Hi PMI9697, Thank you for your question regarding whether you need laser lipo or an arm lift for the upper arm "Bat Wings." Thank you for your history and your pictures. First, we should analyze your pictures to determine the best procedures. From your pictures, you have upper arm cutis pleonasmus (excess skin) and dermatocholosis (loose skin) without stretch marks (stria). Also, You have Class 3 arms. That means you have excess skin and fat from the elbows to the armpit. Your best surgery would be a longitudinal brachioplasty. During a longitudinal brachioplasty, upper arm liposuction is performed. This will de-bulk the upper arm of a majority of the fat. Then, an incision is made from the armpit to the elbow. A large elliptical area of upper arm skin and fat is then removed. The eventual scar is between the biceps and the triceps. This is the best position for the arm lift or arm reduction scar. By placing the incision between the biceps and the triceps, the brachioplasty scar is hidden by your arms when you naturally hold your arms by your sides. Since you have excess arm skin, your arm skin will not bounce back, even if you use laser lipo, VASER lipo, or radiofrequency. Because you have a significant amount of arm skin, liposuction procedures alone are not optimal for your arms. You need a full longitudinal brachioplasty. I would not waste your money or time having arm liposuction. You need an arm lift. I hope this helps to answer your question regarding laser lipo or arm lift for your upper arm "bat wings." Since a brachioplasty or arm lift surgery is difficult, 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. Sincerely, Dr. Katzen, MD, MBA. (Plastic Surgeon, President of the American Society of Bariatric 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, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)