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Posts Tagged ‘armlift’

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

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


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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