Flabby and loose arms are often referred to as “batwings” this is a common problem many encounter. This problem can affect any range, gender and body type. Factors that can contribute to flabby and loose arms include, genetics, aging and weight loss.
Did you know that by the time you turn 30, muscle mass can begin to decrease by 5%? Patients who have experienced massive weight loss, as seen with gastric bypass, are particularly prone to experiencing flabby skin.
An arm lift, or brachioplasty, is a surgical procedure that reshapes and improves the appearance of the upper arm, which is often required after massive weight loss. A reduction in “bat-wings” or sagging of the arm skin as well as tightening and smoothing of the supportive tissue in the upper arm region can be achieved. Both women and men can struggle with these aspects, that even with proper diet and regular exercise, it may be impossible to improve. In this case, a brachioplasty will be necessary to restore youthful, trim arms.
Ideal Candidate for an Arm Lift
Good candidate for an Arm Lift:
- Has hanging, loose, lax and excess skin along the upper arm
- Has achieved an ideal and stable weight and is not significantly overweight
- Has no medical conditions that will hinder surgical healing
- Is a non-smoker
- Has positive outlook and realistic goals for what can be achieved
- Is in overall good health
Arm Lift Surgical Technique
The arm lift procedure will be performed under general anesthesia at an accredited surgical center and you will be able to go home the same day. This procedure can take anywhere from two to three hours to perform.
Steps to Performing an Arm Lift
STEP 1: An ellipse incision, running along the bottom portion of the arm, from the armpit region towards the elbow is made. The level of correction and individual patient’s anatomy will determine the exact pattern and incision length.
STEP 2: Starting from the elbow region and proceeding towards the armpit, unwanted fatty tissue and skin is removed.
STEP 3: As the unwanted tissue is resected, remaining tissue is pulled taut and secured with temporary staples. To achieve optimum results, liposuction may also be used to nicely contour the upper arm.
STEP 4: Sutures are placed with a plastics closure to ensure proper healing.
STEP 5: Compression garment is applied to ensure proper healing and minimize swelling.
Different Arm Lift Techniques
Liposuction of the arms
This technique offers the least-invasive manner to contour the upper arms along with minimal scarring and short recovery time compared to other techniques. However, this approach primarily addresses the fat in the arms, and tends to leave patients with excess skin if there is poor skin elasticity. A surgeon would typically choose this approach for younger patients or those with good skin elasticity in the upper arms, thus providing a smoother and trimmer contour afterwards.
Hidden/Minimal incision brachioplasty
A less invasive approach to brachioplasty with the ability to address some excess skin is available. This technique creates an incision in the armpit region resulting in a minimally visible scar, and most patients experience minimal discomfort after this procedure. Liposuction can be used in conjunction with this technique to remove excess fat. Yet, adequate skin elasticity and minimal excess skin are considered when a surgeon determines whether this is the appropriate approach.
Traditional brachioplasty can remove excess skin as well as fat in the upper arm region, thus tightening the skin and producing a desirable contour. The incision runs along the bottom of the upper arm, from the elbow to the armpit, which tends to result in a significant scar. This is the most common approach surgeons use to address excessively loose skin in the upper arm region.
Extended brachioplasty addresses more than just excess loose skin and fat in the upper arms as seen in the traditional brachioplasty. This technique also addresses sagging on the side of the chest which is typically seen after massive weight loss. Ultimately, improvements in the appearance of the upper arms and sides of the chest can be achieved. Though, the incision extends from the elbow, under the arm, and along the chest wall leading to an extensive scar. This would be the preferred approach for patients with excessively loose skin in the upper arms and sagging skin on the sides of the chest caused by extreme weight loss.
The Fish-incision brachioplasty, like traditional brachioplasty, addresses both excess skin and fat of the upper arms that results after vast weight loss. The two techniques differ in the shape of the incision, and ultimately, the resulting scar. Instead of a straight scar which results from the traditional technique, the resulting scar from the fish-incision brachioplasty is an S-shaped scar concealed along the bicep, making it hidden from front and back views. Fish-incision brachioplasty is performed if patients prefer to have a scar in the inner arm rather than the bottom portion of the upper arm.
