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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘brachioplasty’

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

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.


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.


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.


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.


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.


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 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

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

Common Questions on Bariatric Plastic Surgery (Body Contouring after Massive Weight Loss)

Wednesday, January 13th, 2010

1.      How soon after my weight loss can I get plastic surgery done?


Large amounts of weight loss, generally 75 to 100 lbs or greater, will cause significant loose skin on multiple areas of the body. It does not matter whether that amount of weight loss is from dieting, gastric bypass, or lapband surgery, the skin can not shrink back done in most people.


Because body contouring surgery is about removing as much excess skin as possible, one should have maximized their weight loss and proven that this new weight is stable. For some patients, that may be 9 to 12 months. For others, it could be much longer than a year.


The other benefit to waiting until your weight loss is stable is to make sure you are in  a good nutritional state. Weight loss, no matter how it is done, depletes one’s body of vital nutrients and other stores that are needed for the healing of long surgical incisions and extensive wounded tissues.


2.      At what weight should I before I can have body contouring surgery?


Many extreme weight loss patients have a specific target weight in mind. Whether they make it or not depends on a lot of factors and one of those is certainly time. Whether any patient will hit their weight target is unknown. But at some point one will realize a point when their weight will not get any lower. Once one has bounced around at a low weight for awhile, then you can be certain this is where your body will live. Once you are comfortable that you have found this weight, and can keep it, then you are ready for surgery.


3.      What’s the difference between a tummy tuck and a circumferential body lift?


The one body area that bothers all extreme weight loss patients is the abdomen or waistline area. Loose skin is always present in front of, over, and behind the hips. For some patients, a skin overhang is only present in the front. For many others, the skin excess extends around the waistline and across the back, resulting in sagging of the buttocks and posterior thighs as well. These concerns are almost always addressed first in most bariatric plastic surgery treatment plans.


When the excess skin overhang is primarily in the abdominal area, a tummy tuck or abdominoplasty is all that is needed. While it can be a conventional horizontal elliptical excisional pattern, the amount and stretched out quality of the skin may need  a modified pattern to provide optimal tightening. This may require the horizontal cutout to go further back along the waistline or to include a vertical skin wedge resulting in an invert T or anchor closure pattern. (fleur-de-lis tummy ruck)


When the loose skin incorporates the entire waistline, a circumferential or 360 degree cutout is needed. This is known as a circumferential body lift. It is a lot like ‘pulling up your pants’. The scar will run completely around your waistline. In some cases, the front side of the circumferential body lift may include the fleur-de-lis cutout pattern as well.


4.      How can I reshape my saggy breasts…or my manboobs?


One of the most challenging of all body parts to reshape after extreme weight loss is the female breast and the male chest. The female becomes essentially a deflated bag of skin with severe sagging and the nipple often pointed downwards. The male chest also loses volume, although less so than the female, but the chest skin shifts and sags downward with a lower than normal  nipple position.


 The breast often requires a combination of an implant, for volume replacement, and a lift (mastopexy)to reduce the amount of sagging skin and bring the nipple back up to a more central position of the breast mound. This is a difficult operation, from an artistic standpoint, and it often requires two separate surgeries to get the best result.


The sagging chest in the male, while not trying to make a mound like in the female, is complicated by trying to limit scarring. There are no natural creases or folds to hide scars in the flat male chest. Getting the nipple back up on the chest and tightening the skin requires a compromise between the result and the amount of scarring. The chest lift in a man is done differently than a breast lift in a woman.


5.      I hate my ‘batwing’ arms, what can I do about them?


Loose skin in the arms is another common extreme weight loss problem. In the back of the upper arms (triceps area), loose skin and fat hang off and below the humerus bone. This creates a large fold of hanging skin. It often extends into and past the armpit and down into the side of the chest. In some cases, I have seen the skin excess goes past the elbow into the forearm.


The good news is that arm recontouring, known as brachioplasty, is the ‘simplest’ of all body contouring procedures. The arm’s circumferential measurement can be measurably reduced.  Skin and fat is removed longitudinally along the arm and the cut out often takes a right turn into and past the armpit. The bad news is that it does result in a long scar in an unnatural area on the inside of the arm. Scar healing problems are not uncommon in the moist and moveable armpit area.


6.      How bad are the scars from bariatric plastic surgery?


Body contouring after extreme weight loss is about making a trade-off…scars for improved contours. Depending upon the body area, scars tend to turn out somewhat different. Breast and abdominal scars generally look best while arm and thigh scars tend to become wider. Most of these scars are more than just fine or pencil-line in width and some of them will end up becoming hypertrophic or wide due to the tension placed on the wound closure.


