Congratulations on your significant weight loss. The arm lifting procedure is a great procedure to remove excess skin and adipose tissue of the upper arms. However, this procedure carries a major drawback: occasional difficult scarring that may require scar revision (more so, in my experience, than in other procedures).
I have tried placement of the resulting scars in the bicipital groove (between the biceps and triceps muscles) as well as a long the inferior–lower aspect of the upper arm. I have found higher patient satisfaction with the latter approach. If the excision can be planned such that the scar falls along the frontal aspect of the lower arm, then the scar may be visible only when the patient raises his/her arms.
As with many plastic surgical procedures, the planning of the incisions and resulting scar line is critical. However, even with attention to detail, the resulting scars may not be ideal and revisionary surgery is often necessary to improve the appearance (for example, the width) of the scars.
I hope this, and the attached link, helps. Best wishes.
Your final arm scar is based on many factors. The final arm lift scar depends in part, on you and in part, on your surgeon. Certain patients have a pre-disposition to forming thick scars or keloids. The genetics of the condition cannot be changed; however, the appearance of the final scar can be influenced by your surgeon's technique as well as post-operative scar treatment.
Let us look at your contribution to arm scaring. To determine if you are prone to keloids, you should look at your scars. If your scars are thick and raised, you may have a propensity to develop keloids. Even if your surgeon does a perfect, meticulous job and you strictly adhere to the postoperative instructions, you may still develop a keloid. If you do not have thick, raised scars, it can be reasonably assumed that you should heal well without developing hypertrophic or keloid scars.
Your plastic surgeon's technique is essential to your healing and eventual arm scar. To minimize scarring, the surgical closure should be done in multiple layers to minimize the wound tension. To further minimize scarring and to decrease swelling (edema), light compression should be applied. Different plastic surgeons have different techniques on how to achieve this light arm compression. Some plastic surgery to use drains, however, most surgeons do not use drains for an arm lift or brachioplasty.
Post-operative scar treatment also influences your final arm lift scar. After the arm lift wound has healed, tight arm compression and a silicone-based cream are strongly encouraged. Arm compression is achieved with an arm garment. The arm garment should extend from the forearm to the armpit. Arm compression should continue as long as there is arm swelling or for a minimum of 6 to 8 weeks. Silicone-based creams or strips should be used on a daily basis for 4 to 6 months. It is rare that you would need laser arm scar treatment. However, if you did require laser arm scar therapy, I would suggest the Erbium:YAG laser.
An arm lift is the only way currently to recontour your arms as dramatically as you'd like. You can try nonsurgical methods of skin tightening/fat reduction however results tend to be unpredictable and may take several sessions spaced out over the course of several months.
scar treatments, such as silicone sheeting and silicone gel, can help reduce the visibility of scars.
Scars look worse when they are under tension. Long term taping, silicone pads and gels, compression garments all can take the tension off the scar to allow it to heal its best. It may take a year for the scar to improve. There are laser treatments that are available to make it look better if needed. They usually involve a fractional ablation such as a CO2 or an Erbium laser.
With massive weight loss, there is an abundance of extra tissue that needs to be removed. The incision is usually full length, as the "shorter incisions" can bunch up in the arm pit and give you less of a result. The scar is the down side but methods like Embrace scar therapy and Biocorneum can help. Consult with a board-certiied plastic surgeon with experience in weight loss patients and see many before and afters.
An arm lift will reshape your upper arm and tighten the loose skin you are referring to as wings. With this particular procedure, you must be willing to accept that you will have a scar in exchange for more shapelier looking arms. There is no guarantee, nor are there current products on the market, that will leave you completely scar free. However, there are products to help minimize and manage the appearance of your scars. I recommend trying embrace and biocorneum.
A brachioplasty is essentially an upper arm lift. In this procedure, the excess hanging skin and fat in the upper arm is removed. Its the procedure used to correct the common "bat wing" of skin that manifests in patients who have lost a significant amount of weight. I prefer to place the incision in the posterior shadow line of the upper arm. I recommend you consider Embrace for scar management 2-3 weeks after your procedure. Best wishes.
Although the scar is lengthy, it is positioned over the inner part of the upper arm. I am very excited about the new post op dressing Embrace. This is worn for several weeks and helps minimize the tension which can lead to a more narrow flatter scar. Once all healed, one can consider medical tattooing to blend the scar into the surrounding tissue.
Your concern is the same as many patients considering brachioplasty. Brachioplasty will improve the contour of your arms but the trade off is a scar which is harder to conceal than others. Your best chance to have the best scar possible is to see a board certified plastic surgeon and to realize each patients scars depend a great deal on their genetic make up. Gentle tissue handling and good post op care also impact on how the scars appear over time.
In your situation, you need a full arm lift with a scar from the elbow to the armpit, ideally with an extension into the side of the chest. Other than your surgeon's technique, there is a special dressing called Embrace that could help. After the Embrace, you could consider laser scar treatments such as fractionated erbium to minimize your scars. It is unlikely that you will end up with invisible scars in this area. Most patients have to accept they will have visible scarring after surgery.