What can be done to minimize the appearance of rippling and bunching at incision site after 1 year post op? (photos)

Question

So it’s been a 1 year since my brachioplasty and I’ve developed “rippling” or bunching near the incision site and it’s unsightly to me. I have it more on my left side than my right, but I’d love to know if there’s any way to mitigate this without the need for a revision?

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding the rippling and bunching near your incision site. I appreciate you sharing your history and photos.

After closely examining your pictures, it appears you have ripples of excess arm skin, which is not uncommon following a brachioplasty. While these ripples often improve gradually over time, it typically takes about two years for the skin and tissues to fully settle and remodel after an arm reduction. However, if the appearance of the ripples is bothersome and you would like to address them sooner, the most effective solution would be a surgical revision.

Further liposuction on the arms is not advisable in this situation, as it would likely exacerbate the rippling by removing underlying fat and reducing skin support. Instead, a revision procedure to tighten the arm skin in the affected areas is the most reliable way to achieve a smoother contour. The revision does not necessarily require redoing the entire arm lift; the focus would be on the specific areas of concern. This type of revision can often be performed under local anesthesia in the office, minimizing downtime and recovery.

Non-surgical options like microneedling, steroid injections, Morpheus8, or radiofrequency treatments are unlikely to significantly improve or eliminate the rippling. While these modalities can help with minor skin tightening or scar refinement, they are not effective for addressing ripples caused by excess skin.

I recommend consulting with an experienced, board-certified plastic surgeon who has expertise in arm lift revisions. They can evaluate your case in person and discuss whether a targeted revision procedure is the best option for you.

Good luck, and I hope this information helps answer your question regarding rippling and bunching after brachioplasty.

Sincerely,
Dr. Katzen

Stefan Mark Szczerba, MD · Answer

Hmmm... that's not easy.  The location of your incision is not what I use however one idea may be to liposuction the area and deflate the skin.   Wait 6 months and then redo do the scar?  Again, not easy.  Get a few opinions on this.  Best Wishes!!

Arif Eroglu, MD · Answer

Hello; I believe the skin folding in the anterior axillary area has occurred because the upper end of the incision was planned too far forward, and the tissue removal planning was done while the arms were open. Unfortunately, correction without surgery is not possible.

Ryan Rebowe, MD · Answer

At this point, it is likely that some sort of revision would be necessary. This could be a formal excisional revision or an additional skin tightening procedure such as BodyTite.

Zoran Potparic, MD · Answer

It appears that your scar still did not mature? A treatment with compression garment like elastic sleeve and silicone based scar tapes would still have a place. Consider laser as well. Conversation with your surgeon about scar management  is needed. Good luck.

Connie Hiers, MD, FACS · Answer

Without doing a revision, the Morpheus micro-needling might be helpful. It is the deepest type of micro-needling and has radiofrequency to help decrease some excess fat.

Camille Cash, MD · Answer

At one year post op you will likely need some sort of revision for noticeable improvement.  You can consider scar revision to help improve the overall contours.  See your surgeon to learn more.

What can be done to minimize the appearance of rippling and bunching at incision site after 1 year post op? (photos)

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