Q: Dr. Eppley, I am 41 years old and weight 96 lbs. I have sagging, wrinkled loose skin at elbows and knees and was wondering if an elbow/knee lifts would be an option. I’ve never had a large weight loss but did lose 10 lbs about 2 years ago. Thanks so much for any info.
A: My guess is at your age and relatively stable weight, this is simply loose skin due to lose of elasticity of thin skin. This is very common at the elbows and knees due to the frequent flexion movements across the joints. It is not really question of whether elbow and knee lifts can be done…but should they be done. There is the aesthetic trade-off of a fine line scar which I consider more of a potential issue in the knees than the elbows due to the visibility. The good news is that thin skin usually scars the best, so this is a consideration not necessarily an impediment to doing it. I would need to see some pictures of the knees and elbows in the straight position (extended) to judge how much loose skin is present. It is that determination that makes the decision about whether elbow and knee lifts (so called ‘joint lifts’) are worthy of that scar trade-off.
Dr. Barry Eppley
Q: Dr. Eppley, I have loose skin on elbows and I only want the elbows done, I have had a quote but unsure how and when I can drive, and I am not sure about visible scar will be which worries me. It’s just coming into summer and not sure if that would matter to have it done now or wait. Can you advise me Thanking you in advance.
A: The biggest issue with elbow lifts, very similar to armlifts, is that there will be a visible scar as the trade-off for the loose skin. Whether this is a good trade-off will differ for each patient. If you have a scar concern, then this may not be a good procedure for you. That aside, my patients can drive the very next day. This would not be a procedure that most people would want to do in the summertime due to early scar visibility due to short sleeves being worn.
Dr. Barry Eppley
Q: I have loose wrinkled skin on the inside of my arm where my elbow bends. Is there a procedure that would improve this area? It is not due to weight loss. It is due to aging. I am 50 years old and this just appeared recently.
A: Loose skin often appears across joints like the knees and elbows as a result of aging. The near constant flexion and extension of these major extremity joints over time can result in some eventual sag from the wear and tear on the skin. While not seen in flexion, this skin becomes more evident in extension of these joints.
There are plastic surgery procedures to remove this excess skin. Known as elbow and knee lifts, they are almost exclusively done in extreme weight loss patients. With a lot of weight loss, the sagging skin extends from the body outward towards the hands and feet. Rolls of skin can frequently be seen past the elbows and knees. In bariatric plastic surgery patients, removal of this excess skin is commonly considered and done. While this results in scars, it is usually considered a more favorable trade-off.
In the comparatively mild amount of loose skin that can develop from aging around knees and elbows, replacing it with scars is a more dubious trade-off. Many cosmetic procedures involve scars as a substitute for the original problem. As a result one has to be crystal clear that this trade-off is clearly better. In the weight loss patient, there is usually no doubt. In the non-weight loss patient, the amount of loose skin and how bothersome it is must be carefully considered.
Dr. Barry Eppley
Q: Hi Dr Eppley, I was wondering if fillers can be used on a sagging elbow area instead of the surgical procedure?
A: Sagging of skin around the elbow area can be the result of age, body type, and weight loss. Most commonly I have seen it to be an issue in the extreme weight loss patient (greater than 75 to 100 lb weight loss) and it is one of the areas dealt with using bariatric plastic surgery techniques. While the usual approach to loose skin is to cut it out, the creation of a scar around a joint area can be problematic. The skin around joints, such as the elbows and knees, is not meant to be fixed. Rather it needs to have some flexibility and movement so the joint can go through its range of motion. Scarring around the joint may cause joint motion restriction in the long run and wound healing problems in the short run. (motion across a suture line) Known as elbow or knee lifts, the excision of loose skin must be carefully done to avoid these problems.
I suspect in this question that it is not a weight loss issue. Rather it likely is aging and the development of some loose skin around the elbow in an otherwise non-overweight person. (can particularly happen in an aging thin person) Therefore, excision and the scar that it creates is not an acceptable solution. This changes the approach to maybe an opposite solution…filling or reinflating the tissues. While injectable fillers can be placed anywhere, their temporary effects and the large volumes needed for a body area make them impractical. The only soft tissue filling option to be considered would be fat grafts. Harvested by liposuction, fat can be purified and then reinjected into soft tissue spaces. This is the only option I would consider when it comes to injecting any body area.
Dr. Barry Eppley