Your Questions
Your Questions
Q: Dr. Eppley, I had a stomach stapling done in June and have lost 56 pounds. I have had a tummy tuck, breast reduction and a brachioplasty ten years ago but have obviously ruined that. But now I’m on a healthy eating plan for life. I’m 64 years old and wondering what you would recommend for my body contouring. I have attached some pictures of how my disgusting body looks now.
A: Since you have all the scars from the prior procedures, you may as well take advantage of their existence and use them for skin and fat removal and overall tightening of the areas for your body contouring surgery. For your abdomen you need a fleur-de-lis extended tummy tuck to get rid of the loose skin in all dimensions. (horizontal and vertical) Thuis would need to extend around the flanks to chase the loose skin/dog ears. You would also benefit by a major breast lift, keeping all your existing breast tissue and lifting and tightening the breast mounds back up onto the chest wall. You can just use the breast scars that you already have. For the arms (which seem to have the least amount of excess and sagging skin) a repeat arm lift would be needed.
Most of these body contouring issues are fairly straightforward. The real question at age 64 is to not overdo any single operation and stress your body too much. While in younger patients I would do all three body contouring procedures together, that would be a lot for you to go through at your age. Thus I would recommend only the extended tummy tuck combined with at the breast lifts. These two procedures target the biggest problems that I see (and what most weight loss patients focus on the most) and would yield the single greatest body change.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like your input on the possibility of me being a good candidate for an arm lift procedure. I am 28 years old, I have lost 80lbs through diet and exercise, while I still have more weight to lose, I do not think that my arms will see any more of an improvement. I have also had abnormally large arms, as the photo shows, my left is approximately 2 inches larger than my right. Do you believe I could be a good candidate for this procedure? Is liposuction an option? I am concerned about bad scarring given that I am African American.
A: By your pictures which show large hanging ‘bat wings’, you would be an excellent candidate for arm lift. I would agree that the size of your arms is not going to change at all with more weight loss. The biggest issue is the amount of arm skin that you have which can neither shrink nor disappear with liposuction. The only way to get improvement is with an excision procedure where the excess arm skin and fat is removed. This would drop your circumferential arm size down to about half, if not more, than what it is now.
The dilemma that you have is that no change can be done to your arms without the scar. Nothing else will make any difference. You do not have the luxury of having a scarless operation that will work. You have to decide to balance the scar and its associated risks vs. living with your arms the way they are. I can not say I have seen any worse scarring in African Americans with arm lifts than any other patients who have had the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am average build. I was a patient a few years ago from a Groupon and received an estimate at that time. I had Smart lipo on my arms last spring, by a dermatologist, but the skin still bags below short sleeve tops, I would like to find out if there is anything that can help with that.
A: Unfortunately, getting liposuction through Groupon is probably not the best way to have any form of plastic surgery. By definition of the way Groupon works, you are going to get liposuction for the problem area (whether it would be effective or not) and are going to get the fastest and cheapest way to do it. It is not really any surprise that you have found the result wanting.
In looking at your pictures, without the benefit of not knowing what you looked like initially, I would say that any form of liposuction never had a reasonable chance to work. What you really needed all along is a formal arm lift. You have too much loose hanging arm skin to think that it could possibly be tightened by laser liposuction. You may not want the scar from an arm lift but that is the only treatment that is worth undergoing if you want a real arm shape change.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can a mini arm lift tighten loose skin on the front of the arms? I have neither lost or gained weight as I have weighted between 95 and 98 lbs for years and have worked with weights to try to keep toned arms. However, aging has caused loose skin on side and front of arms. One plastic surgeon said the surgery wouldn’t help the front area; another said I only needed a mini arm lift and it would work. What is your opinion?
