Extended Brachioplasty Post MWL with Dr. Peter Fisher -San Antonio, TX

This is a bit of an x-post, as my "main review" is...

This is a bit of an x-post, as my "main review" is in the body lift section. I have lost ~200 lbs and was left with lots of extra skin. The trick with MWL folks is the extended arm lift part which takes the skin excision into the armpit and really onto the back section to correct some of the back laxity. It has only been three days but I think I will be very pleased with the results. Dr. Fisher does his arm lifts a little different with a posterior as opposed to anterior incision as this skin is stronger and results in less scar migration. If prelim healing is telling the story, I think this will end up being quite an easy healing. I already have decent ROM...hopefully will only get better!

Update on arms! Puckery but healing well....

I will post a new pic shortly, but my arms thus far are healing without healing complications, however I am starting to have that "zippery" look where the arm meets the back. Also have "puckering" near the end of the incision at the elbow joint. I have started self-massage to try to flatten out the scars and keep them a little pliable. They are 100% closed, but still scabbing a little, so massage is fairly gentle using Tripple Antibiotic Ointment. I will go see doc on Monday and find out which silicone scar therapy may be best for arms - i have some Biocorneum on the way, so this may be my "best bet" for arms, but i also some silicone tape called Mepitac - i can see if this will stay on, but trying to figure out how to do this in combo with the self-massage???

I guess I will have to massage with whatever product i chose to massage with, then thoroughly clean and dry the area prior to applying silicone, removing the massage product. Scar management on arms is already shaping up to be quite a time investment!!!

If anyone knows the answer to this.....?

I am 13 days post op as of TODAY, i was wondering when am I "out of the woods" for superficial necrosis or Wound dehiscence?

the only other complication I can think of is "spitting stitches" that cause a wound to reopen - when is one "out of the woods" for this one? Is that more like a six month window?

Darn it...forgot to get pics today!

Soooo....brachio is healing VERY WELL! My surgeon is calling it a "J" brachioplasty by the way....the part that extends onto my back and goes under the breast to correct loose back skin. I meant to get pics today, but hubby was tired after shower, so just put the silicone tape on both arms and the compression sleeves. I tried the Mepitac silicone tape and I can say without reservation that it DOES HELP. I have seen scar improvement in the last 36 hours! AND it is staying on no problem....even in the crook where my back and arm meet.

The only literal and figurative complication may be an elbow pucker.....doc says he rarely gets these on his brachios, so unsure if I can massage it out or will eventually need a minor revision.....honestly not too worried about it either way. Neither hand is swollen tonight so VERY grateful for that! Will take pics next week of brachio and post I promise! Also with MUCH better lighting! Headed home to Atlanta on Friday....cannot WAIT to get home to my own bed, my own kitchen, and my Tivo!

Oh....the answer on potential complications....

I am out of the woods for fat necrosis..... I am not out of the woods for dehiscence as it happens between the 2 to 6 week mark and I am just now coming into that window.

Apologies for the lack of updates!

My "main" review is on the Body Lift forum, so if you want to hear about entire journey, it is posted here: http://www.realself.com/review/san-antonio-tx-body-lift-dr-fisher-post-massive-wl-specialist-excellent

Soooo....arms are healing A-OK. Range of Motion is completely awesome. My arms are waaay more usable that what i expected at every stage during healing. I am not feeling the need to "baby" them in the slightest. I have had no healing complications whatsoever on the arms.

Scars are seemingly "on track" to be thin and white, blending with the rest of me (think "Casper"). I think one arm (righty) may be 1/2" larger than the other (may result in minor revision) but it could be unresolved swelling so i am withholding the final call on this. Even if true, this is common enough with us post MWL folks - there is a lot of excess skin to navigate for the surgeon. More was removed from the right arm than the left, and the right one, I think, despite the PS taking this into account is still slightly larger. I love the contours so far. I am pretty "sold" on the posterior (as opposed to interior) incision placement based on my relatively effortless healing on the arms.

I am still wearing arm compression. Solidea arm sleeves have been my standout favorite. I am hoping it will provide good skin re-adhesion.

As for scar treatment I am *trying* to do 10 minutes of fairly aggressive self-massage every/every other day using aloe vera, but you have to rewash arms prior to reapplication of silicone treatments....so it is quite a high maintenance routine to remove strips + biocorneum, wash strips, massage arms, wash ME, reapply strips, reappy compression.....just typing it all makes me tired.

