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.

First you should do weight training to strengthen the muscles of the arms increasing the circumference of the area to stretch the skin at a surplus. After 3-6 months , I suggest you to lose weight with aerobic training(running, spinning, f.e.) and not carry more weight in his arms, coming close to your ideal weight. Thus, one can resect scars and perform refinement . Another solution is the placement of expanders for 2 months , to stretch the skin region with expansions 2-3 times per week, and at the end removed the expander and the scar is refined.
The scar also has significant improvement with CO2 laser.
Regards, Dr. Chris Willenshofer

I am sorry that you are having concerns about your procedure
and thanks for sharing your question. I can appreciate your
concern and agree with your assessment.



Revision at this point will become more
invasive than the desired outcome. You may want to wait. Allow the scars to
mature. Maybe consider scar revision after 1 year of your latest surgery.
Maybe, Smartlipo triplex may help with the excess fat and tightening in the
future.



Wishing you the best in your journey

Scar revision is the process of removing the scar and replacing it with a new longer scar while taking out additional tissue.  In this case, removing what appears to be your Z plasty scars as well as the desire to reposition your "linear" scar more anteriorly would sacrifice too much additional skin.  This would create an abnormal arm contour that would be far more dissatisfying.  I would agree that a in person consultation would give you a more accurate assessment. 

After Brachioplasty and revision and what seems multiple Z-plasties. The scar is too posterior, can be seen from the back view. The arm is possibly still swollen and may be lots of fat, makes doing any thing else more difficult. In general time would be on your side. Do not hurry to do another revision. Loose the weight. Mean while get multiple in person consultations. With loss of weight, resolution of swelling and time things will get more clear. Then one needs to think of the best revision surgery. it could be a combination of all the above plus liposuction and revision of the brachioplasty

In this presented case of 2 x brachioplasty I recommend ONLY in person opinions. The excellent posted photos do not equal in person views....