Northern Virginia- Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
Extra skin and fat in the upper arms can cause a person significant grief. When someone loses weight, inherits bad genes, or simply ages, the upper arm skin can sag, leaving the arms to have a batwing-like appearance. Exercise may tighten the muscles and reduce the fat, but it will not improve sagging skin that has lost elasticity. The best solution is an arm lift.
The arm lift operation has gained a lot of popularity in recent years due to gastric bypass surgeries and a large population of people who are left unhappy with the droopy appearance of the underside of their upper arms. An arm lift surgery is a straightforward operation with very high satisfaction among patients because it enables them to have a more toned upper arm appearance, more self-confidence, and more fashion choices.
The scar on the inner aspect of the arm, extending from the underarm to the elbow, is usually well tolerated given the benefits of this procedure. This procedure is often combined with other upper body procedures in the significant weight loss patients.
Preparing for Surgery
An initial consultation is set-up where we discuss the arm lift procedure, and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (usually in a day or two). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Arm Lift Procedure
The appropriate candidate for the arm lift procedure is a patient who has loose skin, or loose skin and excess fat of the upper arm. It is important to note that if a patient has good muscle tone, good skin tone, and excess fat of the upper arm, then they may be a better candidate for liposuction of the upper arm without and resection of skin, i.e. arm lift. In some patients with significant weight loss, there is excess skin as well as residual excess fat of the upper arm. In this situation, an arm lift can be combined with adjunctive liposuction to contour the arm.
The arm lift procedure is about one to three hours long. It involves making a Y-shaped or S-shaped incision placed in the upper arm extending from the arm pit to the elbow, depending on the amount and location of the sagging skin. The excess skin and fat are removed to create a more aesthetically pleasing, and firmer, upper arm with a Y-shaped or S-shaped scar.
How We Minimize Complications of Arm Lifts:
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible, anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to lower the risk of complication is to operate at first class facilities with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after an arm lift is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. In our practice the rate of significant bleeding is less than 1%. The treatment of a hematoma or a blood clot under the skin of the arm is to open the incision and evacuate the blood clot. Typically this is a straightforward procedure.
The most important step in avoiding infections/wounds, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, my patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, my rate of infection after an arm lift is extremely rare. Conservative removal of skin is important for the results to be good, but also so that the skin is not under too much tension after the arm lift. It may occur at the superficial incision level where the tension is highest, and a small open wound may occur which will usually heal nicely with dressing changes and antibiotic ointment.
There are important nerves that pass from the neck, down the arm, and to the hand. In performing an arm lift, it is important to avoid injuring these nerves. The way to minimize nerve injury is to resect a conservative amount of skin, thus creating minimal tension in the upper arm, but yet achieving an aesthetically pleasing result. Occasionally, nerves can get stunned or bruised, and function may take a few days to weeks to return. Our rate of permanent nerve injury in arm lifts has been minimal.
Seroma, Lymphocele, Lymphedema
There are important lymphatic and nodes around the elbow and in the arm it region. In performing an arm lift, it is important to preserve as many of these lymphatic channels as possible. This will reduce the chances of a lymph collection or prolonged swelling. If you have a history of a mastectomy or radiation to the area, you should discuss this further with your surgeon.
Smoking is an absolute contraindication for an arm lift. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and breast tissue during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.