Thank you for your question about what to do with your arms. Let's analyze your pictures. You have excess skin and fat from the armpit to the elbow. Therefore you have two unbalanced organ systems. If you address one, the other will not be correct. Since you have excess skin and fat and only undergo arm liposuction, you will not obtain optimal results. It would help if you decided whether you want to get rid of your excess arm skin and fat permanently or live with a partial result obtained with arm liposuction. Almost all my patients opt for an arm lift reduction or brachioplasty. This is what I would suggest for you. My concern is that if you just have arm liposuction, whether that's air sculpting, smart lipo, laser lipo, or even VASER liposuction at the end of the procedure, you WILL have hanging arm skin I think you will be even more upset with the appearance of your arms if you just undergo liposuction. Therefore I would highly suggest a formal brachioplasty. During brachioplasty, liposuction is performed, and an incision is made from the armpit to the elbow. A large elliptical fat area is removed from the arm to the elbow. Sometimes the incision is extended in the armpit and down the side of the chest to remove excess skin and fat that hangs over the bra line. The brachioplasty takes about 3-4 hours to complete based on the complexity of your arm. I do not use drains. Usually, you can return to work 1-2 weeks after the procedure, depending on your healing and type of work. I hope this helps answer your question on what to do with your arms. In conclusion, I highly suggest you undergo a formal brachioplasty which combines arm liposuction and an incision from the armpit to the elbow. I specialize in arm lifts. I hope that I have answered your questions regarding the arm reduction. If you have any more questions regarding the arm lift, arm reduction, brachioplasty or arm crease fat grafting, please contact my office. Since a brachioplasty or arm lift surgery is a difficult procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing these types of arm lifts. Do your research. Make sure your chosen plastic surgeon has performed at least 100 arm lifts. Make sure they have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf.