Q: Dr. Eppley, I am interested in having my upper arms “done” by the best method. Another surgeon recommended Smart Lipo. I am researching the best method and am interested in a second opinion. I am 40 years old, not overweight and exercise daily.
A: When it comes to your arms, you represent a classic ‘tweaner’, which is someone who has a plastic surgery problem that can not ideally be treated by either of two different methods.
Your arm problem is not big enough with enough loose skin and fat to justify a formal armlift and its associated scar. No one really wants an armlift but it is the most effective arm reshaping procedure. (because it removes a lot of skin and fat)
Your arm problem is also too big, in my opinion, to have liposuction and GET THE RESULT THAT YOU REALLY WANT. It just isn’t effective enough to make a really big difference or have a dramatic reduction in arm size that any woman that I have ever seen with such arms really wants and hopes the liposuction procedure can achieve. But it is the only procedure that is justified (has no awful scars) and can make somewhat of a difference.
When it comes to liposuction, do not get caught up in all the hype about various liposuction technologies including Smartlipo. Despite widespread internet promulgation about its magical skin tightening properties, Smartlipo offers few if any advantages over any other liposuction method. (I can say this quite objectively since I have owned a Smartlipo device for years) Compared to the skin tightening you would need for your arms, no amount of fat melting and heating the tissues by a fiberoptic laser probe is going to make a big difference in the natural skin contraction that can occur with good skin elasticity. And unfortunately most upper arms that need to be made smaller do not have good skin quality over the back/triceps area.
In short, liposuction of your arms is the only reasonable treatment option. But the key to not being disappointed with the results from such a procedure is to have realistic expectations (modest not dramatic improvement) and choose a surgeon who has a lot of liposuction experience and not one based on a liposuction technology. At the end of the day, the most important predictor of success is the hands that is holding the device, not the device itself.
Dr. Barry Eppley
Q: Dr. Eppley, I would like a more toned looking armpit, upper back, and upper arm. I feel that, although I am relatively lean and well proportioned throughout the rest of my body, where my arms attaches to my shoulder and chest is just too thick. I have attached some pictures so you can see what I mean. There is also a glob of fat in my upper breast next to the arm that sticks out in clothes.
A:What you have is a very common problem, known as axillary breast fat. When combined with some circumferential fat around the upper arm and back, it makes the whole area look undesireably thick and full. Liposuction (technically liposculpture given the small volumes and discrete areas) of the axillary breast (upper lateral breast quadrant) and front and back of arms (extending into the upper back) would be a good approach to help contour this area and create a more sculpted look of the upper arm/chest area. That could be performed as an outpatient procedure done under anesthesia to get the best result in the most efficient time period. While there would be some swelling and maybe mild bruising, it would not be much of a prolonged recovery. It could be done late in the week, for example, and you could be back to work by Monday or Tuesday. (albeit with sore upper arms) Be aware that the final result from such a procedure would take a minimum of six weeks to become fully evident.
Dr. Barry Eppley
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
Q: Do you use the BodyTite Radiofrequency Assisted Liposuction (RFAL) for upper arms and abdomen areas? Is it safe to this while I am breastfeeding?
A: RFAL is a modest skin tightening and fat removal method. Whether that is an appropriate technique depends on how much fat vs loose skin one has in their upper arms. Based on my experience in upper arm reshaping, I would have little confidence that any method of skin tightening alone on the body in general is a good financial value. (i.e., a satisfied patient) Almost every upper arm that I have seen in my Indianapolis plastic surgery practice, even if there wasn’t a fat issue, needs at least an inch or more of skin tightening. That is well beyond what any method of nonsurgical skin tightening can do. The arm is a tough area when it comes to decision making between an arm lift and liposuction. Armlifts are never worth it unless there is a lot of skin. Even liposuction can produce only modest arm changes. For arm issues that do not justify an armlift scar, the dual approach of Smartlipo followed postoperatively by skin tightening, such as Skin Tyte or RFAL, would be a good consideration.
Dr. Barry Eppley
Q: Dr. Eppley, I’m hoping you will be able to advise based on your article on conservative vs aggressive liposuction and the trade-off with skin contouring. Would you please tell me what my options are to correct the skin irregularities on my upper arms as a result of liposuction done severalyears ago? Would weight training or weight gain or massage help? What are the odds that a second liposuction procedure on the arms would correct vs worsen the skin irregularities? Thank you!
A: The number one complication after liposuction is contour irregularities, i.e., lack of perfectly smooth skin. Certain body areas are more prone to that problem than others. The arms is one of those potential areas and that has to do with how liposuction is performed in an axially-oriented extremity…usually from one direction. It is very difficult, from an access standpoint, to treat the back of the arms from different directions. The concept of cross-tunnelling, an old liposuction concept, still has merit even with today’s advanced liposuction technologies.
Massage therapy done early after liposuction surgery can help with working out any irregularities and uneven areas. However, months to years later when the tissues have healed, make such tissue manipulation unsuccessful. Weight training or arm toning would be unsuccessful as the contour problem does not lie at the muscular level.
The only option for improvement would be another liposuction surgery. The scarred and irregular subcutaneous tissues must be released for any better contour to be achieved. Since the old motto of ‘plan B should not be the same as plan A if you want a different result’ applies, how the liposuction was done and what was done afterwards should be different. In my Indianapolis plastic surgery practice, I would use laser liposuction (Smartlipo) as a different method, access the area from both at the elbow and from behind the arms, and institute massage therapy beginning two weeks after the liposuction surgery. While no guarantee can be made that it would be better, my experience is that it would. If the same technique was used as the last time, the odds are higher that it could be worse.
Dr. Barry Eppley
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