A 60 year old woman with heavy arms and very loose skin. The patient complains of inability to wear certain clothes, skin irritation and poor appearance.

Two weeks after short scar contouring, removing fat and skin. Arms reduced by 18

A 35 year old patient with congenitally heavy arms but with good skin tone.

1 week post small tube liposuction.

A 33 year old patient desiring more arm definition.

Three weeks post small tube liposuction.

These photographs are the result of a very popular procedure. The reason is that our arms always age and they will not look better unless some procedure is done. Most requests are for liposuction. The advantage is little to no scarring. The skin can contract significantly. We frequently advise patients who have hanging skin and who believe the skin must be removed that we can obtain an excellent result with our small tube lipo which causes the skin to contract-avoiding scars. For larger arms however and with marked excess skin, a brachioplasty must be done. A large patient is shown here as well as a small tube lipo brachioplasty.

BACKGROUND

Slender, trim arms not only have cosmetic appeal, but a functional importance as well. The posterior, or back, surface of the arms is normally firm with an outline of the underlying triceps muscle. The skin is adherent. With time, genetics, and weight fluctuations, the anatomy can change. The fibrous bands running from the muscle to the dermis under the skin stretch, lessening the skin's elasticity and "bounce back" feel. If there is a change in weight, the skin's inherent elasticity will age, adding to the problem. If the skin becomes too loose, the areas around the elbows and axillae can be irritated. Treatment of the deformity consists of analysis, plan, treatment, and maintenance.


ANALYSIS

Analysis of an arm deformity begins with anatomy. The skin is examined for length and texture. Measurements of skin length from the triceps groove are taken at three locations. Excess skin over the elbow and excess skin in the axilla are noted. The next layer to be analyzed is the adipose, or fat layer. Fat distribution from armpit to elbow is examined for amount and consistency. It is this fat that pushes and extends the skin away from the muscle. Running through the fat are thin fibers of collagen which provide support to the skin. The fat is further divided into superficial and deep by another layer of collagen, called fascia. The deepest layer that requires analysis is muscle. Well-developed and toned muscle will obviously improve the odds of a good result.

The arm deformity is classified in five stages according to the skin elasticity: 1, 2, 3, 4, and 5. 1 is normal and 5 is the most severe.

PLAN

Brachioplasty (brachio=Greek for arms) consists of two general therapies: liposuction and open brachioplasty with direct removal of skin and fat. For repair of classifications 2, 3, and 4, liposuction is used. We use small 2-2.5 mm tubes, which create maximal contouring and maximal skin contracture. For classes 2 and 3, all the fat is removed. For class 4, some fat is left since removing all of it might create the necessity of an open brachioplasty and its scarring. Class 5, with significant excess of skin and fat, is treated with an open brachioplasty. The incision length depends on the extent of the deformity. The incision is placed on the inside of the arm to further hide the surgical site.

PROCEDURE

Treatment for any class of deformity is performed under intravenous anesthesia in our office operating suite. Liposuction takes 45 minutes, and open brachioplasty takes one hour. Recovery after liposuction classes 2 and 3 is very rapid with minimal bruising and discomfort, with return to normal activities in two days. It is important to wear some compression, such as an Ace bandage for two weeks. Class 4 requires longer compression depending upon the circumstances. Class 5 may require compression for three weeks, with suture removal at one week.

AFTERCARE

Recovery is surprisingly fast. You may shower the second day after surgery. Most women prefer an elastic bandage or a sports bra for the first two to four days after surgery. You can return to work in three to four days and exercise, wearing a supportive bra, in two weeks. Sexual activities can resume in 10 days. Small amounts of fluid may drain for up to one week, and simply placing gauze under your bra will handle this.

Brachioplasty maintenance consists of exercise of the upper arms and weight control. Scar contracture is part of the normal healing process and will occur over six months to one year, while actively helping to firm the skin.