Which Lipo Procedure Would Fix Fat On The Axillary Area and Upper Arm Liposuction on Active Female?

I'm a 29 year old active female interested in getting liposuction on the axillary area and upper arms. I'm very active (5'3 and 120 lbs) but cannot get definition in my arms and I have unsightly fat that hangs over all of my strapless clothing. I'm confused by the different liposuction procedures - smartlipo, vaser, tumescent, PAL, UAL, etc. Can someone please help clarify the differences, or perhaps recommend one? Is the recovery period different for each of these procedures?

Doctor Answers 12

Liposuction options for upper arm, axilla

Liposuction is an option for the reduction of fat of the upper arm and axilla if skin elasticity is adequate.  It is very easy to get confused by all of the marketing of the different liposuction companies and clinics.  Liposuction is best suited for patients that have good skin elasticity and their fat deposits are small, localized and remain after diet and exercise.  Plastic surgeons have extensive experience in liposuction and are specialists in this area of surgery.  Laser assisted liposuction (Smartlipo) and ultrasound assisted liposuction (UAL) were marketed as specialized technologies that would tighten the skin after the fat is removed.  This tightening effect appears to be very minimal as reported by experienced plastic surgeons at the national conferences. 

Liposuction of the arms and the axilla is more involved because of the delicate, thin skin present in this area.  The experience of your surgeon is critical in this anatomic location.  Liposuction with the tumescent technique is a very reliable procedure.


San Antonio Plastic Surgeon
4.9 out of 5 stars 20 reviews

Upper arms and axillary folds can be contoured with Liposuction.

Liposuction works to contour areas that are more bulgy than we would like.  It is best used in a patient such as yourself who is in good physical shape and at a healthy body weight, but who has small fat pockets in unwanted places.  The fact that you are aware of the names smartlipo, vaser, tumescent, PAL, UAL demonstrates how effective these companies are in their direct to consumer marketing campaigns.  And because your awareness is based on their marketing, it is no wonder you are confused.  Basically, liposuction is the removal of fat from the area between the skin and the deeper muscle layers.  Cannulas are used to suck this fat out through very small incisions.  The ultimate result you achieve depends on how well your skin tightens after the procedure, on how much fat was removed and on the finesse of your surgeon. 

Liposuction is hard work for the surgeon, and multiple different energy modalities have been developed to help break up the fat, and the fibrous connections between the skin and muscle, and so make the surgeon's work less strenous.  These include, ultrasound energy (UAL, VASER) and more recently, laser (Smartlipo) energy.  Power assisted lipectomy or PAL uses a handpiece that vibrates to help the surgeon dissect.  Blood loss during the procedure is usually decreased by the use of what is called "tumescent solution."  This is basically salt water with some anesthetic and epinephrine.  This solution is used with all liposuction modalities.  It is the use of this solution that decreases bleeding and therefore decreases bruising, probably not the liposuction modality.

The biggest problem in trying to get good, smooth liposuction results is that the patient's skin often does not tighten enough and loose or dimply skin compromises the result.  Toward that end, laser companies have worked to make a laser that tightens skin.  Ultrasound energy has proven not to be of significant benefit and now laser is probably not that much different, contrary to the claims of the equipment manufacturers and their marketing teams.

So, in my opinion, modality is not really the key ingredient in good outcome.  A good result is obtained when the skin is of good quality, the patient is in good shape, the procedure is being done for "sculpting" rather than for weight loss, and the surgeon is skilled.  Make sure you see a surgeon certified by the American Board of Plastic Surgery.  Try not to be confused by the misleading advertising campaigns out there.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 54 reviews

Liposuction is more important than the type of energy used

The sculpting and removal component of liposuction is much more important than if there is power assistance, laser assistance, ultrasonic energy, water jet propulsion, etc.  How the fat is removed and how the residual fat is allowed to stay behind in contour is most important.  Different technologies have evolved over time to help protect the surgeon's arm from fatigue.  Additional energies, especially those that produce heat to liquify the fat, might provide greater risk of complications, especially if the surgeon does not take care to keep the cannula at a certain depth and to monitor the skin temperature and to keep the cannula moving because holding the cannula still could heat up the overlying tissues excessively and produce scarring.