Crescent brachioplasty or a “mini-arm lift”
A crescent brachioplasty, or “mini arm lift”, is a surgical technique that can address minimal fat and skin excess that results from weight loss. For this technique, a “crescent shaped” incision is made near the arm pit region. As a result, the scar is virtually hidden within the armpit and confined within short sleeves. This is the preferred approach for those who have minor skin laxity and excess fat in the upper arms.
Immediately after surgery a compression garment is put on the patient and this must be worn all day and night for the first three weeks, and longer if recommended by your surgeon. The special post-surgical garment should only be removed while showering in which the waterproof dressing would protect wound but should resume wear immediately afterwards. Patients are advised to not bend the elbow for the first 24 hours after surgery. After a week, the dressing will be removed and will be replaced with special scar tape. Any strenuous physical activity should be ceased for the first two weeks, and then light physical activity can be resumed 3-4 weeks after surgery.
Improving the appearance of your scar
Brachioplasty has become increasingly popular as means to rejuvenate the upper arm, especially after massive weight loss. Though hindrance towards this procedure mainly lies within the extensive scar that can result, many would deem a lengthy scar an appropriate trade-off for more contoured arms. The double ellipse technique results in a straight scar that runs along the underside of the upper arm, making it inconspicuous during most daily activities.
The extent of scarring is variable between patients. There are many factors that can contribute to the appearance of the resulting scar including;
- Location of scar
- Skin tone
- History of keloids or raised scars
- Post-operative sun exposure
The scarring that can result after surgery is inevitable, but thanks to the progressive nature of modern medicine, there are ways to minimize the visibility of scars. Using the garment as recommended by the surgeon in conjunction with taping along the scar can help with healing and preventing widening of the scar. After about 2-3 weeks after surgery, which is when the incision is fully healed, you can use silicone-based gel to assist with further scar healing. It is essential that the patient uses sunscreen of 30 SPF or greater along the scar and avoids direct sun exposure to the scar for at least six months after surgery.
Are the results of an arm lift permanent?
As long as you maintain a stable weight the result of your arm lift will be permanent. As you age the skin will increase in laxity and the original firmness of the arms after your brachioplasty will diminish slightly. However, with a stable weight and exercise the arm lift results are permanent.
Before & After Photos
There are a variety of factors that determine the overall cost of your arm lift procedure.
- Surgeons fee: $7,500 – $9,500
- Anesthesia fee: Depends on length of procedure
- Hospital and Surgical Facility Fees: Depends on length of procedure
- Post-Surgery Garments: Included with surgeon’s fee at The Naderi Center
- Pre-Surgical Medical Clearance and Lab Tests: Usually covered by medical insurance
- Medication Costs: Usually covered by medical insurance
- Follow-Up Visits: Included with surgeon’s fee at The Naderi Center
Preparation for an Arm Lift
At The Naderi Center we believe the success of any cosmetic procedure can be improved with proper patient preparation. We go above and beyond to make sure that our patients are medically, emotionally and physically ready for surgery.
Submitted to your pharmacy. Your pharmacy should contact you when ready to pick up.
Stool Softener (preferably MiraLAX)
Helps with constipation associated with narcotic pain relievers.
Alternative to narcotic pain medication if pain is not severe. Do NOT take NSAIDS.
Provided to you by The Naderi Center.
3-4 WEEKS BEFORE SURGERY
- Obtain Medical Evaluation and Clearance. Make a visit to your primary care doctor to complete your medical evaluation and laboratory testing. Your surgeon may request for you to also be evaluated by a specialist. Please ensure any preoperative requests are completed 2 weeks before surgery.
- Work and Recovery Arrangements. Make any arrangements to be off from work or other strenuous activities while you are recovering from surgery. Have extra help available, particularly if caring for small children.
- Smoking. Tobacco, cigarettes and nicotine consumption will cause poor wound healing, longer healing times, and excessive scarring. We advise to discontinuing these products more than 4 weeks prior to surgery.
2 WEEKS BEFORE SURGERY
- Surgery Preop Appointment. You will come in for your preop appointment where you will review the surgery plan with your surgeon and go over logistical surgery details with your patient coordinator. Bring your questions as well as any individuals that will be part of your support and healing.
- DIET/SUPPLEMENT RESTRICTIONS. Avoid foods, drinks and herbal supplements than can increase risk of bleeding and bruising. Avoid aspirin, Ibuprofen, Naproxen, Motrin, blood thinners, vitamin E, omega-3, fish oil, and alcohol. Use Tylenol in place of other over the counter pain medications.
- Fill Prescriptions. These may include antibiotics and/or pain medication for after surgery. Make sure you understand how and when to take all medications. We suggest keeping a note pad to keep track of the medications you have taken.
NIGHT BEFORE SURGERY
- DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT OR SURGERY WILL BE CANCELLED. If prescribed, take medications with a small sip of water.
- Set Up Home Recovery Area: This may include pillows, blankets, books, television, and anything else to assist with a comfortable recovery.
- Bathing: You can shower but do not apply lotion, perfume, hair product, etc.
Recovery after an Arm Lift
The recovery from a brachioplasty will take from one to two weeks. Patients generally feel well enough to return to work in seven to fourteen days, sometimes sooner. At this time, light activities can be resumed, although heavy lifting and vigorous exercise should be postponed for three to four weeks.
Bruising and swelling are common along the upper arm during the initial brachioplasty healing period. To avoid unwanted swelling or fluid accumulation, we recommend a compression garment be worn for two to four weeks. In some cases, drain tubes may also be necessary. Mild to moderate discomfort is not uncommon, so your surgeon will prescribe pain medications for a comfortable healing period.
NIGHT OF SURGERY
- Movement is Important. Make sure to get out of bed and be up and walking around immediately after your surgery. When lying down in bed or on the couch, make sure you are moving your legs and ankles. Take deep breaths frequently to keep your lungs clear.
- Sleep. Sleep on your back with your head and legs elevated (1-2 pillows). Since the incisions are on the front and the back it can be difficult to get comfortable. Sleeping on your side is ok too if that allows you to feel less pulling at the incision sites. Continue this for one to two weeks.
- Pain. You will be prescribed pain medication for post-operative pain control. If your discomfort after surgery is not strong you are welcomed to take Tylenol in place of the prescribed medication. Do not take the Tylenol with the pain medication, as most often the medication you are prescribed will have Tylenol in it. Do not exceed 4,000 mg of Tylenol in any 24-hour time period. Take medication with food to minimize the risk of nausea.
- Nausea. If you are experiencing nausea, which is common after general anesthesia as well as a known side effect of some stronger pain medications, we advise that you take your nausea medication. You may have been given a Scopolamine patch that is placed behind your ear. This will deliver anti-nausea medication for three days after its placement.
- Constipation. You will experience constipation if taking narcotic pain relievers. Miralax or other over the counter laxatives are recommended. Do not wait to take until you are constipated. Begin treatment with narcotic use.
- Medications to Avoid. Take only those medications approved or prescribed by your surgeon. Avoid medications containing aspirin or ibuprofen (Advil, Motrin, Ibuprofen, others) for two weeks before and after surgery. These medications may increase bleeding.
- Substances to Avoid. Avoid alcohol, nicotine, and caffeine, for these will dramatically slow the healing process.
- Diet. A light low-fat diet is best after surgery. You may start a regular diet after your surgery as long as you are not feeling nauseated or vomiting.
- Hydration. Stay hydrated by drinking 8-10 glasses of water a day. Avoid alcohol for two weeks and while you are still having to take pain medication.
- Physical Activity. Do NOT remain in bed all day. Although it will be uncomfortable it is imperative that you move around and at least take walks around the house in order to facilitate healing. Avoid lifting more than 5lbs, straining, bending, or any cardio activity.
- Exercise. Light physical activity may be resumed 3-4 weeks after surgery. Remember to start easy and build back up to your previous exercise levels. At 4- 6 weeks or when further instructed by Dr. Anderson, more intense exercise can be started. Just know that swelling may transiently be worse with exercise.
- Compression Garment. Expect to wear a compression garment all day and night for the first three weeks, and for a few weeks thereafter as wanted or suggested by your surgeon. The garment should fit snug but not too tight that you have trouble breathing or you develop wounds or blisters from the compression. Wear your garment at all times except for when you are showering or to wash it. This will help with minimizing swelling and help in contouring the body.
