Brachioplasty (Arm Lift)
Brachioplasty or arm lift, is a popular procedure of Plastic Surgery, aiming to remove the excess of skin, to decrease the underneath fat infiltration and to redistribute the skin.
Before the operation
A meticulous clinical examination will determine the most appropriate type of surgical procedure for your case (choice of incision, associated liposuction indicated or not).
At the time of the first consultation, you will be provided with precise information on the different surgical steps, on the follow-up and the expected results, especially as regards the scar.
You will be asked to undergo a pre-operative evaluation. An anesthesiologist must be seen in consultation, at least 48 hours before surgery.
No medicine with aspirin must be taken for at least 10 days before surgery.
Depending on the type of anesthesiology, you can be asked to you to fast (no food, no beverage) for 8 hours before surgery.
Hospital stay and type of anesthesia
Type of anesthesia: Arm lift can be done under general or ‘twilight’ anesthesia (local anesthesia with intravenous sedation). The choice will follow a thorough discussion with the surgeon and the anesthesiologist.
Hospital stay: The surgery can be done in the “day care” department; this means that you can leave the hospital the same day of the surgery, after a few hours of medical supervision.
However, in some cases a short hospital stay can be preferable; this means that you enter the hospital early morning, the day of surgery and leave the day after the surgery.
The procedure
Techniques may be adapted to each case, in order to get optimal results.
Different techniques have been described. In general, fat excess is removed by liposuction and skin excess is removed by incision, the length of which depends on the degree of skin laxity and on the procedure chosen. The incision can be vertical, longitudinal, along the arm inner or back side or horizontal, following the armpit fold. Sometimes, the two types of incisions can be combined.
Arm lift with longitudinal incision along the arm inner or back side, is mainly applied to patients having a major skin laxity. At first, a liposuction is conducted. Then, the skin excess is taken away as necessary, with a longitudinal incision along the arm inner or back side. The average time of the surgery is about two hours. It may vary, depending on the extent of improvement needed. At the end of surgery, a compressive dressing is applied
The scar often remains visible; that is why there needs to be rigorous selection of the surgical indications, as well as thorough patient information and consent.
Considering the disadvantages of this type of arm lift, from a scar point of view, there is an alternative less ambitious surgery but with a more acceptable scar: an arm lift with an isolated armpit incision or a combined procedure with an armpit incision plus a short vertical one of less than 10 cm.
Arm lift with horizontal armpit incision is aimed at a patient with less skin excess and laxity, mainly located at the upper third of the arm. From a single horizontal incision, hidden in an armpit fold, combined with a liposuction, we can take away the skin excess of the upper part of the arm inner side. The residual scar is usually not visible but the aesthetic result is less dramatic that the one obtained with a vertical scar arm lifting. The average time of surgery is one hour. At the end of surgery, a compressive dressing is applied.
As this procedure is lighter than the previous one, it can be conducted on an outpatient basis, under ‘twilight’ anesthesia. Furthermore, due to its simplicity and lightness, it allows to possibly repeat it, one or two times within a few years. The repetition of this procedure will allow, each time, to further improve the result (following the patient wishes) due to complementary skin resection and re-draping without en-longing the scar which should stay inside the armpit.
Combined technique is a synthesis of both previous procedures, realizing a compromising result, particularly from the scar point of view. The technique combines a horizontal incision inside the armpit with a short vertical one of less than 10 cm at the arm inner or back side.
After the operation
During the early follow-up period, ecchymosis (bruises) and edema (swelling) can appear. They will decrease within 10 to 20 days after surgery. The pain is normally limited to a certain discomfort, treated by usual pain-killers.
The healing period can be a little unpleasant due to the skin tension around the scar borders. Return to work might take place within a few days after the surgery, depending on the type of the professional activity. Any sport activity can be progressively started within 4 weeks after surgery.
The scar is often pink-red during the first 3 months following surgery; this usually decreases progressively during 1 to 2 years. Healing depends on the patient’s skin specificity. During the first 3 months following surgery, the scar must be protected from the sun.
