Brachioplasty: extended or CoolSculpting, which is better? (Photos)

Based on your photographs you have a significant amount of excess skin.  Procedures that can remove fat such as CoolSculpting are not intended to specifically tighten skin.  A brachioplasty would be a better choice to remove the excess skin.
William L. Reno III, MD

Congratulations on your weight-loss!
Thank you for your photos. 
CAST Liposuction combined with minibrachioplasty produces excellent upper arm contourLiposuction for upper arm contouring can produce excellent results in individuals with good skin laxity. I recommend the Circumferential para-Axillary Superficial Tumescent (CAST) technique for upper arm contouring. The use of tumescent anesthesia, micro cannula, and meticulous post operative care maximizes skin retraction and can give excellent improvement. If there is skin laxity, a brachioplasty may be required to tighten the skin. The minibrachioplasty is ideal for correcting the loose skin in the upper third of the inner arm. An ellipse of skin is removed from the axilla (arm pit) and the thin skin of the upper inner arm is advanced and tightened. The scar generally heals well and is well hidden, allowing you to wear short sleeves and sleeveless blouses. 
 I generally try to avoid performing a full Brachioplasty unless the skin is extremely loose. In such cases the resulting improvement in the contour of the arm can be dramatic, but the scars are difficult to hide.
Please consult with a Board-Certified Plastic Surgeon.
Best regards,
Andrew Lyos, M.D., FACS

Hi Takingthatcrown, Thank you for your question regarding whether you should have arm CoolSculpting or an arm lift, arm reduction or brachioplasty.  Save your money and time; don't do arm CoolSculpting. With your history of a 126 lbs. weight loss, there is no way your arm skin will contract with arm CoolSculpting.  Due to your massive weight loss, the elastic fibers in your arm have been stretched.  With your massive weight loss, your arm elastic fibers have now contracted.  Due to your massive weight loss, these arm elastic fibers cannot and will not contract any more with arm CoolSculpting.  Bottom line: you need arm fat AND arm skin removed.  CoolSculpting may only partially fix your excess arm fat, but your arm skin will not contract.  So, after arm CoolSculpting, you will be left with hanging, arm skin.  From your pictures, you have Type 3 arm with excess arm skin and fat to your elbow.  You need a full, longitudinal arm lift.   During your arm lift, you will also need arm liposuction.  Your arm lift scar would extend from your arm pits to your elbows.  Some other plastic surgeons call this a full brachioplasty, extended brachioplasty, or formal brachioplasty.  When considering an arm lift, please seek an experienced, board certified plastic surgeon who has preformed hundreds of arm lifts, arm reductions, VASER arm liposuction procedures or brachioplasties on massive weight loss patients.  Thank you for your question regarding CoolSculpting or an arm lift.  With your weight loss history, do not have arm CoolSculpting; you will be sorry.  Do the arm lift.  this will definitively get rid or your excess arm skin and fat once and for all.  If you have any more questions regarding an arm lift, arm reduction, VASER arm liposuction procedures, arm Cool Sculpting or brachioplasty, please contact my office.  Sincerely, Dr. Katzen.