Arm Lift revision needed - is improvement possible? (Photo)

Thank you for your arm history and arm reduction pictures. I am sorry for your misfortune. However, I believe there is hope. I would suggest arm revision. During this arm revision, to decrease the bulk and remaining fat in your arm, arm liposuction must be performed. This should reduce excess arm fat. During the same surgery, excess arm skin must be removed. I would anticipate the entire brachioplasty and Z scar could be excised directly. The Z-plasty scar could be converted into a linear scar from the elbow to the armpit. At the elbow, I would curve the incision to remove excess elbow skin and fat. This new brachioplasty incision will curve gently around the elbow to remove the elbow dog ear. You also included pictures of your torso. I would suggest a torsoplasty. The torsoplasty incision would extend from the armpit to the top of your hip. This vertical torsoplasty would remove the excess skin and fat rolls on your torso or back. I hope this answers your question regarding arm lifts, arm reductions, brachioplasties, arm lift revisions, and torsoplasties. Good luck! If you have any more questions regarding your arm lift revision or torsoplasy, please contact my office. Sincerely, Dr. Katzen.

I am sorry to hear of and see your post-brachioplasty problems, even after revision. Now, 2 years post-revision, this is not going to get better as further time goes by, and trying to remove the unsatisfactory Z-plasty scars and tight circumferential bands will only make things worse.Scarring in the upper arms of many patients is quite bad, making any effort at scar revision, Z-plasty releases, W-plasty, or other "fancy" plastic surgical maneuvers designed to reduce scars, an exercise in futility and often more and worse scarring. Sort of what you accomplished with your second surgery, though we don't know how bad things looked before this last revision.Unfortunately, a more skilled surgeon now still has too little skin laxity to work with, so the previous surgeries and the resultant scars cannot be re-done without you first losing weight or developing more laxity. This is not a question of finding the "right" surgeon. Unfortunately for you, this poor outcome or surgical plan and results after two operations is about too little skin and too much residual scarring. I would recommend consulting with several ABPS-certified plastic surgeons to see what can be determined on direct examination, but I am fearful that a truthful surgeon will tell you much of what I have just described. Sorry. Good luck and best wishes! Dr. Tholen

From your photos I can see your concerns. It would be better to have an in person exam to determine why you have the banding and uneven appearance. 

Ideally, you would want improvement in both the contour of the arm, and the position and quality of the scar.  Unfortunately, this may be a challenge as you already have had two procedures removing skin and excess soft tissue.  It seems unlikely, in your current condition, that additional surgery could be performed removing the scar and closing the incision with acceptable tension to minimize wound healing problems and optimize scars.  A loose skin envelope would facilitate revision, and you could consider a staged approach.  First, you could reduce and contour the soft tissue of the arm.  This could be achieved potentially through a healthy lifestyle emphasizing diet and exercise, but likely will also require some intervention to more aggressively remove adipose tissue and sculpt the arm shape.  It is possible that this could be achieved through thoughtful liposuction, or possibly even cool sculpting (an exam would be necessary to determine if you are a candidate).  With fat reduction and a loose skin envelope, excision of the scar and additional skin may be able to be entertained.  I would recommend consultation with a Board Certified Plastic Surgeon with an expressed interest and significant experience in body contouring of the weight loss patient.  Good luck and don't give up hope!

I would recommend liposuction of the arms to contour the profile of the arms.  This can be followed by removal of excess skin and scar revision to give you an excellent result.  The scar is less of an issue in my opinion than the contour of your arms.Best of luck.