What is this crease in my upper arm and how can it be fixed? (Photos)

Question

I am a 22 year old female. I have been overweight since I was an adolescent and at my heaviest I weighed 220lb. Now I am 180lb. However, I didn’t always have this crease, it wasn’t until I was around 15/16 that I noticed it. Im wondering what could’ve happened. I do have PCOS and Ehlers Danlos. Also what procedures could correct this?

J. Timothy Katzen, MD, FACS · Answer

Hi Fabulous682377, . Thank you for your question regarding what this crease in my upper arm is and how it can be fixed. Thank you for your history and your pictures. First, we should analyze your pictures to determine the best procedures. According to your pictures, you have cutis plica (excess skin) and dermatochalasis (loose skin) without stretch marks (striae). Furthermore, you have arm lipodystrophy (excess fat). Your loose skin, excess skin, and fat are located in the proximal or inner third of the upper arm. Since you did not have this condition until you were 15/16, this is not a congenital band. Most plastic surgeons would agree that this area appears this way due to the excess skin and fat in the upper inner portion of your arm. Because you have a significant amount of excess skin on your arms, liposuction alone is unlikely to provide the best result. In addition to removing fat, surgical removal of the proximal excess arm skin is recommended.

There are several types of arm lift (brachioplasty) procedures, and the most appropriate option depends on the amount and location of the excess skin. The main types include crescent (mini) brachioplasty, modified longitudinal brachioplasty, T-incision brachioplasty, longitudinal brachioplasty with the scar placed in the bicipital groove (the inner arm between the biceps and triceps), longitudinal brachioplasty with the scar placed along the back of the arm (over the triceps area), and an extended upper and lower brachioplasty, in which the incision extends from the armpit down toward the wrist. You would do best with the modified longitudinal brachioplasty. During your arm surgery, upper arm liposuction would be performed. Then an incision would be made from the armpit to about 2 cm past your "arm crease/fold"; this surgical technique would eliminate this fold by removing the excess arm fat and skin around it. If you just excise the arm fold, you are still left with the proximal excess arm skin and fat. Therefore, you "need" the arm skin and fat removed, not just the arm crease. Since an arm lift can be a challenging surgery, please seek an experienced, board-certified plastic surgeon with significant experience performing these types of lifts. Do your research. Make sure they have performed at least 150 arm-lift procedures. 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. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS, FASBPS (Plastic Surgeon, President of  the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery,  and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Yily De Los Santos, MD · Answer

A crease or indentation in the upper arm can develop for several reasons, including natural variations in anatomy, localized fat loss, skin laxity, previous weight fluctuations, aging changes, or scar tissue from prior procedures or injections.

The best treatment depends on the cause of the crease. If it is related to volume loss, fat grafting may help soften the indentation and create a smoother contour. If skin laxity is contributing to the appearance, skin-tightening treatments or, in more significant cases, an arm lift may be considered. When scar tissue is involved, treatments may focus on releasing the tethered tissue and restoring a more even contour.

A physical examination is essential because the appearance alone does not always reveal the underlying cause. Once the source of the indentation is identified, a personalized treatment plan can be developed to improve the arm’s shape and symmetry.

Yasemin Aydinli, MD · Answer

Thank you for the detailed history, and congratulations on going from 220 to 180 lb. A crease or banding across the upper arm that develops after significant weight changes is usually related to how the skin, fat and underlying fascia redistribute. As the skin envelope loses elasticity it can form folds, and your connective-tissue history is very relevant here: Ehlers-Danlos affects collagen and skin elasticity, and PCOS can influence fat distribution &mdash; both of which can contribute to a crease appearing in adolescence and persisting.
Without examining you it's hard to say whether what you see is primarily loose skin, a fat pocket, a fascial band, or a combination, and that distinction determines treatment. In someone with Ehlers-Danlos this matters even more, because EDS affects wound healing and scarring and changes the risk profile of any surgery.
Depending on the findings, options range from non-surgical skin-tightening for mild laxity, to liposuction if there is a localized fat pocket, to an arm lift (brachioplasty) when there is true excess skin &mdash; though in EDS a lift is approached cautiously, with careful scar planning and counseling about healing. I'd strongly recommend an in-person evaluation, ideally coordinated with awareness of your EDS, so we can identify exactly what is causing the crease and choose the safest, most effective approach for you.

Manuel Diaz, MD · Answer

Hello. In your case, we're seeing excess skin and laxity on the inner side of your arm, something that often appears after significant weight changes and can also be more pronounced in patients with PCOS and Ehlers-Danlos syndrome, where the collagen quality is different and the skin tends to sag more easily.From what we can see, you are a candidate for an arm lift (brachioplasty). This procedure is the one that truly allows for the effective correction of that fold, as it removes excess skin and redefines the arm's contour. In these cases, non-surgical treatments or fat grafting don't resolve the underlying problem because there's not just a loss of volume, but also excess skin.The goal of an arm lift is not only aesthetic but also functional in many cases, as it improves the arm's shape in a more harmonious and stable way over time.

What is this crease in my upper arm and how can it be fixed? (Photos)

Answers (4)

More Arm Lift Questions

Can a breast enhancement and arm lift be done at same time?

What procedures can be used to treat loose arm skin? (Photo)

Is an arm lift right for armpit folds? (Photos)

57 pound weight loss - is an arm lift the right procedure for bat wings? (Photos)

Compression after brachioplasty -no lipo - is two weeks of compression post op enough? (Photos)

How can I fix fibrosis 2 years post arm lipo? (Photo)

WE SEND PRETTY
EMAILS