Dear mrs.impatient, Swelling after a brachioplasty (arm lift) is entirely normal, but the duration and extent can vary among individuals based on various factors, including the extent of the surgery, individual healing response, and post-operative care. Post-Operative Swelling Timeline: Initial Swelling: Most pronounced swelling occurs in the initial days to weeks after the surgery. Residual Swelling: It's not uncommon for some degree of swelling to persist for several months post-operatively. By the 3-6 month mark, a significant portion of the swelling should have subsided, but minor residual swelling can continue. Prolonged Swelling: If you're experiencing prolonged swelling, especially if it's associated with tenderness or tightness, there could be a few reasons: Seroma: This is a collection of clear bodily fluid that can accumulate at the surgical site. It may cause swelling and discomfort. Lymphatic Disruption: The surgery can sometimes affect the lymphatic drainage of the arms, leading to lymphedema or swelling due to lymph fluid accumulation. Infection: While less likely at the 4-month mark, it's worth considering if there are other signs like increased redness, warmth, or fever. Tissue Reaction: Sometimes, the body can have prolonged inflammatory responses to sutures or other aspects of the surgery. As for the swelling you feel with temperature changes, it's possible that the sensory nerves are still healing, and the tissues are adjusting, leading to these sensations. Nerve regeneration and tissue remodeling can take many months and even up to a year or more in some cases. Given your concerns and the duration of your swelling, it's crucial to schedule a follow-up with your plastic surgeon or seek a second opinion if needed. They can evaluate your arms directly, conduct any necessary tests, and provide insights and interventions tailored to your situation. Your well-being and satisfaction with the procedure are paramount. Seeking professional guidance will ensure you're on the right track to a full and successful recovery. Sincerely, Dr. Katzen