Regardless of how the scars may look, there can be a lot of them if multiple body areas are treated. Despite the plethora of this new skin ‘problem’, weight loss patients universally prefer them to their prior ‘sharpee’ body look.


7.      Will insurance cover my skin removal surgeries?


While third-party payors often pay for surgical and non-surgical weight loss treatments, such widespread coverage for body contouring is not so generous. The line between cosmetic and reconstructive procedures for removal of excess skin is a judgment call that does vary amongst different insurers. Ultimately they are looking for functional problems that this skin causes, such as infections, to determine medical necessity for the operation. In general, the most commonly covered procedure is the abdominal panniculectomy or frontal abdominoplasty. The procedures never covered are breast and chest reshaping.

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions about Arm Lift Surgery (Brachioplasty)

Wednesday, January 6th, 2010

1.      How do I know if an arm lift is right for me?


Deciding about an arm lift (also known as a brachioplasty) is a balance between how much does a scar bother you versus how much does the way your arm looks now bother you. In other words, would a scar running down the inside of your arm be better than the floppy saggy skin that is there now? It is about trading off one ‘problem’ for another. You just have to make sure the new problem (scar) is preferable to the way the arm looks now.


2.      Would liposuction work as well as an arm lift?


In almost all cases, no. Liposuction only removes fat. And while some skin shrinkage (contraction) does occur with liposuction fat removal, that skin change is not nearly as much as the skin that is removed with an arm lift. When you look carefully at arms that are saggy, a lot of the problem for many patients is primarily loose skin which hangs down from the triceps area. While there certainly is some fat as well, the amount and stretched nature of the skin is usually the greater problem.


3.      Will an arm lift get rid of loose skin in my armpit or on the side of my chest?


In many upper arm problems, particularly after large amounts of weight loss after bariatric surgery, the skin problem extends beyond the arm into the armpit (axilla) and even down onto the side of the chest or breast. When this occurs, one needs a modification or extension of the traditional arm lift procedure. The cut out pattern must extend beyond the arm (horizontal component)to include this vertical excess as well. This is known as an extended arm lift. The transition area in the axilla poses the biggest potential postoperative problem as any scar that crosses a joint area is prone to developing a tight scar band. When this occurs in the axillary region, the full upward motion of the arm may be restricted and painful. Secondary scar revision may be necessary. 

4.      Where and how long is the scar on the arm?


The scar will be as long as the distance between your elbow and the armpit. In an extended arm lift, the scar will be double that length as the vertical length of the scar extending down from the armpit may be just as long as the horizontal arm scar. In my opinion, I would be less concerned about the length of the scar and more focused on how the scar will look. Arm scars do tend to get wide and be red for sometime after surgery. And I have rarely seen what I consider a great armlift scar. Because of the location of the scar and that it is closed under considerable tension, they never turn out to be great-looking scars. That being said, most armlift patients do not undergo scar revision as they usually feel that however the scar looks is preferable to what they had before. This is also the reason why one should not undergo an armlift unless the arm problem is fairly severe. These type of scars are not a good trade-off for a minor arm sagging problem.


5.      Is an arm lift painful?


Remarkably, no. The arm will feel tight and little sore, but there is no significant pain afterwards.


6.      How soon after can I shower and use my arms?


I have my patients remove their arm wraps and shower after 48 hours. All sutures are under the skin and the incision is covered with tapes. There is no harm in getting the tapes wet. They will be removed in one week. In some cases, I do place a drain which is usually removed in two or three days after surgery.


7.      Will insurance pay for my arm lift?


Unfortunately, no. While sagging arm skin is unsightly and does interfere with the wearing of certain clothes, its correction is not considered a medical necessity. The insurance companies do not see any medical benefit to be gained by its removal.


8.      How can I improve the arm scar if it looks bad?


Arm lifts scars can be revised six months to a year after surgery if a patient desires. Seconday revision always produces a better looking scar as the skin is more relaxed, less tissue is being removed compared to the original arm lift, and the incision is closed under much less tension. One can use topical scar creams after the original arm lift surgery but they tend to have limited benefit in the arm lift scar.

