Thank you for your question regarding alternatives for the treatments of the arms. Based on your arm picture you have a type 4 arm with excess arm skin and fat to the elbow. Therefore, you need fat arm fat an arm skin removed. Arm liposuction alone will not remove the arm skin. Therefore, you need a formal arm lift (brachioplasty) or arm reduction. This would include arm liposuction and an incision for the arm pit to the elbow. I would ask you why you would not consider surgery. The arm lift is performed under general anesthesia. The procedure takes approximately 3 hours. You will have some mild pain not extreme pain. Your results will be life-changing and extremely dramatic. The arm lift scar is a trade-off for getting rid of the excess arm skin and fat. However, by far, the majority of my patients would trade the excess arm skin and fat for an arm scar any day. Very few of my arm lift patients need arm scar revision. However, the arm lift revision can be done in the office either with surgical revision or with a laser. I would not waste your money on anything else, but an arm lift. CoolSculpting and Thermage will do nothing for your arms. Save your money. I hope I have answered your questions about your arms. If you have any more questions regarding the arm lift, please call my office. Sincerely, Dr. Katzen