Speaking of silicone treatments, I am using mepitac tape on the arms, with a 3" application of Biocorneum at the elbow area. Highly recommend the mepitac as one of the cheapest silicone treatments. I don't know for sure, but i would suspect "silicone is silicone" so as long as it is coated with pure silicone it should be doing its job regardless of price. You can wash and reapply the strips maybe 6-8 times....i may have gotten more "wear" from the original set, but i am on my second set of mepitac strips now.

I am unsure which treatment you get more "mileage" from - self massage or silicone?

My ad-hoc observation, for the one day and night i didn't wear my silicone, is that my arms scars were seemingly quite tight to the point of being slightly painful the next morning when i raised my arms above my head. This suggest the silicone is doing its "job" in keeping the scars soft and pliable.

My arms still have that lumpy/bumpy pie-crust look a little, but it is getting better.

Arm puckers - completely resolved!

8 week pics + Update on Arms

Apologies for the timely lack of updates - please also see my main review on the body lift forum. But this is for my ARMS - my incredibly small well shaped ARMS! The absolutely **amazing** thing is that I have had no healing complications whatsoever on my arms - I was able to use them pretty quickly and have always quite functional! They have been so easy compared to some of the other stories I have read.

Returned to work at my client site this past week, which for me means bi-weekly plane rides, hoisting bags into an overhead bin, walking through airports with luggage, and also through the streets of Philadelphia (we don’t have rental cars - all transportation is planes, trains or bipedal!) All of that went wonderful…no issues!

I have noticed a couple of the scars are widening just a tiny bit on my right in two places: Just above the elbow and a little on the side adjacent to my breast. Two week ago I was exercising without the silicone tape on…which in addition to being a silicone treatment is also just “tape” which distributes tension away from the delicate scar and onto the surrounding skin…prior to silicone, PS were recommending just plain ‘ol paper tape for just this action. So this week, I wore the silicone tape (and arm compression unless sleeping) unless I was showering or massaging the scars. I may not be able to control all aspects of the scarring, but I will “go down” trying! Other than that, loving having small arms (I know everyone says this ;-) ) - cannot wait to feel comfortable in short sleeves or even (dare I say it?) **sleeveless**!

Almost forgot the **bonus** corrections....

The back skin! This has been the largest "bonus" feature of my brachio as going in, I didn't fully comprehend how much back correction would take place (and i really was *not* considering a full bra line UBL - just didn't think it was worth it for the scar) - even the breasts are sitting in a much better place than they were before. OK enough gushing for one night! ;-O

Arm Lift Update - 15 Weeks Post Op + Pics!

Hi everyone - apologies it has been **forever** since I have updated my reviews. This review is a bit of a "satellite" review to my LBL review - you can go here if you want more pics and a bit more of my "story" : http://www.realself.com/review/san-antonio-tx-body-lift-dr-fisher-post-massive-wl-specialist-excellent


Soooo Arms! Doing really well....scars healing nicely...

Arms are still a bit uneven - left side has some "droop" towards the elbow where the lipo was done (assume this was the culprit) - and the right is still 1/2" larger near the top - the right started out a good bit larger, and the good doc did his best to even these out....may get small revisions to these...(still adore my doc though...no grousing from me on this point) - and have i mentioned that i **love** the back correction?? Honestly I am still thrilled to pieces with **all** the work!

Surgery Tomorrow including minor arm revisions.....

Here is the laundry list of what I am having done, and it includes minor revisions to my arms…lower left near elbow and upper right near armpit - see pics!

Even with the minor revisions I am getting tomorrow I am ***MORE*** than thrilled with my “J” brachio. I have been rockin’ maxi dresses and racer back tanks all summer…..WHAAAAAT??? That is such a freaking FIRST for me. It is amazing and makes me feel amazing. I am finding I am not shy about the scars - they get lighter all the time anyway - I am just THRILLED to have properly shaped arms.

On July 29th, (yes Tomorrow!) I am having several different procedures performed in one 10 hour operative setting:
• Thigh Lift (Long + Spiral + Calf Skin excision)
• BA/BL - Anchor Incision
• Bletheroplasty (Eye-Lift) - upper and lower lids
• Minor revisions to Arm lift (little sag on the left near the elbow, little more skin off of the right)
• May have one hip re-pulled a bit tighter - lateral thigh (this tissue naturally relaxes after LBL, especially with the compromised post massive weigh loss skin quality!)