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The result
It will be appreciated within 6 to 12 months after surgery. Most of the time, we can see a good correction of fat infiltration and skin laxity, which improves significantly the arm aspect. The functional improvement is also clear, especially in case of longitudinal incision arm lift.
The scars are usually visible, particularly after the longitudinal incision procedure, along the arm side which is not hidden in a natural fold.
Thanks to the technical improvements and to my long-term experience, the results of this surgery are really good. It remains, nevertheless, a delicate surgery and even a sophisticated technique never totally protects from a certain amount of imperfections or complications.
Imperfect results
Most of the time, a well-indicated and a well-performed inner arm lift provides satisfactory results. However, localized imperfections are not rare, mostly concerning the scar, as it can be too visible. In case of too high tension on the sutures, the scar can get an unpleasant aspect (hyper-pigmentation, thickness, retraction, adherence or enlargement). The scars decrease with time but never disappear totally. Depending on the patient, the scars always entail a risk of getting hypertrophic requiring specific treatment.
As far as the results of liposuction are concerned, they may present either an insufficiency of hypo-correction, a slight residual asymmetry or small irregularities of the skin.
These imperfections can usually be treated by complementary “touch up” surgery, usually conducted under local anesthesia. However, no secondary surgery must be performed before 6 month post-operatively, when the result starts being stabilized.
Possible complications
Even if conducted for aesthetical purposes, an arm lifting remains a true surgical procedure, entailing the same risks as any surgery. Firstly, concerning anesthesia, it may sometimes induce unpredictable reactions. However, dealing with a competent anesthesiologist, working in a real surgical environment, pushes down statistically the risks up to an almost insignificant level.
Arm inner side lifting remains one of the more delicate procedures in the field of aesthetic plastic surgery. Hence, possible complications may include:
- General complications: thrombo-embolic failures (phlebitis, pulmonary embolism) which are however quite rare.
- Local complications, such as:
– Occurrence of a hematoma is quite rare but could indicate its evacuation to protect the quality of the aesthetic result
– Occurrence of an infection is enhanced by the proximity of a natural fold (usual bacterial pool). It can be prevented by meticulous hygienic care during the pre- and post-operative period, up to the time of complete healing. If necessary, surgical drainage and antibiotics can be required.
– Occurrence of persistent lymphatic flow may be presented, which times will spontaneously disappear without sequels.
– Skin necrosis can exceptionally be seen. It is usually limited and localized. To prevent necrosis, the arm lift must be well-indicated and the surgery well-adapted and carefully conducted.
– Sensitivity troubles, especially along the inner side of the arm can be seen. Normal sensitivity, most of the time, reappears within 3 to 6 months after surgery.
My Way …. “Metron Ariston”
Ageing, loss of skin elasticity, fluctuations in weight, heredity… are all causes of redundant, sagging skin that spans from elbow to armpit, along your upper arms, which can be truly frustrating and diminishing your self-concept. Most times, diet and exercise cannot help…
Brachioplasty (Arm Lift) is one of the most rapidly growing operations in plastic surgery nowadays, which however has a high “price” to pay: Long Scars.
There is an alternative using a single horizontal incision, hidden in the armpit fold, however the results are less dramatic… Most times the procedure needs to be repeated to get the desired results…
For really dramatic results, I combine a single horizontal incision, hidden in the armpit fold, with WAL liposuction and a longitudinal incision along the arm back side. This enables thorough removal of excess fat and skin, and tightening and reshaping of the underlying tissues, for a truly firm, aesthetically optimal and long-lasting result. The scar is placed in as inconspicuous a position as possible, toward the back of the arm, and depending on skin laxity, I adjust it to be as minimal as possible, too.
This webpage aims to provide some information about the subject. Individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
Source:
American Society of Plastic Surgeons, British Association of Plastic, Reconstructive and Aesthetic Surgeons, French Society of Plastic, Reconstructive and Aesthetic Surgery