Your Questions
Your Questions
Q: Dr. Eppley, I am considered having an armlift for my bat wings. I have looked at a lot of scars from that surgery and most of them are underwhelming. I hate my batwings but am worried that I might hate the scar to remove them just as much. Some of the armlift scars seem to be quite long, often crossing the elbow and down past the armpit. Does every armlift scar have to be that long? Do you have any pictures of really good looking armlift scars?
A: The length of the arm lift scar can be shortened or lengthened as the patient desires although, in some cases, that may affect how much improvement is seen. It is also important to understand that with varying degrees of bat wing problems the skin excess may cross the shoulder and elbow joint areas, particularly in the bariatric or massive weight loss patient.
When it comes to the scar for the armlift, one has to approach it as the worst case scenario..as you never know in anyone how well it would do. In looking at our people’s photographs, one has to understand that is them and may not signify at all what may happen in you. Even if you saw a great arm lift scar on another person, that should not be the motivation to undergo the surgery…as you are banking on that will happen in you. You should make your decision for surgery based on ‘typical’ or ‘average’ results, not the best that has happened. If you look at an airlift scar and think it looks terrible, then this surgery is not for you. If you look at an arm lift scar, wish it looked better than that but still think that trade-off is better than having batwings, then it is a good operation for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I weighed around 95 pounds before I had ovarian cancer. After my cancer treatments, I gained 130 pounds. I ended up have gastric bypass surgery and now have lose skin that needs to be taken off. Had a tummy tuck in 2001 so, don’t have too much loose skin in the tummy area. I am interested in my butt, arms and legs…can you help me with this?
A: Thank you for your inquiry. I am going to assume that you need a traditional arm lift (brachioplasty) and an extended inner thigh lift, which would be standard for many extreme weight loss patients after gastric bypass surgery. While every patient is different, I will assume these issues as a starting point. Your butt concern is harder to figure as I am uncertain whether an upper buttock lift or a lower buttock tuck tuck needs to be done. I will assume for now that an upper buttock lift (lower back lift) need to be done as this would be most common in the bariatric surgery patient. It is also a way to finish off a circumferential lower body lift as a second stage procedure to your initial tummy tuck done previously.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have several body problems that I would like to get rid off. I have lost 100 pounds and have kept it off for 11 years. First, my large batwings are causing strain on my shoulders I exercise five days a week but they will not go away. Will insurance pay for this since I am having it done to decrease my pain and not for cosmetic reasons. Also the loose shin around my inner thighs is increasing. I also have engorgement of my varicose veins I am currently looking to have surgery for these three problems. Will insurance pay for this two also.
A: After a 100 pound weight loss, most patients will suffer loose and redundant skin which can not be exercised off. Such loose skin in the arms and inner thighs is common and can be removed through arm lifts (brachioplasties) and inner thigh lift procedures. It is highly unlikely that either procedure would be covered by insurance. These are viewed as procedures that largely have cosmetic benefits not functional ones. But no plastic surgeon can tell you whether any procedure would be covered by insurance. There is a process known as insurance pre-determination in which the information would be submitted by the consulting plastic surgeon on which your insurance would make the final decision. My experience has never been favorable in that regard. Conversely, the varicose veins should be covered by insurance but you will need to be evaluated and treated by a vascular surgeon for that problem. Varicose vein surgery should not be performed at the same time as the body contouring surgery. It should be done first so that your risk of DVT (deep vein thrombosis) is lessened for the body procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in getting just a mini-armlift. I can’t seem to find any plastic surgeons that say they have actually done one. I don;t think my arms are bad enough for a full armlift and I don’t want that scar anyway. I just need a little tightening in the upepr part of my arm.
A: Armlifts, known in plastic surgery as brachioplasty or upper arm reductions, are traditionally thought of as a long excision of skin and fat between the armpit (axilla) and the elbow. While this is tremendously effective for ‘bat wings’ after a lot of weight loss, those women with more minor degrees of upper arm sagging on not good candidates because the scar would be worse than the sagging arm problem. This leaves the alternative arm strategy to either liposuction alone or liposuction combined with some limited upper arm skin removal, known as the limited brachioplasty or mini-armlift.
In the mini-armlift, the removal of skin for tightening is restricted to the upper 1/3 of the arm or just that of the armpit area only. (crescent-shaped excision) It can be removed staying inside the axillary skin folds or be extended somewhat further out onto the upper third of the arm. That scar can be placed on the inside of the upper arm or from the backside. The scars end up in different locations and there may be advantages either way for each patient. I have done the skin removal from both upper arm locations successfully and each patient must carefully consider their preference for scar location. While the skin removal adds an obvious tightening effect, the aggressive use of liposuction is really the mainstay of the procedure and is responsible for much of the result.
Dr. Barry Eppley
Indianapolis, Indiana