If you?ve lost a dramatic amount of weight, you already know the exhilaration of stepping on the scales and seeing that pounds are dropping off. And, you know the added joy of arriving at a day that you thought might never come?the day you reached your goal weight. But now, some of that delight may now be tempered by the fact that you find yourself with excess skin because of the weight loss.

As you probably know, this extra skin does not respond to exercise or more dieting. But, there is a way to resolve the problem: plastic surgeons can remove this extra skin. In this article, we?ll review a bariatric plastic surgery procedure for removing excess skin from the upper arms.

Arm Lift

The surgical procedure, called brachioplasty, or an ?arm lift,? restores the contours of your arms from the elbow to the underarm. Arm lifts are becoming more and more popular following massive weight loss. Last year, about 9,000 people underwent arm lifts, according to the American Society of Plastic Surgeons.

There are several types of incisions used for arms lifts. The type that is best suited to your needs depends on the amount of loose skin you have on your arms. For example, in a standard brachioplasty an incision is made that extends from the underarm to the elbow, and the drooping skin is removed. If you have additional excess skin in the underarm area, you may require what?s called an extended brachioplasty, in which the incision extends beyond the underarm and to the side of the chest, allowing the surgeon to remove more skin.

If you have only modest amounts of extra skin that are confined to the uppermost part of the arm, you may be a candidate for a short-scar brachioplasty, in which the incision begins above the elbow and goes to the underarm area. However, following massive weight loss, a short-scar brachioplasty typically doesn?t remove an adequate amount of excess tissue to provide a satisfactory result.

Arm lifts can be performed alone but are often done in combination with other procedures, such as, breast lifts or upper body lifts.

Are You a Candidate for an Arm Lift?

If you have excess skin on your arms and are generally in good health, you?re most likely a candidate for an arm lift. It is important to understand that you?ll have scars on the undersides of your arms; even though they are on the underside, they are visible. Some scars are thin and light, but sometimes scars can become thick and raised.

Undergoing an Arm Lift Procedure

When performed alone, an arm lift typically takes about two hours. The procedure begins with an incision along the inner arm or the back of the arm. Depending on the amount of excess tissue to be removed, the incision may extend past the elbow to the forearm or past the underarm to the side of the chest. In these cases, a Z-shaped incision may be used at the elbow or underarm. This type of incision helps prevent the resulting scar from tightening and constricting movement.

After the incision has been made, liposuction may be performed to remove fat deposits. Then excess skin and tissue is removed until satisfactory contours are achieved. A surgical drain may be placed in the arm, and the incision is closed using layers of sutures. The process is repeated on the other arm, with great care taken to maintain symmetry in the size of your arms.

After Your Arm Lift Procedure

A hospital stay usually isn?t necessary after an arm lift if that is the only procedure being performed. In most cases, you?ll go home the same day.
Typically, you?ll be sent home with drains near the surgical site and compression garments on your upper arms. The drains are used to draw blood and other body fluids away from the incision site. Draining away these fluids helps in the prevention of infection. Drain insertion involves placing a small, pliable tube under the skin near the incision and attaching it to a small plastic bulb that remains on the outside of your body. The bulb uses suction to draw out fluids. The compression garments do several things. They minimize swelling, increase blood circulation, and provide support. The garments also help skin ?re-drape? to the new body shape.

Is there much post-surgical pain? Most people do not have a lot of pain after bracioplasty and many patients describe the pain as mild to moderate. Your surgeon will prescribe pain medications and may also recommend over-the-counter pain relievers.

Recovering from Your Arm Lift Procedure

Arm lifts are usually associated with a rapid and relatively easy recovery. As your arms heal, you?ll be advised to follow your doctor?s post-operative instructions. For instance, you?ll be informed how and when to empty your drains, and you?ll be instructed on how long to wear the compression garments. To further reduce swelling, keep your arms propped up on a couple of pillows while you?re lying in bed or sitting in a chair.

Typically, following an arm lift, you?ll be able to use your arms for normal daily activities, such as brushing your teeth, eating, and getting dressed. You will be advised to move your arms carefully for about three to four weeks, and you should avoid any heavy lifting for about six weeks. Otherwise, you may be able to engage in other activities sooner than with most bariatric plastic surgery procedures. In fact, your surgeon may advise you to let pain be your guide. That means that if an activity causes pain, you should stop.

Risks of Arm Lifts

The general risks of surgery apply to arm lifts, including infection and improper wound healing. Other risks, such as hematoma, seroma, and blood clots, are much less common, but are potential risks. A hematoma is the pooling of blood at the incision site; a seroma is a clear pocket of lymphatic fluid that may collect under the skin after surgery. Both a hematoma and a seroma need to be drained to prevent infection and to avoid tissue death.

In extremely rare cases, a blood clot may break off and travel to the lung, causing a potentially life-threatening condition called pulmonary embolism. If a blood clot is detected, it may require hospitalization and treatment with blood-thinning medication.

In addition to these general risks, there are also specific risks associated arm lift procedures. These include:

  • Uneven skin contours: In spite of your surgeon?s best efforts, the skin on your arms may appear uneven, with slight depressions, rippling, or wrinkling.
  • Differences in size: Your surgeon will make every effort to make your arms appear equal in size, but in most cases, there will be slight differences. You should realize that, usually, your two arms are not exactly the same size pre-operatively either.
  • Asymmetrical scars: The scars on each arm heal independently and may not be completely symmetrical.
  • Interference with lymph system: In rare cases, temporary interference with the lymph drainage system may occur. When this happens, it is usually minor and may require a compression stocking to be worn on the upper arm for a period of time.

How Long Will an Arm Lift Last?

Arm lifts, which permanently remove excess skin and fatty tissue from the upper arms, are generally considered to be long-lasting. Maintaining a stable weight and engaging in a physician-approved exercise routine can help you keep your arms looking as good as possible. However, since the skin on the upper arms is thin and delicate, it may be more prone to recurrent laxity. In some cases, this may necessitate a minor revisionary procedure.

Thomas McNemar, MD, FACS, is a noted cosmetic plastic surgeon, as well as co-author of Breast Augmentation & Body Contouring and a new book entitled Bariatric Plastic Surgery: A Guide to Cosmetic Surgery after Weight Loss. His offices are located in Tracy & San Ramon, CA. For more information visit www. or