15 Wks Post-op Brachioplasty and my Arms Are Still Hanging. What Can I Do? (photo)

Needless to say, you should have no bat wings after a brachioplasty.  The scars after a brachioplasty can sometimes be very unattractive.  The tricks to getting a thinner, finer scar in a brachioplasty require understanding of good wound healing techniques:  use dissolvable sutures that last at least 6 months in the deeper tissue to take the tension off the superficial repair; put in subcuticular sutures with buried knots; close the skin with a running intradermal, usually barbed, dissolvable sutures; and, if needed, a very few permanent sutures that are removed after 5 days.  As I always say, surgery doesn't end at surgery, and therefore, tape the wound with proxistrips (a J & J product) for at 3 - 4 months after surgery.  The improvement will be impressive. 

As far as your residual bat wings, go back and discuss this with your plastic surgeon.  He or she will be the best person to explain what is going on now.  If you are still dissatisfied, seek out a second opinion from a Board Certified Plastic Surgeon experienced in body lifting procedures.

do happen.  That is why it is imperative you understand your doctor's revision policy as most doctors have one.  This covers the issues of who pays and what is covered.  You result does not meet perfection but it must be an improvement over where you started from.  Scarring from brachioplasty is well known and the reason the posterior scar technique has evolved and is favored by many understanding the scar is visible from behind with your arms at your sides.  To get a better result, you will have to have more surgery.  You should discuss this with your original surgeon first and if you cannot resolve your issues, find a doctor that works with you better.

You have two of the most common limitations and perhaps complications of brachioplasty. One is inadequate excision leading to a poor result and residual skin. The other is a poor scar. As our experience has grown we have realized that fairly aggressive excision is the rule. Otherwise you will have residual skin. Also the position of the scar and the post-operative care of the scar determines the best possible outcome for the scar. Having said that, brachioplasty scar is at risk of thickening and widening despite best of practices. It looks like you need a revision.

Although it is not possible to give you precise advise without direct examination, based on your description you may benefit from further arm lifting surgery. I would suggest that you continue to do as you are doing with the weight loss and then seek consultation with well experienced board-certified plastic surgeons who can demonstrate significant experience helping patients in your situation. There should be no reason you are left with “bat wings” after arm lifting surgery. Hopefully, your current scars may be improved upon with the revisionary armlifting surgery.

Best wishes.

There are different approaches to arm lift scar. The best location of the scar is below the arm so it is not visible. You may need a revision some time down the road. At that point, the scar can be repositioned in an un-noticeable location.

It's not unusual for patients who undergo arm lift surgery to be concerned about the appearance of their arms in the immediate post-operative period. The majority of these concerns disappear as swelling and inflammation resolve. This usually occurs in about three months.

Although, scarring will continue to improve for up to a year following surgery, arm contour and symmetry won't significantly change after the first three months of recovery. For this reason, residual bat wings 15 weeks after surgery will probably require a surgical revision.

Under these circumstances, it's appropriate to consult your plastic surgeon to discuss correction of this problem. If you're not satisfied with his response, it's appropriate to obtain a second opinion.

A preop photo for comparison would be helpful.But what you have now is what you have now, and  I can certainly see the issues that are causing your dissatisfaction. 

The scar itself look about average. These are the most difficult scars for plastic surgeons to deal with because they are not hidden, and they are not placed in an area or direction that can be expected to form nice scars. That said, these typically continue to improve over the course of a year--less red, narrower, less raised.

It does appear that the amount of resection was not sufficient to get enough of a correction. At some time in the future, hopefully after you achieve your desired weight loss, a secondary procedure should be considered. Speak with your surgeon about timing. Most offices have a revision financial  policy that you may have received in your pre-op packet. 

Thanks for your question, best wishes. 

I would agree with the above doctor answers. Two main problems are discussed.

1. Poor scar healing - Most brachialplasty scars are visible in a cut-off top.  Also it appears you have a widened, reddened hypertrophic scar.  This should improve and flatten with time, however may require revisional procedures.

2. Excess skin - With your continued weight loss the excess skin will most likely increase. A revisional procedure would be able to address this issue.