You need an experienced liposuction surgeon who has a very good reputation amongst physician colleagues and who has good recommendations from patients.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

What liposuction does and doesn't do

Of the responses I see here, I agree with Dr. Yuan. Liposuction is the removal of fat cells in the subcutaneous layer from an inherited excess to the minimal amount normal without cutting or altering surrounding structures. It is not a weight loss procedure. It is not a "sculpting mechanism". Properly done it does nothing to the skin and doesn't add or subtract elasticity or require adequate skin elasticity. Liposuction is the general term for the technique and does what it does but doesn't do a lot we might like it to do even with high-tech equipment or fancy names. "Tumescent" is the term for the local anesthetic technique to prepare for the liposuction including avoiding blood loss and has nothing to do with the actual liposuction. The other terms are modalities of accomplishing liposuction and are mostly advertising hype. I agree that the answer is in the surgeon's skill in analyzing the patient's situation and carrying out liposuction properly for properly selected patients and areas. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Lipo choices

I always tell patients that it is not the wand but the magician waving the wand that creates all the magic. You can get great results with all forms of liposuction.  Tumescent is usually the safest.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Liposuction techniques for Upper Arms and Axilla

I agree with my colleagues regarding upper arm and axilla liposuction, the skill of the surgeon is much more important than the type of technology or machine which is employed.  Adding an energy source to the liposuction such as ultrasound (UAL/VASER) or laser (SmartLipo) or power assisted lipo (PAL) can aide the surgeon in performing the liposuction, but each can carry additional risks as well.  In the upper arm the most significant issue is usually skin tone or elasticity.  If the skin tone is poor or there is a excess amount of skin, liposuction may not be the best treatment and an arm lift or brachioplasty may need to be considered.  Before having this surgery I would suggest you be evaluated by two plastic surgeons who perform both liposuction and brachioplasty surgery to determine what procedure would be right for you.  Best of luck.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

Liposuction techniques

Liposuction, no matter what machine or technique is used, is simply a method of, more or less, selectively removing fat cells. All methods do this. The main problems are not with how to remove the fat but in which patients, under what circumstances, and in what controlled and predictable manner. None of the techniques protect against poor patient selection. And none of them override operator-dependent skill. The best results are achieved by surgeons who select their patients carefully and are judicious in their application of whatever technique or machine they are using.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Liposuction for underarm

Dear Smallfixes,

As stated by my colleagues below the technique of the surgeon is the most important part regarding your results after a liposuction procedure.  Liposuction is a sculpting mechanism and requires a delicate touch and the surgeons full attention.  The type of liposuction performed(ultrasound, mechanical, laser) doesn't matter as long as the surgeon performing the procedure is experienced.  All of your studies show that despite the liposuction mechanism used (laser, ultrasound, mechanical) all the results are the same in experienced hands. 

Ernesto Hayn, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 2 reviews

Liposuction for the upper arms

The upper arm is a difficult area for liposuction to handle, and we prefer tumescent liposuction with a small suction cannula to avoid any dents. Laser or ultrasonic liposuction in this delicate area may be prone to problems for some. The surgeon's skill and judgment is the most important factor of all, not the particular tool used.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Liposuction Techniques

Hello Smallfixes,

It's not the machine, its the doctor!!!!!!

The most important point we've obtained from good clinical research, that gets drowned out by the marketing noise, is that the various liposuction techniques only help the doctor, they do not have an influence on the result.  Vaser, UAL, PAL, or laser devices do not produce a different or better result than standard liposuction and all of them rely on standard liposuction to get the job done.  Contrary to advertisements, none shrink skin more effectively than standard liposuction.  Recovery times are similar.

Find a surgeon certified by the American Board of Plastic Surgery or the American Board of Dermatology with a great reputation and look at his results.  That's the choice you should be making!

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.