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Archive for the ‘elbow lift’ Category

Case Study – Male Elbow Lifts

Monday, December 11th, 2017

 

Background: Loose skin develops over time around joints due to their repetitive motion. The skin around knees and elbows must be flexible to allow the range of motion needed for all forms of physical activity. But this tissue flexibility and repetitive motion adds up over time to create rolls of skin above the joints.

Removal of this excess skin (knee and elbow lifts) involve the excision of skin rolls above the joint. While that can be effectively done, the tradeoff of the scar must be very carefully considered. A wide scar or a postoperative wound dehiscence would likely create an aesthetic result that would not be viewed as better than the original skin rolls.

The key to a successful lift around a joint is the preoperative markings. They must be done with the motion of the joint considered into the amount of the skin excision pattern. Without this consideration it is easy to remove too much skin and create adverse healing and scarring.

Case Study: This middle-aged male was bothered by skin rolls that had developed above the elbows on the back of his arm. He had a lean body frame and the skin rolls could be pinched up to two inches of excess skin.

Preoperative markings were done both in a conservative excision (solid upper line) and maximally with the pinch test. (dotted upper line)

Under general anesthesia (he was having many other procedures as well) the elbow skin excisions were done slightly inside that of the original conservative markings. This was done as the elbow was bent at 120 degrees, accounting for any range of motion after surgery in the healing process.

Elbow lifts do create scars. But as long as they stay very narrow and do not extend any further than the medial and lateral epicondyles of the elbow, they will create minimal scarring.

Highlights:

1) Excess skin can occur around the elbow in both women and men.

2) Preoperative elbow markings must be done with the arm both fully extended and flexed.

3) The skin removed should be conservative and within the skin makings to prevent adverse scar widening or even wound dehiscence.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Bilateral Elbow Lifts

Saturday, September 9th, 2017

 

Background: Loose skin all over the body can be removed and the tissues tightened in a wide variety of procedures known as lifts. The most common body lift is that of a breast lift to correct sagging breast mounds which aero both lifted and tightened. Most other body lifts, however, are done as a result of weight loss such as arm lifts, back lifts and thigh lifts.

The most common reshaping procedure on the extremities that involves skin removal is an arm lift. The longitudinal excision of skin and fat at the junction of the back and inner aspects of the arms is very effective at getting rid of bothersome ‘batwings’. But this is not the only extremity lift procedure that us possible.

The elbow lift is the least known and performed of all body lifts. Designed to remove horizontal skin rolls over and above the elbow joint, it is one of the only two lifts performed in the body that has to be planned across a moving joint. (the other would be a knee lift)

Case Study: This 45 year-old female had been bothered by loose skin above her elbows for years. Bothersome skin above the elbow occurs when there are at least two distinct horizontal skin rolls.

When making an elbow lift before the procedure, a superior crescent-shaped pattern is used. All excess skin rolls should be included in it when the arm is extended and the elbow is straight. The length of the incision should not go beyond that of the bony epicondylar points win each side of the joint. The amount of excision should be checked by flexing the elbow and pinching the marked edges together to ensure an over resection of skin is not done which will result in adverse scar widening.

Under local anesthesia, the crescent pattern of skin is removed keeping all fat beneath it. Closure is done in dermal and epithelial layers. With the am extended good reaction is evident when no skin rolls are seen. Glued tapes and ace wraps are the dressings.

When contemplating an elbow lift, like all body lifts, strong consideration must be given to the aesthetic tradeoff of the scar. As long as over resection of skin is not done elbow lift scars remain narrow and usually heal uneventfully.

Highlights:

  1. Elbow lifts represent the smallest type of body lift.
  2. Elbow lifts are unique as they are only of two types of body lifts hat are done that involve a moveable joint.
  3. The only aesthetic risk is removing sagging skin at the elbows is whether the scar is a worthy tradeoff.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – The Elbow Lift for Saggy Elbow Skin

Saturday, August 26th, 2017

 

Background: Collections of excess skin rolls all over the body occurs from a variety of conditions. The most common  is from aging with weight loss being a second source of its occurrence. While such rolls of skin can be aesthetically bothersome for some people, others accept it as a natural body process.

