Background: The arm lift, 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 arm lift 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 arm lift 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 arm lift, 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 arm lift scars can never be considered great-looking scars in most cases.
Case Highlights:
1) An arm lift 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 arm lifts is acceptable and not seen from the front or when the arms are raised.
Dr. Barry Eppley
Indianapolis, Indiana