- Driving. Do NOT operate a vehicle or make important decisions until you have been off pain medications for 24 hours. Use good judgment. After being off pain medications automobile travel can be resumed, although frequent breaks are needed approximately every 2 hours to prevent blood pooling and clots.
- Return to work. Most patients require approximately 7-14 days off work depending on their job responsibilities. Returning to work with a light schedule initially or even part-time can be beneficial as well.
- Travel. Automobile travel can resume though frequent breaks are needed, approximately every 2 hours to prevent blood pooling and clots. Airline travel is restricted until 1-week postop. You will notice increased swelling with airline travel and this can happen even 6-8 weeks postop related to the pressure changes that occur.
- Sexual Intercourse. Sexual activity can be resumed when you feel ready with no restrictions and incisions have adequately healed.
- Showering. You may shower with assistance the day following surgery. Remove your garment. Incisions are covered with a waterproof dressing and require no attention. Replace garment after your shower.
- Hot Tubs/Baths/Swimming Pools. No tub baths or Jacuzzi until your incisions have healed, and approved by your surgeon, which is usually around 3-4 weeks. It is best to wait one month for hot tubs as they tend to have more bacteria than regular chlorinated swimming pools.
HOW TO TAKE CARE OF YOUR INCISIONS
- Incisions. Your incisions are covered with a waterproof dressing. No dressing changes or incision care is required. After your first postop visit, the dressing will be removed and a special scar tape will be applied. Additional tape is provided so you can continue a planned scar regimen.
- Stitches. All stitches are dissolvable.
- Sun Exposure. Avoid and minimize sun exposure. Use an SPF of 30 or greater when outdoors. Even a mild sunburn can worsen swelling and irritate an incision that is healing.
- Scar gel. Scars may take up to a year to fully heal. After your incisions have completely healed and when your doctor has told you it is safe, you can begin to use silicone-based gel on your scars to improve healing.
WHAT TO EXPECT
- Drainage. Drainage can occur from the incision sites for the first week after surgery. The drainage will be blood-tinged. You may use gauze or a light pad to reinforce post-op dressings if this occurs.
- Bruising. You can expect to have bruising on the affected and surrounding area. Most bruises will heal after about 2-4 weeks. The bruise will go from a purplish color to a yellow/green shade as it starts to resolve.
- Swelling. Swelling in lifted and all surrounding areas is to be expected for weeks and sometimes months. The swelling can improve with intermittent rest and compression garments. Exercise and physical activity can transiently worsen swelling but is encouraged.
- Itching. Itching at the incision sites and surrounding areas is normal for a few days or weeks. You may take Benadryl to help with this.
- Pain. It is normal to experience tightness, pressure, soreness, itchiness, and fatigue for several days to weeks following surgery as the body recovers.
- Range of motion. You may experience a limited range of motion for the first couple weeks depending on the extent of the body lift, especially if a tummy tuck has been incorporated. This is normal. By the second week you will gradually notice more range of motion and ability to stand more upright.
- Sensory Changes in Skin. You may feel reduced or heightened sensation in the affected areas. This is normal. You can expect return of normal sensation after a few weeks to months.
HOW TO TAKE CARE OF YOUR DRAINS
- Drains. Suction drains are needed typically after body lift surgery. They prevent fluid build-up and help with healing. If drains are placed, you will need to empty their contents and record output. The nurses in the recovery room will provide detailed instructions. You should also watch our video DRAIN CARE on our website.
- Do NOT apply hydrogen peroxide to incision sites. Keep postop dressings in place until follow-up.
- DO NOT soak in baths, Jacuzzis or hot tubs until all incisions have fully healed.
- DO NOT take Aspirin, Ibuprofen, Naproxen or other blood thinners until your surgeon advises you it is safe.
- Do NOT apply heating pads or ice packs to the treated areas unless otherwise instructed by your surgeon.
EMERGENCY SITUATIONS – WHEN TO CALL THE OFFICE OR GO TO THE HOSPITAL
- Signs of Infection. Spreading redness, worsening swelling, increased drainage or drainage of pus, worsening pain and warmth at the incision site. Temperature over 101 degrees Fahrenheit.