A: While a formal arm lift is the most effective procedure for tightening the arms and reducing its circumferential size, many women who do not have extreme amounts of loose skin (usually due to weight loss) do not want the trade-off of a long inner arm scar just for skin tightening alone. The mini-arm lift is a smaller version of its longer cousin that can be done in two ways. The traditional mini arm lift is a crescent-shaped excision of skin in the armpit that only achieves some tightening in the inner aspect of the upper half of the arm. Another version of a mini arm lift takes out a small ellipse of skin in the central aspect of the inner arm, which more effectively provides some tightening in the front and outside of the upper arm.
I have seen many thin older women who have developed some overall skin looseness and wrinkling of their arms and elbows due to age. If you would look like any version of this form of arm skin looseness, I would not be optimistic that any mini arm lift type would provide an effective improvement for your concerns.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley. I am interested in getting liposuction to make my upper arms smaller. They are so big I can not get shirts over them and it has been an annoyance for a long time. They flop around and it is so embarrassing. I only wear long sleeve shirts so they stay hidden. I think liposuction will help make them smaller but I am confused as to what method of liposuction is best. Should I get Smartlipo, Cool Lipo, Vaser Lipo or Lipotherme?
A: While it is understandable why you are considering liposuction for your upper arms, it will not produce the result you are looking for not matter what the liposuction technique. Based on your description of your arms, it sounds like you simply have too much skin to get the arm reduction you desire. Ideally you need liposuction combined with an armlift or arm skin reduction procedure. This does result in an upper arm scar so you have to consider that carefully as a trade-off. There is nothing wrong with doing liposuction alone but your expectation of the arm reduction results should be appropriately tempered. As liposuction removes fat, it makes the skin of the arm like the belly of a pregnant women who has just delivered…deflated and more loose. This is why consideration must be given to the resultant skin excess after arm liposuction alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in SmartLipo on the upper arms. I have lost over 100 pounds with lap band surgery and would still like to lose some additional weight. I was wondering about the effectiveness of having the liposuction while still planning and needing to lose weight. I may want to have additional procedures in the future but would like to get my arms now if that is feasible.
A: When it comes to losing a lot of weight, the arms in women will always show the result of that effort…with sagging ‘bat wings’ in many patients. The use of liposuction for the treatment of saggy upper arms (back of the arms or triceps area) is not the right treatment approach. Liposuction only removes fat and not skin. The problem in the weight loss arm problems is about 85% to 90% skin. Therefore, what you really need is an arm lift or brachioplasty. This is where all the loose skin on the back of the arm is removed with the trade-off of a long scar. What undoubtably drew you to Smartlipo for your arms is the perception that it can tighten skin. This is a frequently touted property of laser liposuction. While Smartlipo can tighten skin, it does so as measured in millimeters. Patients, however, want and need centimeters of skin tightening. Simply put Smartlipo can not tighten the skin on the back of arms, it needs to be cut off.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi Dr. Eppley. I am a 56 yr old female and I am interested in liposuction for my arms. I am currently losing weight and have lost just about 25 pounds. My current weight is 186 and my question is… do I need to wait till I have lost all the weight I want to lose or could I have liposuction on my arms now? I am exercising on a regular basis, but I am seeing very little if any progress on my arms. I am having to cover my arms as much as possible and I so want to wear sleeveless tops. I have researched this subject and have read where liposuction of the arms produces “only modest improvement”. Would I even benefit from such a procedure?
A: Like all liposuction, but particularly in the arms, patient selection is key for a satisfactory result. The real question is what is making your arms big? Is it fat alone, extra skin or a combination of both? Conversely, a good question is how much improvement is needed to make a visible difference? How much change is necessary to be able for you to comfortably wear sleeveless tops again? That is the bottom line question and objective.
While I can not obviously see your arms, I have never seen any patient at a weight of 186 lbs where fat removal alone with liposuction will produce a significant arm contour change, particularly in someone losing weight. Significant arm changes at this size require both skin and fat removal, otherwise known as an armlift or brachioplasty. That procedure can make a dramatic arm change at the price of a scar running down the backside of the arms. More likely your decision is whether an arm scar is a good trade-off for a noticeable arm improvement.
Dr. Barry Eppley