Arm lipo or arm lift after VSG? (Photo)

Question

I had gastric sleeve surgery about a year ago and I am considering having plastic surgery. I dont know if I qualify for arm lipo or arm lift. I dont want my arms to have loose skin but also dont want that long scar instead have the scar from the armpit. What do you suggest?

J. Timothy Katzen, MD, FACS · Answer

From your shared history and photos, my primary recommendation leans towards an arm lift. Given your significant weight loss post-VSG, your skin likely lacks the elasticity seen in individuals who haven't undergone such weight loss. For optimal results, a standard arm lift involving an incision from the armpit to the elbow seems the most suitable. However, if you have reservations about having a longer scar, a crescent or mini arm lift is a possible alternative. It's essential to note, though, that results from this might be less optimal than the standard procedure.
Sincerely, Dr. Katzen

Sean Younai, MD, FACS · Answer

people who have had weight loss surgery with significant weight loss usually have loose skin with poor elasticity. your pictures show that you do have loose skin which in my opinion as a body contouring plastic surgeon with many years of experience in post weight loss surgery would require an arm tuck or brachioplasty. obviously, nobody wants to have scars, but it is possible to hide the brachioplasty scar under the arm.

Harry T. Haramis, MD, FACS · Answer

I recommend Vaser ultrasound liposuction  or smart lipo to remove the fat and tighten the skin, usually avoiding the arm lift scars. Some patients may require further procedures after allowing for final healing time.An exam and consultation with a plastic surgeon who performs these procedures is recommended to discuss your options and expectations.

John J. Edney, MD · Answer

Judging by your photographs it appears that you would require a full brachioplasty (arm lift) in order to achieve your goals.  Although arm lift surgery in the past has been associated with unsightly scarring improvements have been made over the last several years resulting in more acceptable scar appearance.Brachioplasty or arm lift surgery is one of the most frequently requested body contouring procedures performed today.  The demand for this procedure has increased more than 800% since 1997.  This is the greatest percent change of any of the commonly performed cosmetic surgical procedures  Much of the increase in popularity is due to the growing number of patients who undergo massive weight loss.  In performing this procedure an incision is made on the inside of the arm extending from the elbow into the armpit.  Sometimes it is necessary to extend the incision further into the armpit and sometimes past it.  Utilizing this incision excess skin is removed and the wound is closed.  It is very important to position the scar properly so that it is concealed as much as possible.  A well-placed incision should result in a scar that is only visible when the arms are raised.  This operation is normally performed as an outpatient.  It is very important for the surgeon to discuss the resultant scar thoroughly with the patient preoperatively.  Very commonly this scar takes a longer time to undergo the full healing and maturation process.  Maturation refers to the process whereby the scar becomes less apparent.  Brachioplasty scars commonly take up to 2 years to fully mature.  Immediately after the operation compressive Ace wraps are placed from the fingers up to the armpit.  These can normally be removed within 24-48 hours postoperatively.  Elastic compression sleeves commonly worn by athletes can be purchased relatively inexpensively at any sporting good store.  Many patients wear these for up for up to 2 weeks postoperatively.  No vigorous activity or strenuous activity is recommended for 3 weeks postoperatively.  Complications following a well planned and well executed brachioplasty are uncommon.  They may include however wound infection or wound breakdown.  Is very important to follow the directions of your surgeon postoperatively to ensure the best years improvements have been made in the performance of brachioplasty (arm lift) leaving better scars than had been achieved in the past.  This includes more precise incision placement, better closure techniques and use of post operative scar reducing systems.  With greater attention to these details the benefits of arm lift surgery can be achieved with more acceptable scarring than in the past.

Christian N. Ford, MD · Answer

Thank you for your question and congratulations on your weight loss so far!  Please keep in mind that achieving your stable goal weight will enhance the overall aesthetic result of any procedure.  Based on your photo, liposuction alone may improve your contour, but is unlikely to provide optimal correction due to skin laxity.  A brachioplasty or arm lift would likely provide the best result.  As you mentioned, the tradeoff would be a longer scar.  I would advise you to seek out an experienced plastic surgeon for an in-person consultation to discuss your weight loss goal, your goals and expectations from surgery, answer all your questions and to help you determine the best course of action.  Best wishes!

Zachary Farris, MD, FACS · Answer

Thank you for your question.  Based on your photo which demonstrates excess skin and fat of the arm, an arm lift combined with liposuction would address these issues the best.  Considering the extent of skin excess, liposuction alone would only leave you with more sagging skin.  Unfortunately, there's no way around getting rid of this much excess and optimizing contour without leaving a scar.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Harold Bautista, MD, FACS · Answer

the biggest question is how elastic the skin of your upper arms are. If you cant bear the thought of a long upper arm scar a slimmer arm after some skin retraction provided by laser or ultrasonic assisted liposuction may provide an acceptable result. It is not an easy decision.

Peter Fisher, MD (retired) · Answer

Hello and thank you for your question. Congratulations on your weight loss. To obtain an excellent result you will need a combination of an arm lift and liposuction. You will need a long arm incision.  When placed appropriately  (nearly posterior ) the scar typically heals better and cannot be seen from the front whether your arms are up or down. Liposuction alone will give a small amount of improvement,  but I doubt that you would be happy with it.Peter Fisher M.D

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