Should I proceed with revision already after these initial results a year ago? (photo)

Question

I am due to have revision surgery next month with the same consultant. My concern is that he has stated he is only performing revision scar surgery on my legs, and despite my request for another attempt at a short scar arm lift now, he has stated he will only give me further liposuction to my elbows, this will only serve to make my arms even flabbier. Am I not in a position where I can be more assertive and insist on a revision arm lift given the poor initial results?

J. Timothy Katzen, MD, FACS · Answer

Hello ALENASA in Great Britain,
Thank you for your question about whether to proceed with revision surgeries following your initial procedures a year ago. Your decision to consider further interventions is significant, and it's crucial to make an informed choice based on your current results and goals.
Based on your history and the photos you've provided:
Leg Revision: It appears that additional leg liposuction, coupled with a revision of the incision extending from the groin to the knee, might be beneficial. This could help remove more excess skin and fat. This type of surgery, often referred to as a medial thigh lift or reduction, is typically performed under general anesthesia. Recovery can take around 2 to 3 weeks and may involve the use of drains to manage fluid accumulation postoperatively.
Arm Revision: For your arms, considering a formal brachioplasty (arm lift) seems advisable. While additional liposuction might address some fatty tissue, it won’t necessarily correct the issue of hanging skin. A brachioplasty typically involves liposuction and the removal of excess skin and fat through an incision from the armpit to the elbow, leading to a more contoured arm appearance.
Scheduling Surgeries: Most plastic surgeons recommend not combining an arm lift with a thigh lift, as recovering from both simultaneously can be challenging. It might be more manageable to first undergo the thigh lift and, once fully recovered, proceed with the arm lift. This staged approach allows for a more focused recovery and minimizes overall strain on your body.
Before proceeding, it's important to have a detailed discussion with your plastic surgeon. They can provide tailored recommendations based on a thorough assessment of your current condition and desired outcomes. Make sure to discuss all potential risks, benefits, and the anticipated recovery process for each procedure.
I hope this advice provides clarity and assists you in making the best decision for your revision surgeries. Wishing you a successful journey towards achieving your aesthetic goals.
Good luck with your continued transformation.
Sincerely,
Dr. Katzen

Amir Sadr, MD, MSc (Plast), FEBOPRAS · Answer

Dear AlenaSA
Thanks for your question and sharing your photos. Decision to revision is based on multiple factors:
From surgical point of view, after 1 year tissues are lax enough to perform another revision. So you are in the right timeline of having a revision. I agree with you that further liposuction might leave you with more loose skin on your arms. Looking at your photos, I believe that your original arm lift surgery has been a conservative one and you may benefit from a further attempt at removing a bit of more skin.
The other important factor is the revision policy of the surgeon which should have been discussed with you before surgery. Have you discussed the expected outcome with the surgeon before surgery? If this has been discussed and the surgery failed to achieve it , then I would think that any professional surgeon would honour their promise and have an attempt with revision. 
I hope you find this explanation helpful.

Kenneth Hughes, MD · Answer

Looks like you still have excess skin and a revision should take care of it, consult carefully with a board certified PS. best of luck!

Gary L. Ross, MBChB, FRCS · Answer

It would appear that you have excess skin and liposuction will not help the excess skin. There may be a reason that your PS does not wish to excise the excess skin of the arms and I would discuss this with him/her.

John W. Menard, MD · Answer

It does appear that you do have excess arm skin which would have to be excised for improvement. I would  discuss this with your surgeon then find another for a second  opinion if necessary.

Ahmed Abd EL Gawad, MD, FEBOPRAS, FRCS(Plast) · Answer

Scar revision would offer better looking scar but won't have a significant effect on the outcome. I should see your preop photos to be in a better position to offer details advice.

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