Limited ROM, pain, banding/webbing, hypertrophic dark scars, adhesions 9-mos post brachioplasty. How would you fix my arm? (pix)

Hello, and thank you for your question regarding a limited range of motion, pain, banding webbing, hypertrophic dark scars, and adhesions nine months after a brachioplasty, and how does a plastic surgeon fix these issues in your arm? Thank you for your history and your pictures. I’m sorry for your misfortune.
Brachioplasty (a.k.a. arm lift, arm reduction) surgery is not an easy surgery. Unfortunately, webbing and wound breakdown in the axillary (armpit) region is not an uncommon complication after a brachioplasty. There are several reasons for wound breakdown in this area, including the presence of hair follicles, sweat glands, and lymphatic vessels, as well as postoperative infection, too early range of motion after the brachioplasty, and abrasion due to compression garments or Ace bandages after the procedure. In terms of treatment, several options are available. Since your plastic surgeon has already done a Z plasty, options are slightly more limited. However, treatment options include micro-needling of the scar and Morpheus 8, which are treatments specifically designed for scars. More aggressive treatments would include the sectioning of the scar tissue and application of a full-thickness skin graft. A full-thickness skin graft could be harvested from the lower abdomen or inner thigh. The skin graft would heal the open wound, add tissue to the area, and allow for the return of range of motion. The skin graft site could be revised or removed at a later date. Ideally, during the skin graft revision, the entire skin graft can be excised. For now, be conservative. The body does a remarkable job of healing. Make sure you give yourself time. Regarding the rest of the scar, most plastic surgeons would recommend a V-beam laser. Once your scar has healed further, consider a Fraxel laser. I hope my answers helped address some of your questions regarding the limited range of motion, pain, banding, webbing, hypertrophic scarring, dark scars, and adhesions that occurred nine months after your brachioplasty, as well as how a plastic surgeon might address these issues. Good luck. Since a brachioplasty or arm lift surgery is a difficult procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing these types of arm lifts. Most plastic surgeons offer free virtual consultations. Do your research. Make sure your chosen plastic surgeon has performed at least 150 arm lifts. 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. (Plastic Surgeon, President of the American Society of Bariatric 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, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Thank you for your pictures. Sorry for the complications. All the appropriate measurement of been taken. I will allow for healing in the area. Aggressive physical therapy may be your best and only option at this point. Please keep yourself sufficient time (6-12 months) to see improvement.

This is a very common post operative issue from over resection in a brachioplasty operation. Sounds like you are having corrections done. Can not add more.. 

It is very unusual to have limited ROM especially after weight loss.   Continue massage, silicone sheeting and compression garments.   If this does not improve then a repeat , largery Z-plasty should be done in the axilla, followed by a skin graft.   Best to you

Thank you for your question and photos.  It is very uncommon for axillary scarring to cause permanent loss of ROM, especially in patient who have had weight loss.  Yours scars are significantly hypertrophic leading in large part to the symptoms you are experiencing. A Z-plasty was a reasonable first attempt to address this issue. I would recommend a series of kenalog injections to soften the scar, silicone sheeting and arm exercises (walk your arm up the wall with your finger 5-10 times per day).  This will help the scar to loosen up and improve your range of motion. If that is not completely successful, the next step would be to perform a larger z-plasty to lengthen he scar further.  Keep the line of discussion open with your surgeon and you will likely continue to improve. Best wishes on your recovery.

It appears that you had a lot of problems with wound separation after your arm lift.  This is cause you to have a scar contracture in the form a web.  If therapy does not make this better then you will need a procedure called a Z-plasty which will lengthen your scar and drastically improved your range of motion.