Dr. Barry Eppley

Indianapolis, Indiana

Different Approaches to Arm Lifts in Extreme Weight Loss Patients

Thursday, November 27th, 2008

Arm lifts or Brachioplasty is a plastic surgery procedure that removes excess skin and fat from the arm. The trade-off for this skin removal and tightening of the upper arm  is a long scar that runs down the arm. This cut out of skin and the resultant scar can be done on either the inside or back of the arm. There are advantages and disadvantages  to either approach and I always leave the decision up to each patient. The arm lift can be done successfully with either approach.

The most common location for the skin and fat cut out for an arm lift is the medial approach on the inside of the arm. In theory, this places the scar on the most hidden part of the arm. That point is debatable in my mind as the scar would only be hidden if your arm is down and by your side. Certainly if you raise your arm and are in short sleeves, the scar is not hidden. A fair amount of skin can be removed with this approach but cutting out too much is a possibility, making for a very tight closure and the likelihood of having wound separation problems after. It is easy to take too much with this approach and a tight closure with the very thin skin on the inside of the arm makes for some wound healing issues which are common.

The other approach for an arm lift is on the back of the arm. The skin and fat cut out and final scar runs down the backside of the arm. In theory, the patient doesn’t see the scar but everyone else does. (at least if they are behind you) I think that more skin can be removed and better arm tightening can be obtained with this approach. My experience is that less wound healing problems occur when the arm lift is done this way, probably because the skin is a little thicker and holds sutures better.

With either approach it is often necessary to extend the skin excision into the armpit and even beyond. This is unique to the extreme weight loss patient. The sagging skin usually extends into the armpit and into the side of the chest.  Either the inside or back of the arm lift approaches can be extended downward  to include this area. By doing so, both approaches run the risk of creating a scar contracture or tight band where it crosses the attachment of the arm skin to the chest skin. This is noticeable only when one raises their arm, particularly above the level of their shoulders or above their heads.

Despite their subtle differences, both the inside and back of the arm approaches to the arm lift are equally effective. One should choose either approach based on which scar location one finds the most acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

Arm Lifts(Brachioplasty) in the Extreme Weight Loss Patient

Monday, November 24th, 2008

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

Indianapolis, Indiana

Arm Lifts in the Bariatric Surgery Patient

Monday, April 28th, 2008

Of the many bariatric surgery patients that I have seen over the years who have lost 100 or more pounds, the concern over their saggy arms is often a top concern. I would have to say that the arm concern combined with the stomach or waistline are almost always the top two priorties of the massive weight loss patient. I should add one caveat, the arms are an issue exclusively for women. I have yet to see a male patient who has put forth this concern to me. That does not mean that men don’t develop flabby arms after bariatric surgery, it just doesn’t cause the same problems that it does for women.

Because of high arm concerns, most female bariatric surgery patients often undergo a combination of an arm lift (brachioplasty) and an abdominoplasty as the first stage of their body contouring. Full arm lifts, which all bariatric surgery patients require, always result in a long arm. The patient can choose whether this scar ends up on the inside of the arm or on the back of the arm. There are arguments for its placement in either location. It is a choice of whether you see the scar but others not so much so (inside of the arm) or whether others see it but you can’t. (back of the arm) Either way, I caution patients that, from my perspective, I have seen very few good-looking scars. Scar from arm lifts seem to do rather poorly in terms of their width, redness, and their tendency for hypertrophy. (raised scar) I think it is the very thin skin and the tension that it is under from the tight closure that makes them often appear fairly unsightly. While they can be raised revised later, from which they turn out much better, an arm scar that parallels the vertical axis of the arm is one of the poorer scar outcomes from body contouring in the bariatric surgery patient. Then there is the scar banding (contracture) issue that can occur as the scar crosses from the arm into the axilla. (armpit) It is always necessary to bring the skin excision pattern into the armpit and often down into the side chest wall. Like all scars that cross areas of movement, a tight band often develops. Sometimes I have incorporated a Z-plasty into the skin cutout and other times, I have just waited to see whether a bothersome scar contracture develops. For most patients, the degree of improvement in the shape of their arms seems to overshadow significant concerns about an axillary scar contracture.

One of the nicest things about an arm lift procedure is that it is associated with little to no postoperatve pain and recovery from it is fairly quick. Other than some mild swelling in the hands during the first few days after surgery, most problems with arm lifts are relatively minor including snall fluid collections (seromas), spotty areas of delayed incisional healing, and the scar issues previously mentioned. For these reasons, an arm lift is a perfect compansion to other more major body contouring procedures in the bariatric surgery patient such as tummy tuck, circumferential body lift, and breast lift/implants.

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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