Also posted a thigh lift review that should be published tomorrow …
Dr. Peter Fisher

Absolutely adore Dr. Fisher. Completely who I was looking for in a MWL body contouring specialist. If you think any run-of-the-mill PS knows how to do extended brachio corrections like mine, think again....he is amazing and a pleasure to work with! This actually corrected all of my loose back skin *without* a bra line incision.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
Was this review helpful? 2 others found this helpful

Comments (31)

Sort by

My surgeon also recommended the posterior approach. I am really worried about people standing behind me and seeing the scars. I was glad to read that you were "sold" on the approach. Was wondering if you work - with regards to your arms - how soon would you have felt like going back?
  • Reply
I am so very SOLD on the approach and so is my surgeon (who used to do interior placements and didnt like his results) - it is brilliant IMHO...i had the easiest healing EVER and barely any restrictions...arms were so very functional right away...scarring is good too!
  • Reply
Do you have any photos here??
  • Reply
I saw them -- I should look before I type!!
  • Reply
Your arms are looking fantastic!! The scars are healing up so beautifully, Congratulations! I know you've got to be thrilled!!!
  • Reply
@Thankful...thanks so much! I am quite happy with the results! ;-)
  • Reply
Thank you for posting the update - I had my arms done two weeks ago and my PS said that sometimes the dominant arm ends up a little larger due to his making it proportional during surgery or from swelling more due to use during recovery and it will take six months before they can be compared. Your issue free healing gives me hope that I won't end up with an incision opening.
  • Reply
I had puckering down by the elbows on both arms. The left arm is a lot better but the right arm still has some puckering with a thicker scar than the rest of the arm. I think I will need a little re-do in that area when I go back for another procedure. I took a picture of it several months back and since the time I posted the pic it has gotten some what better....
  • Reply
I think having the posterior incision is better for the thickening scar although it is more visible. I still have my armpits too! The incision actually goes behind the armpits area. I have seen the same on other brachios with the puckering and widening towards the elbow area.
  • Reply
First i need to congratulate you... 200lbs!!!!! Woot ! Woot!!! Thank goodness for bariatric surgery. You are so early in your.recovery how in the world are you even typing. You are looking great btw.
  • Reply
@ better liz - awww thanks! I actually have pretty good use of my arms - not anything too heavy of course, but i was expecting less than what i have actually. Still cannot reach my toes but i think that is the back incision!
  • Reply
From my own experience w/ TT and Brachio.. Stitches spit out between 1-3 months post op and then by 4 months it had stopped, a small area on my arm opened up due to a few stitches coming to the surface, and it scared a little wider then the rest of the incision, not so wide that it would have to be revised I don't think. I didn't have as many spit out of the arm. I've also noticed that my arm scars have gone through way more changes then the TT scar did (and my PS had mentioned that before hand so I was expecting it).. I'm thinking of you! I'm not sure about the Necrosis.. "My Bariatric life" has gone through that and it looks like it's healing beautifully.
  • Reply
thanks Thankful!! Did you have any puckering or widening at the part of the incision towards the elbow? mine is looking sort of puckered towards the end there....?
  • Reply
I had steri strips all the way down the incision, so I really didn't see anything until they fell off. My skin is a little puckered around the elbows but it takes a while for swelling/ etc to smooth out so I not worried. Your skin just goes through so many changes... For sure talk to your PS about your concerns, he sounds like a wonderful PS and he's done a beautiful job on you
  • Reply
I'm doing well. She treated my necrosis in her office last week. She expects it to heal more each week. I had so much skin to remove, the blood supply was compromised at the suture line. But I'm healing well.
  • Reply
Awwww thanks! Patience is the hardest part of this I think!
  • Reply
I agree! I'm heading out to get laser on my incisions tomorrow.. I'll let you know how it goes. YOU are doing fantastic!!
  • Reply
Mine are puckered, too, and I am 3-mos post op. I was told it goes away but I never asked how long it would take. I thought by now it would have resolved.
  • Reply
what i mean is the skin above my elbow is puckered.
  • Reply
gotcha! i met a couple of folks that were a year+ out that had the pucker...both said that the original surgeons offered the revision to fix, but both were not bothered enough by it to go back to get it fixed.... I am hoping the silicone + scar massage + time will take care of. I just feel a little freaky/Frankenstein right now with the way my arms look....i think i am just at that part of the process though! I am optimistic i won't *always* feel like this!
  • Reply
Me too, the skin is a little puckered at the elbow, but it is slowly smoothing out. Early on one of my arms was very swollen at the elbow area, it looked a little misshapen.. that has completely gone away (4 months out almost),
  • Reply
Wow. Very interesting the drawings on you. How is the pain factor? I shall go look at your other thread and get up to speed with how your doing x
  • Reply
@ Jules - really very little pain! Just uncomfy from time to time!
  • Reply
Good looking scars. I'm three weeks out today from upper body lift and brachioplasty. I have some healing issues on my back but I'm ok. Thanks for sharing!
  • Reply
Thanks for commenting! I actually got a lot of back correction too...I am so hoping it will heal well!
  • Reply