Hello, Thank you for your question regarding the likelihood of achieving your desired outcome with just arm liposuction and skin tightening. I appreciate the history and pictures you've provided. The answer partially depends on your definition of the desired outcome. Most patients aim for thin arms without irregularities or scarring. In your case, I believe the optimal choice would be a formal arm lift (brachioplasty) or arm reduction. This procedure involves arm liposuction and the removal of excess hanging skin, ensuring thinner arms without loose skin. However, it does involve a scar. Alternatively, you can opt for arm liposuction with skin tightening alone, but this method does not guarantee that the skin will adequately retract, and it is scar-free. If you are willing to accept the potential risk of loose hanging skin, then you might consider proceeding with liposuction. But, if you prefer to avoid that risk, I would recommend a formal arm lift, which most plastic surgeons agree provides the best results. If you decide to undergo liposuction, the consensus among plastic surgeons is that the VASER is the best machine for skin tightening. Arm liposuction is typically done under general anesthesia and takes about 2 to 3 hours. I hope this answers your question regarding whether arm liposuction and skin tightening alone will help you achieve your desired outcome. Good luck with your decision. Sincerely, Dr. Katzen