Show Your Arms Again With An Arm Lift After Weight LossJanuary 5, 2018
Flex! Proudly Show Off Your Arms!
Let them see you FLEX! Arm lifts have become one of the most common procedures I perform.
Do you tell yourself you won’t ever wear short sleeve shirts even if it’s 95 degrees outside?
Do you have to buy larger clothing sizes to accommodate your arms, yet feel like you are swimming in your clothes because the rest of your body is smaller but your arms aren’t?
These are common complaints I hear from my patients and if these concerns sound familiar, then an arm lift or brachioplasty may be right for you.
Following significant weight loss, your body and your skin go through numerous changes. Despite liking the number you see on the scale, you may not like the how your loose skin appears when you look in the mirror or in certain types of clothing. Many patients feel they can hide some of the excess skin they have in other areas with clothing, but there is no way to hide their arms; especially when summer rolls around with tank tops and bathing suits.
Arm lifts continue to grow in popularity so much that, according to the annual statistics compiled by The American Society of Plastic Surgeons, arm lifts are up over 5000% over the past 15 years.
So the next questions I am often asked are “How big will the scar be?” and “How does all this work?” Unfortunately, there is no way to do these procedures without an incision. During your consultation, a plan will be formulated to help you achieve your goals and expectations.
Are You A Good Candidate?
Ideal patients are at or close to their goal weight and have been weight stable for at least three months. On an individual case-by-case basis, the arms can be done prior to reaching a patient’s goal weight when the arm laxity is severe and the remaining weight to be lost is unlikely to come from the arms.
Patients should be in good health and their nutritional status should be optimized. In my practice, I recommend a high protein intake of 80-100 grams/day for at least four weeks, before and after surgery. Patients undergoing this procedure need to understand the scarring potential and must be willing to accept the tradeoff of skin for scars.
Armpit Crease Versus Short-Scar Versus Full Arm Lift
The length of the incision is really going to depend on how much loose skin is present and how far down your arm there is loose skin. The longer the incision, the more skin that can be removed. Short-scar techniques do exist, but the smaller incision will result in less skin being removed.
There are four basic incision types: armpit crease incision, short-scar incision, full arm lift, and an extended arm lift. In addition to skin removal, I commonly perform liposuction of the arms to optimize the contour and long-term results. It also allows me to remove more skin.
The armpit crease only incision will address skin in the upper one-third of the arm. The biggest shortcoming of this technique is that the direction of pull is into the armpit so it won’t make the width of the arm smaller. For most of my patients, they don’t like the way that their arm “spreads” when it is by their side. For this reason, this approach is least likely to work for most of my weight loss patients. In the short-term, it also significantly decreases your range of motion in your arms due to its direction of pull. This does resolve with time.
Surgeries With Longitudinal Incisions Down The Arm
The next three incision types involve a longitudinal incision down the arm. The length of this incision will vary depending on how far down your arm your loose skin extends.
A short scar usually extends halfway down the arm, the standard or full incision goes to the elbow, and the extended incision goes onto the forearm.
This longitudinal incision allows the width or cylinder of your arm to be made smaller and allows for maximal skin removal giving you the optimal contour and tightness to your arm.
A longitudinal incision that extends to the elbow is the most common incision used for weight loss patients given their degree of skin laxity in the arm region.
This incision is placed on the inner aspect of the arm towards the bottom of the arm. This is similar to the position of a tailor’s seam on the inside arm of a dress shirt. This placement allows the scar to rest against your body when your arm is relaxed and at the bottom of your arm when it is elevated. It also prevents people that are walking behind you from seeing it. There is also an incision in the armpit region as well that helps remove some excess skin from this region as well.
As a plastic surgeon, my goal is to minimize scarring during the healing process. However, there is no way to completely predict how a patient will scar and most often the patient’s genetic predisposition to scarring will be the strongest factor in how you heal. There are now several different treatment strategies available to help minimize scarring and treat poor scars in they occur. The scars can take up to two years to completely fade.
The Day Of The Procedure
Arm lifts can be done as a standalone procedure or in combination with other body contouring procedures. When done alone, the procedure takes between three to four hours depending on the complexity of the procedure and whether liposuction is performed; as this adds time to the procedure. It is performed as an outpatient procedure. I personally don’t use drains in the arms, although many plastic surgeons still use them.
When arm lifts are combined with other procedures, it may require an overnight stay depending on the total anesthesia time. Generally, patients undergoing more than 6.5 hours of anesthesia should stay overnight in the hospital.
Recovery Of An Arm Lift After Weight Loss
The key to recovery is taking it easy and minimizing the use of your arms. Patients need to keep their arms elevated following their procedure to minimize the risk of seroma (fluid collections). They can move freely at the elbow, but stretching of the armpit region needs to be minimized to avoid pull on the incision and possible wound separation.
Exercises for a range of motion will begin after a couple of weeks once the healing process has begun. Lifting restrictions are for six weeks. Compression garments are also worn for a minimum of four weeks to help minimize swelling and skin stretching. Swelling can persist for several weeks. Patients most commonly take one week off from work. Final contour results will not be seen for three months and final scar maturation can take up to two years.
Risks Of An Arm Lift After Weight Loss
With all surgical procedures, there are risks involved. That being said, common things happen commonly and uncommon things happen uncommonly.
The two most common complications that occur are wound separation and seromas (fluid collections). Wound separation can occur where the horizontal arm incision meets the armpit incision. This is generally minor and most commonly heals on its own with local wound care using an antibiotic ointment.
The second most common complication is a seroma or fluid collection. This is generally seen at the elbow region as a result of gravity. It can be minimized by arm elevation, good compression, and high protein intake. Other potential risks include contour irregularities, recurrent skin laxity, asymmetry of the arms, and paresthesias (numbness). Less common risks include bleeding, persistent swelling (lymphedema) and blood clots.
An arm lift or brachioplasty is a procedure with a high level of patient satisfaction. The concern for scarring is real, but it is far surpassed by the improved self-confidence that patients have following their procedure.
Stop hiding your arms and let them see you FLEX. Be armed and dangerous!
ABOUT THE AUTHORDr. Joseph Michaels is a board certified plastic surgeon specializing in after weight loss body contouring in the Washington, DC area. He is in private practice and he is also an Assistant Professor in the Department of Plastic Surgery at Johns Hopkins Medicine. He received his B.A from the University of Pennsylvania and his M.D. from The Mount Sinai School of Medicine, where he graduated with honors. Dr. Michaels currently practices at Michaels Aesthetic and Reconstructive Plastic Surgery.