Q: My upper arms are huge and flabby. I can’t get rid of it. My arms hurt to move. I’ve had rotator cuff surgery on both shoulders and bicep reattachment on my right shoulder. I have Medicare and Tricare insurances. My shoulders and arms hurt terribly. What can I do?
A: Based on your description of your problem, you appear to have the intent or belief that one’s medical insurance will cover you upper arm surgery. 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. While you have shoulder and arm symptoms, no insurance company is going to cover this type of cosmetic surgery. While an armlift can make a dramatic difference in the appearance of your arms, there is no medical evidence that it will improve shoulder pain or the function of the arm. That is not my medical opinion but the written stance of every insurance company. Your only option is to consult with a board-certified plastic surgeon and get a fee quote for this type of surgery. It can be done as an outpatient in a 90 minute to two hour operation. Arm lifts generally do not cause a lot of discomfort after surgery and recovery is fairly quick. While it does result in a long arm scar, it makes an immediate and dramatic change to the arms… that might even make your shoulders feel better. 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
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
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
Q: I’ve lost about 90 lbs and now I have excess skin that hangs on my upper arms that I want to have fixed.
A: One of the many skin problems that develops after large amounts of weight loss is that of loose hanging arms. The skin on the back of the upper arm in the triceps area hangs down, creating what is often called ‘bat wings’. The excess skin frequently extends into the armpit (axillary) area and down into the side of the chest wall. Such large amounts of upper arm skin are a unique finding amongst extreme weight loss patients, particularly after bariatric surgery. Interestingly, this arm problem occurs overwhelmingly in women and not usually in men. (I have never performed an armlift in men) It may be that men’s skin shrinks down better after weight loss.
An armlift, known in plastic surgery as a brachioplasty, is an extremely effective procedure for reducing the size of the upper arms and getting rid of this loose floppy skin. While it accomplishes this result with the trade-off of a long arm scar, patients with this amount of loose arm skin consider that scar better than the excess skin. Armlifts are one of the most satisfying of all weight loss body contouring surgeries.
Armlifts traditionally have either placed the scar running down the middle of the inside of the arm or on the back of the arm. Recently, I am using a new technique during surgery that places the scar between the middle and the back of the arm with significantly better results. The scar is not only better hidden but the common postoperative wound healing problems that used to occur (particularly when using the inside of the arm location) have been largely eliminated.
Dr. Barry Eppley