Incision Placement

The severity of skin and fat excess of the upper arm will determine the placement and extent of incisions.  Patients who do not require any skin excision can be treated with liposuction alone, with small, inconspicuous incisions in the upper arm.  Patients who have mild to moderate skin excess will have incisions that are well hidden in the armpit.  Patients with severe skin excess, most commonly “massive weight loss” patients, may require incisions from their chest wall, across the armpit, and down the inner part of the arm to the elbow, in the shape of the letter “L.”  The larger the arm lift needed, the longer the incision necessary to improve the upper arm appearance.

Liposuction-only Arm Lift

Patients that have developed excess fat in their upper arms, but have maintained excellent skin quality and elasticity, are candidates for a liposuction-only arm lift.  These patients will not require any skin removal, and will avoid any incisions larger than those created during liposuction.

Skin Resection Arm Lift

Most patients seeking an arm lift will require some degree of skin resection to reach their desired aesthetic goals.  These patients are treated initially with liposuction to remove excess fat from the back of their arms, before reducing the circumference of the upper arm with removal of any skin excess.  Incisions may be limited to the patient’s armpit, but larger arm lifts may require incisions down to the level of the elbow.

Liposuction-only Arm Lift

Liposuction requires creating small (0.5-1.0 cm) incisions in the skin, camouflaged in body creases or inconspicuous areas of the upper arm.  Fluid containing medications aimed to provide pain-relief and limit blood loss is then infused into the arm, before special instruments are used to suction out excess fat.  Careful attention to detail during the suction phase of the procedure ensures enough fat is removed to narrow the upper arm, while leaving enough fat behind to create a pleasing contour with the shoulder and forearm.  This avoids a “Popeye” arm effect, whereby the upper arm does not match the contours of the forearm.

Once liposuction is complete, surgical tape and gauze are placed over the incisions, and a compression garment applied to help with skin retraction, and help reduce arm swelling.

Skin Resection Arm Lift

These cases start by duplicating the liposuction-only arm lift.  After liposuction removes the excess fat from the back of the arm, the amount of skin needing to be excised is patterned on whether the skin excess is running down, or around, the arm.  Incisions are then created, and the excess skin and fat elevated from the underlying muscles.  The excess skin is removed, and the remaining skin redraped over a drain, and sutured closed in multiple layers.  Sterile gauze and a compressive garment are then applied to help with skin retraction and help reduce arm swelling.

When performed alone, brachioplasty is an outpatient procedure.  Patients are instructed to maintain their arms elevated to the level of their heart for the first few days after surgery to prevent undue swelling that can cause discomfort, or affect the healing process.

Any drains placed during surgery will require a logbook to record how much fluid comes out of the drains in a 24-hour period.  These measurements are important, as they will determine when the drains can be removed.

The compression garments are maintained for several weeks after surgery, during which time strenuous activities and workouts are limited.  Most patients can return to their exercise regimen 6 weeks after surgery.

Full recovery will take weeks to months, depending on the type of brachioplasty performed.  A return to work is dictated by how well patients feel, and the typical duties required of their job.

We believe in being preemptive to avoid any risks associated with surgery, but occasionally the following may occur:

Bleeding/Hematoma – A small amount of bleeding is common after surgery, but if severe enough, another operation may be required to stop it.  Bleeding can also form a collection, termed a hematoma, which presents as a swollen, painful, bruised, and tense arm.  These require drainage to prevent secondary problems.

Seroma – A fluid collection may form under the skin after an arm lift and may require drainage. This can typically be performed in the office.

Infection – Brachioplasty carries a small risk of infection, but if one occurs, it may require oral, or intravenous, antibiotics.

Poor Cosmesis: This may include poor wound healing with a widened scar, irregularity of the scar contour, or partial wound separation.  These may all lead to suboptimal results, and the possibility of additional surgery to correct.

There are risks factors that may increase your risks of these complications that can be optimized before surgery

Blood Clots: Brachioplasty can result in the development of blood clots in the arms or legs.  These clots can travel to the lungs where they can be fatal.  Precautions before, and after, surgery are taken to avoid blood clots from forming.

Skin Laxity: As much skin is removed during surgery as safely possible. Once the swelling from surgery has resolved, there may be some skin laxity present.

Sensory Changes: Patients may have altered sensation to their upper arms after surgery.  Typically the result of nerve swelling and irritation, it can cause numbness, tingling, or a burning feeling.  In most cases this is temporary, with spontaneous improvement over several days to weeks.  In rare cases, a more permanent numbness can occur.

What will my scars look like?

As with much of plastic surgery, we trade incision length for an improved contour.  The larger the arm lift needed, the longer the incision necessary to correct.  If a patient is receiving only liposuction, or a small amount of skin resection, the incisions can be well hidden in the patient’s arm or armpit.  In the case of a full arm-lift, incisions will run from the chest wall and armpit, along the inner aspect of the arm, down to the elbow. Dr. Castillo is cautious during surgery to minimize tissue injury to leave the best possible outcome.

What type of anesthesia is used?

Most full arm-lift patients require general anesthesia for safety, due to the extent of surgery typically required.  Patients needing a small amount of correction can have surgery with local medication and sedation.  Dr. Castillo never compromises on patient safety, and will discuss anesthesia options with you prior to scheduling your surgery.

How quickly can I resume my exercise regimen?

We ask that you allow your incisions to fully heal before resuming strenuous activity.  On average, 6 weeks is required from surgery before weight training can be restarted.