were used for both sides.

Her drains were removed five days later and she wore compression wraps for three weeks after surgery. Her armlifts results were immediate and dramatically improved. At six months after her armlifts, she had scar that were still slightly red, had developed some widening but had no scar contracture or  restriction of movement across the armpits. Fading of the redness of her scars is expected to take up to one year after surgery.

The scar location could be seen to be completely on the back of her arms which was not apparent to her. But the scars can be seen from behind by others.

Case Highlights:

1) Armlifts can produce a dramatic reduction in the circumference of the upper arm by removing excess skin and fat from the back (triceps) area.

2) The most important consideration in an armlift is the patient acceptance of a scar trade-off. This scar is easy to accept in the bariatric patient who usually has a large amount of hanging arm tissue.

3) The best location of the armlift scar is on the backside of the arm. This location also heals better with less scar widening than when it is placed on the inside or medial aspect of the arm.

Dr. Barry Eppley

Indianapolis, Indiana

The Differing Types and Indications for Armlift Surgery

Monday, April 4th, 2011

In youth, the upper arm has near equal proportions between the internal bone (humerus) and the skin on the front or back (arm held down by one’s side) or the top or bottom (arm held away from the body) of the arm. With age, the distance on the back of the arm (triceps) elongates and accumulates fat.  This change in the arm with age or weight gain has led to arm reshaping procedures, most commonly known as a brachioplasty.  

While once a very uncommon procedure, the armlift (brachioplasty) procedure is done routinuely today. Much of the reason is the popularity of bariatric surgery which has created a lot of loose floppy arm skin, unflatteringly referred to as batwings, as a result of extreme amounts of weight loss. In such large hanging arms, the trade-off of a long scar in the upper arm is very acceptable.

However, in non-weight loss patients where the upper arm shape is not so severely distorted, long arm scars are usually not acceptable. This has lead to the need to use more non-excisional technologies, such as liposuction and other light or radiofrequency-based energies, to help skin contraction. In the right patient, this may eliminate the need for any scars or at the least a much shorter arm scar.

Brachioplasty for the non-bariatric surgery patient (or for the bariatric surgery patient with more modest arm deformities) has evolved to use shorter segments of skin and fat removal. This leaves more limited scars restricted to the upper arm or no further than the middle third of the arm. By tightening the deeper tissues of the upper arm with superficial fascial plication, and using some liposuction, visible improvements in arm shape can be achieved.

 What are the criteria that can be used to determine whom is a good candidate for the different types of brachioplasty? Evaluation of the arm includes a determination of how much skin is present and its amount of elasticity and the ratio of fat to skin in the enlarged or hanging triceps area. In addition, it is critical that a thorough presurgical education be done with emphasis on realistic expectations as to how much smaller the arm can be made and the location of scars if excision of skin is needed.

A large amount of loose skin and a minimal amount of fat, which is typical of a bariatric weight loss patient, will require a traditional long scar armlift. Slight skin excess and laxity with little fat may respond to radiofrequency- or high-intensity pulsed light (e.g., SkinTyte) treatments with some modest improvement. These type patients are quite uncommon although many patients wished they fit into this group. Good skin tone with substantial fat (tight arm) may do well with Smartlipo (laser liposuction) alone. The combination of fat and skin excess with mild laxity will probably respond best to a combined liposuction and skin excisional procedure.

Of these options, the mini-brachioplasty (short scar armlift) requires the most thought and consideration. The limited scar can be either a shorter horizontal scar, restricted to no further than 1/3 way done the inner arm, or an ellipitical armpit removal which results in a fairly hidden scar high up in the armpit. Who best fits this more limited brachioplasty approach? I make that determination based on how the triceps area hangs when the arm is held away from the body at 90 degrees, whether the forearm is held parallel or perpendicular to it. If the lowest point of sag of the arm is located past the central point of the triceps (halfway between the armpit and the elbow) or lower, significant improvement will only be obtained by a long scar armlift. If the lowest point of sag lies central or above, shorter scar armlifts can be considered.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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