- Excessive Bleeding. If the dressings are saturated with bright red blood and you are having to make very frequent dressing changes.
- Other Emergency Situations. Shortness of breath or difficulty breathing, chest pain, lightheadedness that does not quickly resolve, severe vomiting, pain or asymmetric swelling in your legs.
- Prescriptions: fill prescriptions prior to your surgery date
- Compression Garment: provided to you by The Naderi Center
- Tylenol (Acetaminophen): alternative to narcotic pain medication if pain is not severe. Do NOT take NSAIDs.
- Laxative: to reduce constipation that may be caused by anesthesia or narcotic pain medications.
Risk and Safety of Arm Lift Surgery
As with any surgery, there will be the possibility of risks and complications. As a result, it is essential that the patient understands these potential risks and complications that are associated. Despite risk and complications being rare, it is important to discuss them with your plastic surgeon prior to your surgery.
Potential risks from an arm lift include
- Risks of General Anesthesia
- Bruising and swelling are expected to occur after your surgery. The skin surrounding the surgical site can appear to be darker or even lighter than your skin. In some rare cases, swelling and skin discoloration can persist for long periods of time and may even become permanent at the surgical site and in the forearms and hands.
- As with any wound, there is the potential for infection. In some rare cases, the skin may die or slough. This may require frequent dressing changes or further surgery to remove non-healed tissue in those with decreased blood supply to tissue and smokers may be at higher risk for poor wound healing.
- Pain will be experienced after surgery and in varying intensities/duration throughout your healing process. Occasionally, chronic pain can occur from neuromas or decreased mobility of scar tissue.
- Scars are inevitable and permanent as a result of surgery. They can be a different shade than surrounding skin and at times, unappealing. Resulting scars can be raised, red, or discolored at first but then settle over time. However, some patients can be prone to developing keloids, which may require further treatments.
- Every human being is born with some asymmetries. Factors such as muscle tone, bone structure, skin tone, and fatty deposits can contribute to such asymmetries in the body. Symmetry after surgery is not guaranteed, and additional procedure may be required in attempt to lessen asymmetries.
- Diminished (or loss of) skin sensation
- It is common to experience loss of skin sensation in the areas operated on. However, in some rare cases, permanent changes in sensation of the hands and forearms are possible. Complete loss of skin sensation has the potential to not fully resolve after brachioplasty.
- In extremely rare cases, motor nerve injury resulting in impairment of function in the arm and hand.
- The feeling of armpit and/or arm skin being tight can be experienced after lifting the arm. Additionally, a loss in the extent of motion of the shoulder can potentially occur, but typically subsides through time.
- In some cases, fluid can collect under the skin and tissue after surgery, which may require further procedures to drain such.
Arm Lift Specialist, Dr. Erica Anderson
Dr. Erica Anderson prides herself in providing aesthetically pleasing results, which reflects her expertise in body contouring. She is a firm believer in establishing a good patient/surgeon relationship in order to achieve optimal results. Understanding the patient’s personal lifestyle and long-term aesthetic goals are a fundamental part of her consultations. She will also review the patient’s medical history and current medications.
Ensuring that the patient is informed on available techniques for the arm lift is a priority for Dr. Anderson. She will also be able to answer any questions that the patient may have and that may arise during the consultation. Dr. Anderson will show before/after photographs of her recent brachioplasty patients to create a full picture of the potential results. Finally, she will go over the benefits and limitations of the brachioplasty, as it applies to the individual patient, and the potential surgical risks. If the arm lift is determined to be the right procedure for achieving desired results, Dr. Anderson will create a personalized treatment plan. You will also meet with a patient coordinator who will discuss costs and subsequently work closely with you throughout the surgery preparation process.
Schedule a Consultation
Those interested in the potential benefits of an arm lift are encouraged to schedule a consultation with Dr. Erica Anderson at the Naderi Center. When considering a brachioplasty procedure it is imperative to do your research and consult with an expert body plastic surgeon to receive their specialized advice and opinion. Consultations are available at the Reston, Virginia office (703.481.0002). For those coming from outside of the immediate area, please inquire about a virtual consultation with Dr. Anderson.