Why don't more surgeons offer scarless arm lifts?

Question

I’ve seen several physicians making incision under the arm pit for arm lifts with excellent results on Instagram. Why do plastic surgeons continue to make those long incisions on the arms? Why hasn’t this small incision arm lift been adopted by most?

J. Timothy Katzen, MD, FACS · Answer

Hello Spunky1974 in South Miami. Thank you for your question regarding scarless arm lifts.

The small incision you’re referring to is known as a crescent arm lift. This technique addresses only a couple of inches of skin near the armpit. While it can be effective for patients with minimal excess skin localized to that area, it is not suitable for those with significant excess skin and fat extending from the arm to the elbow.

For individuals with more extensive skin laxity and fat distribution along the arm, the crescent lift simply won't provide the desired results. The traditional arm lift, which involves a longer incision, is necessary to remove a larger amount of excess skin and achieve a smoother and more toned appearance along the entire length of the arm.

I hope this clarifies why the small incision arm lift is not adopted universally and why longer incisions are sometimes necessary for optimal results.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Larry C. Leverett, MD, FACS · Answer

The best way to remove excess skin is to remove the excess skin, as in tummy tucks. Short cuts have short lives results and usually compromise shape.

Jeffrey M. Darrow, MD · Answer

In patients who have a relatively thin arm, minimal excess skin in the distal arm just above their elbow, and only a small amount of lax skin on the arm, just distal to the armpit, a small incision in the armpit, help to improve that. However, if there has been a large amount of weight loss, the amount of excess skin extends from the armpit down to the elbow, and the backside of the arm is still full with excess fat, liposuction of the fat would be required to thin this area and the excess skin from the armpit to the elbow would need to be removed utilizing an incision which extends from the armpit to the elbow.  There is no possible way to put enough traction on the incision, which is only in the armpit area to flatten the skin that is down near the elbow.  Best wishes.

James M. Economides, MD, FACS · Answer

The small-incision or minimal-incision arm lift, often performed with an incision in the armpit, can provide excellent results for certain patients, but it’s not always applicable to everyone. Here’s why most plastic surgeons still use the longer incision technique:

1. Extent of Skin Laxity:
The minimal-incision arm lift, where the incision is hidden in the armpit, works best for patients with mild to moderate skin laxity in the upper arms. If the skin laxity is more significant, especially after major weight loss (as in your case), the armpit incision alone typically won’t provide enough access to remove all the excess skin.
For patients with moderate to severe skin laxity, the longer incision along the inner arm allows surgeons to remove more excess skin, achieving a tighter, more comprehensive result.
2. Limitations of the Armpit Incision:
Reduced Access: The small armpit incision gives limited access to the full length of the upper arm. In patients with significant sagging or loose skin that extends beyond the upper arm, it becomes challenging to adequately address the full length of excess tissue through a small incision.
Skin Retraction: Even if some skin tightening can be achieved with liposuction or non-invasive treatments, the skin’s ability to retract fully is limited. Patients with more significant sagging after weight loss often need a full removal of excess skin, which requires a longer incision for optimal results.
3. Aesthetic Results:
While the armpit incision is more hidden and less noticeable, if the skin is too loose, using a smaller incision can lead to suboptimal results, including uneven skin tightening or skin folds. The goal of plastic surgery is to provide the most natural and smooth contour, and in cases of significant excess skin, a longer incision is necessary to achieve this.
4. Why Some Surgeons Don’t Adopt the Armpit Technique:
Many plastic surgeons prioritize achieving the best contour over minimizing scarring, especially when dealing with larger amounts of skin. Since the longer incision often gives the most comprehensive results for patients with more significant skin laxity, many surgeons continue to use this technique.
Scarring Techniques: Surgeons have become adept at minimizing and camouflaging scars from longer incisions, using techniques to ensure that scars fade over time or remain as discreet as possible.
Final Thoughts:
The small-incision arm lift is an excellent option for patients with mild to moderate skin laxity, but it’s not always appropriate for those with more significant excess skin after weight loss. The longer incision provides better results in cases where there is extensive sagging. It’s important to consult with your surgeon to determine which method will give you the most satisfying, long-term results based on your unique anatomy.

Chet Mays, MD · Answer

Thank you for your inquiry!  There are different levels of skin laxity and every doctor has their own technique that is catered to the individual patient for the best obtainable results. Schedule a consult with a Board-Certified Plastic Surgeon to help you reach your personal goals.

Eric Swanson, MD · Answer

The reason many surgeons have not adopted the short-scar arm lift, or mini-brachioplasty, is because it is not as effective in treating the loose skin of the upper arm as the longitudinal incision. I use a posteromedial incision to keep the scar as hidden as possible down the free margin of the upper arm. Almost always I combine the brachioplasty with liposuction. If the sagging is minimal, then liposuction alone may cause a little skin contraction and avoid the need for a brachioplasty.

Kristopher Hamwi, MD · Answer

The arm pit brachioplasty usually is only a good option for a very particular patient where the excess skin only exists near the armpit. You can't get enough pull from an armpit to affect significant looseness to the distal half of the arm. Furthermore the tighter you pull the skin in the armpit the greater the chance for a poor scar. Tension is one of the factors that affect what the scar looks like. Because of the way that the arm moves an armpit lift that is pulled tightly is at risk for healing issues and a poor scar.

Matthew Zeiderman, MD · Answer

Good question. Limited incision to arm pits for arm lifts only work for a very small subset of patients. The vast majority of patients with a bat wing deformity won’t have a good result with an excision only in the armpit. These are ideal candidates or perhaps sensationalized results? It’s hard to say without seeing what’s posted.

Sean Younai, MD, FACS · Answer

I have performed both regular and "scarless" arm lift or brachioplasty. Of all the women who hate there flabby arms, only maybe 1-5% can get away with a small scar in the arm pit, because it does not remove the excess skin of the lower arm. It is usually a waist of money. 
On the other hand, I perform a full arm tuck with the scar placed under the arm, in a similar place to where the seem of the jacket is placed. this scar is not visible from the front or the back. check out the pics.

Jeffrey J. Roth, MD, FACS · Answer

Thank you for your question. First, be careful of the term "scarless." If you make an incision in the dermis, there will be a scar. As Plastic Surgeons, we try and minimize the appearance of incision lines, and also try to hide them where we can. I do understand that what you are referring to is an incision in the axilla area, that is easier to conceal. These incisions typically work for small amounts of skin redundancy in that axilla area. If you have excess tissue more on the arm part, (between the axilla and the elbow), you are not going to be able to effectively resect enough skin, and contour the soft tissue to get your desired shape. Best to see a Board Certified Plastic Surgeon. Share with them your goals, and together you will come up with options.

Jeffrey J. Roth, M.D., F.A.C.S.

Board Certified Plastic Surgeon

Las Vegas Plastic Surgery

Jeffrey J. Roth, M.D., F.A.C.S.

Board Certified Plastic Surgeon

Las Vegas Plastic Surgery

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