Loose skin after arm lift - is a revision needed? (Photos)

Question

Had drainless arm lift after massive weight loss. looking at my arms I know the before and after is a drastic change, but I'm kind of unhappy at the amount of what looks like loose skin and jiggle in my arms Do you think a revision should be requested and more skin removed? I guess i expected less "hang" and a more defined bottom arm / arm pit area and not as much jiggle... would it be able to be cleaned up a bunch more with a revision?

J. Timothy Katzen, MD, FACS · Answer

Hello lavaroach, Thank you for your question regarding loose skin after arm lift and is an arm lift revision needed. Thank you for your history, pictures, and video. Analysis of your pictures reveals bilateral upper arm cutis pleonasmus (excess skin) and dermatocholosis (loose skin) with stretch marks (stria). Because of your excess arm skin, arm liposuction alone is not the best answer. Therefore, you need excision of arm skin. There are six types of arm lifts or brachioplasties: crescent or mini, modified longitudinal, T-incision, longitudinal with the scar in the bicipital groove, longitudinal with the scar along the triceps, and complete upper and lower brachioplasty with an incision from the armpit to the lateral wrist. From your pictures, you would do best longitudinal brachioplasty with the scar in the bicipital groove or a longitudinal with the scar along the triceps. Since your arm lift case is a revision, your prior arm scar needs to be considered. Therefore, an incision would be made about 2 mm above your prior brachioplasty scar. Tissue dissection would be made down the back of your arm towards the triceps region. The excess skin would then be mobilized anteriorly and removed. Usually, drains are not required for any brachioplasty. Arm lift surgery is best performed under general anesthesia and takes about 3 to 4 hours to complete. Allow yourself a 2-week recovery. You will need to wear your compression garment for about 6 weeks. I hope that I have answered your questions regarding the arm reduction, and specifically loose skin after arm lift and is an arm lift revision needed. 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 170 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.)

Gary M. Horndeski, MD · Answer

Yes, you need a revision with more skin removed.  Like you said you had skin removed but more needs to be removed again.

Best Wishes,

Gary Horndeski, M.D.

Mehmet Ozdemir, MD · Answer

It is completely normal to feel a bit let down when your post-surgical reality doesn't immediately match the tight aesthetic you envisioned, especially after the monumental effort of massive weight loss. From a clinical standpoint, your body has undergone significant trauma, and the jiggle you’re seeing is often a combination of residual edema (swelling) and the compromised elasticity of your skin. Because weight loss stretches the collagen and elastin fibers beyond their breaking point, the skin sometimes lacks the memory to shrink-wrap tightly around the new, smaller limb.At this stage, a revision would likely be premature; we generally require a 6 to 12-month stabilization period to allow the scar tissue to soften and the internal swelling to dissipate fully. Before jumping back into the operating room, I recommend focusing on hypertrophy of the triceps brachii ; increasing muscle volume is the most effective non-surgical way to fill that remaining laxity from the inside out. If, after a full year, there is still a clear hang that bothers you, a secondary revision&mdash;where we conservatively remove an additional wedge of skin&mdash;is a standard and safe procedure to refine the contour and achieve that more defined look you’re after.

Laura Roider, MD · Answer

@lavaroach Thank you for including photos with your question! I want to start by saying that anytime you have skin removed after massive weight loss it is possible to re-develop some laxity due to the quality of your skin. However, assuming your weight is stable since surgery it is reasonable to discuss with your surgeon a possible revision. There will always be some skin laxity in the arms to allow for movement but I agree that more skin could be removed.

Darryl J. Blinski, MD · Answer

Revision is indicated best to discuss with operative surgeon to see what fees would be incurred versus having a revision surgery by a different surgeon. Best of virtual consult with for more information. Expect fees for revision to be four to $5000 range.

Loose skin after arm lift - is a revision needed? (Photos)

Answers (5)

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