This story has been medically reviewed for accuracy by Bloomfield, MI board-certified plastic surgeon Dr. Ellen A. Janetzke on September 17, 2020.
Anyone who has ever stood in front of the mirror, lifted their arm to a 90-degree angle, and flapped in such a way that the underside jiggles back and forth is probably familiar with the term “bat wings.” Like all the other less-than-sexy zoomorphic nicknames out there—turkey neck, spider veins, camel toe, crow’s-feet—it doesn’t exactly inspire goodwill toward the body part. Doctors say the upper arm is one of the most commonly complained about areas among older people and those who have had dramatic shifts in weight; but the solution isn’t always as straightforward as simply liposuctioning the fat cells out, as many patients come in thinking.
For liposuction alone to deliver successful results, “you have to assume that a patient’s skin quality is good enough that it will shrink-wrap itself back down once the fat has been removed,” says Dr. Nelson Castillo, a board-certified plastic surgeon in Atlanta. That usually requires skin that is thick, young, and with minimal sun damage and stretch marks—not impossible but a tall order. For that reason, patients with a significant amount of fat in the posterior arm generally need an arm lift, also called a brachioplasty, in combination with liposuction. (And the reverse is true for patients who come in requesting an arm lift: “The arm lift technique I use involves a lot of liposuction first, says Dr. Elizabeth Lee, a board-certified plastic surgeon in Lafayette, California.)
An arm lift involves excising the excess, loose skin to eliminate the crepey appearance and recontour the area. It’s considered to be a low-risk surgery, but it has one major downside: a significant and very visible scar. “Whereas liposuction just involves port sites, which can be anywhere from two millimeters to six millimeters, an arm lift scar runs from the armpit all the way down to the inner corner of the elbow—or some people prefer to go straight down the middle of the back of the arm. It is the greatest negative and what keeps people from doing [it] more often,” says Dr. Castillo.
Dr. Lee adds, “In order for a patient to tolerate the long scar of the arm lift, they really must have a fair amount of deformity. It’s not for somebody who just doesn’t like a little bit of jiggly stuff and their arms are okay. What we do with those patients instead is a lot of CoolSculpting.”
However, the unfortunate reality is that it’s difficult to solve a true skin laxity issue without removing the skin. “There have been some improvements in radiofrequency tightening, but minimally invasive treatments typically give minimal changes. If you have loose skin, whether it’s on your breasts, stomach, or your arms, you have to cut it out,” says Dr. Castillo.
The recovery for arm liposuction alone can be uncomfortable for around 10 days, though most patients return to work earlier than that, but both doctors agree that arm lift recovery is more intense if your provider is recommending surgical drains (not all surgeons do). “With an arm lift, I wrap all my patients with an athletic wrap from the balls of their hands all the way up to their armpit and then switch them into a compression garment after the initial swelling phase has resolved and the drains are out,” says Dr. Castillo. The garments limit movement, so patients won’t be able to lift their arms above their shoulders for a few weeks. If you’re interested in the procedure, you might want to consider scheduling it for fall or winter, when it’ll be easier to hide the compression garments under layers.
The bottom line is that when it comes to the arms, “there are so many individualities to take into account—and [treatment needs] differ patient to patient,” says Dr. Lee. So it’s best to look for a board-certified provider who offers both surgical and nonsurgical solutions and can craft a personalized plan for you.
