It’s winter in East Tennessee, but I’m already looking forward to sunny blue skies with spring blossoms floating through warm breezes. Gone will be the heavy coats and long sleeves, replaced by sleeveless clothes and bare arms. If you’re self-conscious about your upper-arm contour, then spring might not be your favorite season. No worries. Board-certified plastic surgeons like me are at your disposal to give you the confidence to be comfortable in your own skin and bare it all. No more hiding your arms when the temperature rises.
A successful arm-contouring plan depends your specific anatomy. What’s your skin quality and quantity? Is there excess flesh with thin deflated tissue and inelastic skin? Or do you have reasonable skin quality with some increased adipose tissue and a thicker arm contour? Your personal medical history is important as well. Have you gained and lost significant weight or undergone bariatric weight-loss surgery? Do you have a history of large amounts of sun exposure with subsequent sun damage leading to a crepe paper-like skin tone?
The algorithm for management of the unacceptable upper-arm appearance starts with the question of excess skin. Particularly if there is thin deflated skin that is present the full length of the upper arm, a vertical brachioplasty is required. The advantage of this procedure is the ability to remove a great deal of excess skin along with aggressive liposuction to create a wonderful tight contour. The disadvantage is the vertical scar that runs in the posterior medial aspect of the upper arm. Generally speaking, the scar is not visible when someone is facing you or behind you with your arms in repose. The scar can be exposed when the upper arm is extended away from the center of the body.
I can say with great certainty that patients who have undergone massive weight loss, with or without bariatric surgery, would choose the scar over the skin excess any day. Of course, there can be shades of grey in terms of skin excess and laxity. Milder forms may be treated with judicious VASER-assisted lipectomy followed by a modified horizontal brachioplasty, in which the excess tissue is resected and advanced within the axilla (arm pit). Scars are only visible when the arms are elevated with a sleeveless shirt.
If there’s no skin excess and the overlying skin is of good quality and there is contour excess related to an increased volume of fat in the upper arm, the VASER-assisted suction lipectomy is an excellent choice for sculpting the arms to a new contour. The manipulation of the dermis with the cannulas used to remove the fat via small openings in the skin placed in hidden areas of the arm leads to skin re-draping and shrinking. This redistribution creates firmer skin coverage of the arm leading to a nicer sculpted appearance.
What about Cool Sculpting (Cryolipolysis)? My answer is if there is only a very limited amount of excess fat and already tight skin it may work.
However, there is no mechanism with cryolipolysis to induce inflammatory reactions leading to collagen production within the dermis, which causes skin tightening unlike liposuction or micro-needling. My advice is to save your money for the real deal. Radio frequency may have a role in skin tightening, but the results don’t warrant the investment in the expensive equipment, which certainly is passed down to the consumer.
The key to a good result or the avoidance of a disappointing outcome is good clinical experience by a knowledgeable board-certified plastic surgeon with the correct judgment to know which technique to employ to maximize results. Buyer beware when entering the multitude of medispas that exist today without competent medical supervision. Recently in the Atlanta area, an emergency room physician untrained in plastic surgery was performing liposuction in an office without hospital credentials and created injuries to the diaphragm and liver leading to the deaths of two patients. Vetting your physician before undergoing surgery can prevent tragedies like this.