One very unique body area for skin rolls to develop is on the mid-joint of the extremities. At the elbows and knees, which have a wide range of  motion of just over 160 degrees, skin rolls develop by the repeated joint motion over time. These skin rolls appear at top of the joint when it is in full extension and ‘disappear’ when the joint undergoes flexion. This means they appear at the back of the elbow and at the top of the knees.

Treatment of these joint-related skin rolls is difficult as no non-surgical therapies for skin tightening will not work. Liposuction provides no benefit since the cause is not fat-based and often makes look even worse with the volume deflation. Fat injections may have a plumping effect but this often ends up looking swelling and fat survival is poor is any area of high motion.

Case Study: This middle-aged female was bothered by the rolls of skin that had developed on the back of her elbows. She was a very thin female with small arms with little subcutaneous fat. She felt that the trade-off of a scar above the elbow was better than the appearance of the skin rolls.

The patient was initially marked in the standing position with the arm extended. A superior elliptical crescent was marked along the skin roll in natural skin fold lines. After marking the arm is flexed to 90 degrees and the expansion of the excisions pattern could be appreciated. A pinch test is done of he two marked lines to see how tight the closure would be if it was all removed. If it feels to tight the superior crescent marking is lowered. The inferior crescent line always remains in the elbow skin crease which on extension is laying almost onto the joint. But with flexion it can be seen that it moves superiorly than one would think.

Under local anesthesia, the skin excisions are performed removing some deeper tissues but not down completely to the fascia. A layered closure is done using all restorable sutures. Glued in tapes and an ace was are used for dressing. After surgery the only restriction is to avoid as much as possible bending the elbow much past 90 degrees as much as possible.

The elbow lift is the smallest of all body lift procedures. It is a small surgery with fairly easy recovery. While very effective at removing the skin rolls, one must have a strong belief that the scar is better than the skin rolls. To avoid wide or hypertrophic scarring, the tissue excision pattern must take into account the flexion motion of the elbow joint to avoid over resection, a very tight closure and a subsequent wide scar.

Highlights:

  1. The folds of skin above the elbow with aging can be treated by an excisional approach.
  2. Elbow lifts should the marked and performed with the arm in a 90 degree flexion at the elbow to avoid wide postoperative scarring.
  3. The decision for an elbow lift is based on whether the scar tradeoff is worthy one.

Dr. Barry Eppley

Indianapolis, Indiana

The Elbow Lift – An Extension of the Upper Arm Lift

Friday, November 28th, 2008

The elbow lift, or removing excess skin from around the elbow (middle) area of the arm, is an uncommon procedure in body contouring surgery. Most of the time an upper arm lift ( between the elbow and the armpit) is enough to take care of one’s arm concerns. But the extreme weight loss patient can present with loose skin that passes below the elbow area.

When it is obvious that a lot of excess skin sags beyond the elbow area with the arm horizontally extended, then an ‘extended’ upper arm lift can be done and the arm problem can be solved in a single operation. The length of the scar, however, can understandably make some patients hesitant to extend the scar that long in a noticeable area even if it is obvious that the shape of the arm can so benefit.  Other times, the amount of loose skin in that part of the arm is not so evident or the patient does not express concern until after an upper arm lift has been done.

The elbow lift removes skin around and beyond the elbow into the forearm area. The cut out of skin and the resultant scar can be done on the back of the arm or on the inside part of the arm. Like the medial (inside) upper arm lift, the scar continues across the elbow into the inside of the forearm. Because it is on the inside of the arm, it is less visible. Because it crosses the bendabale elbow area, however, it may develop a tight scar. A small z-plasty can be done at the crease of the elbow to prevent this potential problem although I have found this concern more theoretical than one I have actually seen.

The elbow lift can also be done on the back of the arm crossing the thickened pad area with the prominent underlying elbow bone. (humerus) The concern about crossing this area with potential wound problems is a very real one. The skin is thick in this area for a reason, it is the one spot where the traction and sheering from elbow motion is the greatest. And after surgery, patients must bend their arms putting a lot of stress on the wound edges, Wound separation is a not uncommon problem with wounds that cross this area. For this reason, I perform a bilobed or figure-of-eight skin cutout, removing the least width of skin around the elbow area in the longitudinal cut out pattern.

The uncommon elbow lift is a simple procedure that is less in magnitude than an upper arm lift. It can be done on either  the inside or back of the elbow area. Special care of how much skin is removed around the elbow is important to avoid wound separation when the back of the elbow approach is used.

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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