The arms, like many other areas of the body, can suffer from lipodystrophy. On the back of the arms, unwanted skin and fat can hang down creating a larger and undesired appearance to them. Despite how well diet and exercise can help shape out other body areas, the arms are uniquely resistant to such efforts. If the amount of loose skin is large, like occurs after bariatric surgery and extreme weight loss, only an excisional arm lift (brachioplasty) can reduce the size of arms. While dramatically effective, this surgery leaves scars on the inside of the arms that are not insignificant.
Because the scars from brachioplasties are not a trivial consideration, this operation should be reserved for the most severe arm contour issues. For all other arm contouring concerns, liposuction is the only other treatment option. Liposuction can not achieve the reduction or tightening effect of an arm lift, but moderate improvement can be obtained for many patients. Liposuction of the arms is almost exclusively a procedure for women. Exercising and weight lifting typically does not reduce the volume of fat located on the arms, and most women do not want arms that appear muscular or masculine. A heavy, bulky arm gives the appearance of obesity, whereas a thinner arm helps to give the appearance of a thinner body.
Patients often misunderstand the goal of Smartlipo or laser-assisted liposuction of the arms. The objective when contouring the arms is to produce a more proportionate appearance (triceps:biceps ratio), rather than removal of fat circumferentially from the arms. Liposuction is directed to remove fat from the posterior or back part of the triceps muscles. The inner part of the arms does not have much fat and it contains important nerves and blood vessels, thus it is avoided when suctioning.
Smartlipo offers the advantages of removing arm fat using a very small probe and microcannulas. This avoids large entrance scars. Because the arm is very limited as to where these entrance incisions can be made (usually at the elbow) heating and melting fat is more likely to avoid irregularities than the traditional use of multiple linear cannula tracks. Inadequately removing enough fat near its junction with the shoulder is usually what causes asymmetry or unevenness in the result.
There is no great risk to removing too much arm fat, short of causing unevenness. The opposite is more of a concern. Can enough fat be removed to make a substantial difference and the procedure worthwhile? Patients usually see results immediately after surgery when the wraps are removed after 48 hours. But the final end result caused by fat removal and skin tightening will not fully be seen until about three months after surgery. For optimal reshaping and skin adaptation, I like to use compression with coban wraps in my Indianapolis plastic surgery practice for about seven to the days after surgery.
Barry L. Eppley, M.D., D.M.D.
Indianapolis, Indiana