A young 82 yo in good health who is bothered by the wrinkled appearance of her upper arms. After discussing the options of a brachioplasty with a medial incision vs a posterior incision she elected for the posterior incision. The posterior incision , although visible from behind tends to give a tighter result with less recurrence of stretching. The scars typically continue to fade and improve for 3 years. The updated ‘after’ photos are from a 15-month followup.
A woman in her mid to later 50’s who is troubled by excess skin of her upper arms after losing 150 lbs following a gastric bypass. She is currently 5’6″ and 156lbs. She is shown before and again, 4 1/2 months after a bilateral brachioplasty ( “upper arm lift”). In her case she and I chose to place the scar at the groove below the biceps muscle on the inner arm. With a brachioplasty I tell my patients that they are trading a visible and potentially unfavorable scar on the surface of the arm to obtain a better contour. Her photos show that this scar is not visible with her arms at her side from the front or rear. Although her scars will typically continue to fade and improve for 2 years or longer after surgery, she is already thrilled with her new contour and the ability to wear more fitted shirts. The loose skin that she has elsewhere in her body after her weight loss is not as bothersome for her because she is able to hide it with her clothing.
A woman in her early 60’s who has lost 65 lbs after at lap band procedure and is bothered by the appearance of her arms. She is shown before and again, 1 year after a bilateral brachioplasty. She had a posterior scar placement combined with power assisted liposuction of each arm. The posterior incision seems to allow for better tightening of the upper arm skin in patients with significant weight loss, but is visible from behind. The brachioplasty scars typically will continue to improve for 3 years. She is pleased with her early result, and can wear more clothing styles now.
A woman in her early 60’s who has lost 83 lbs with diet and exercise. She is nearly 5 feet tall and is 136 lbs. She had bilateral mastopexy/augmentation (breast lift with implants) with the placement of 300 cc smooth round moderate profile plus silicone gel implants placed in a partial subpectoral (below the muscle) position.She is shown 8 1/2 months after bilateral brachioplasty (“arm lift”) and bilateral mastopexy (breast lift), and then 3 months after extended abdominoplasty. Although scars will continue to improve for up to 2 years, she is already thrilled with her early improvement. The brachioplasty trades a visible scar on the arm for a better contour. I prefer to place the scar on the inside of the arm, where tailors typically put the seam of a suit coat sleeve, as it is not visible with the arms at the side. Some surgeons prefer to place the scar at the back of the arm. The extended abdominoplasty extends the incision around the sides and as far back as we can go without turning the patient over during the abdominoplasty. It gives a better correction of the sides than with a standard abdominoplasty, but is less surgery ( and expense) and an easier recovery than a lower body lift. A posterior excision can be done as a second procedure if the patient wants additional tightening to complete a lower body lift in stages, but many patients, including this one do not need or want this.
A man in his late 50’s who had a gastric sleeve performed endoscopically by the bariatric service 3 years before and reduced his weight from 385 to his present weight of 257. He is 5’9″. He was bothered by a feminine appearing chest and hanging skin of his arms. He is shown before and again, 11 months after bilateral brachioplasty and bilateral gynecomastia excision with free nipple grafting. Discussion: Studies show that the risk of infection and wound healing complications increases above a BMI of and with His BMI of 37.67 we can expect a nearly 3 fold increase in these issues. As expected, he had small areas of skin separation and infection that delayed his healing, and we can see some inconsistent healing of his free nipple grafts. Scars will typically continue to fade and improve in the arm area after brachioplasty for 3 years.
A woman in her mid 50’s who has lost more than 60 lbs with diet and exercise. She is troubled by the ‘bat wing’ appearance of her upper arms and also by the droopiness of her D cup breasts. She would like to be slightly smaller but lifted and still proportional. She is shown before and again nearly 7 months after a mastopexy (breast lift) / minor reduction and a bilateral brachioplasty (upper arm lift). Although scars will typically continue to fade for up to 2 years, she is already quite pleased with her results. The appearance of the upper arms is improved with the arms at the side and raised. The tradeoff of a brachioplasty (upper arm lift) is a scar that is visible and sometimes unfavorable on the inner arm that is hidden with the arms at the side. Some surgeons prefer to place this scar at the back of the arms, but this would be visible with the arms down, and not my preference. As is typical with a brachioplasty in a patient with poor skin elasticity the results are not “perfect” but are much better. Swelling after surgery tends to re stretch the skin slightly, and there is no longer enough “spring” left in the skin to bring it completely back to the contour achieved at surgery. And tighter would risk skin breakdown, wider scars, and possible problems with pressure on the nerves and blood vessels of the arms. But much better is much better. The excision has been continued into the upper axilla (arm pit area) and down the lateral upper border of the breast to improve the contour.