Chronic pain and pressure 7 months after arm lift

Question

I had an arm lift with lipo over 7 months ago and felt like I was recovering well for the first 6 weeks. Then I started having excruciating bilateral arm pain which felt like tight tourniquets on my upper arms. I have seen my PS and multiple specialists, done PT, lymphatic massage, myofascial massage and am taking Lyrica for the pain. But I continue to have this constant tight pressure in my upper arms - feels like I have blood pressure cuffs on - any insights on what would cause this? Help?

J. Timothy Katzen, MD, FACS · Answer

Hi Donnamcc-2000, Thank you for your history.  I am sorry you are having problems seven months after an arm lift, arm reduction, or brachioplasty.  From your description, your post arm lift arm pain is probably due to either arm swelling and/or scar tissue.

Initially, arm swelling after a brachioplasty is normal.  However, swelling seven months after an arm lift is not normal.  Arm swelling can lead to pressure and compression of the nerves in the arm and thus,  lead to pain.  Scarring can also lead to compression of the arm nerves and result in arm pain. 
In terms of treatment, there are several options: lymphatic massage, deep tissue massage, scar release massage, vibration therapy, compression garments, cavitation, acupuncture, injection of steroids or %FU and even repeat surgery.  I would suggest you try all of them to find which modality works best for you.  Good luck.  I hope that I have answered your questions regarding chronic pain and pressure 7 months after arm lift.

If you have any more questions regarding the arm lift, arm reduction, brachioplasty or arm crease fat grafting, please contact my office.  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. Do your research.  Make sure your chosen plastic surgeon has performed at least 100 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. (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.)

Stefan Mark Szczerba, MD · Answer

I have not heard of this issue before, however I do not do armlift and arm lipo at the same time.  Instead I liposuction aggressively and InMode the areas a few months before.  After letting things heal and soften, I then excise just skin.

Since the process started after healing for 6 weeks, I would continue to see the plastic surgeon and continue stretching the arms.  Best Wishes!!

Connie Hiers, MD, FACS · Answer

You may have some scarring around small sensory nerves. I suggest trying acupressure to let minimize and treat the pain.

Camille Cash, MD · Answer

I'm sorry to hear of the issues you are experiencing.  Unfortunately without an exam or more information it's difficult to say what is occurring.  It sounds as though you have been exploring the correct options for relief.  I hope that you find answers.

James Knoetgen, III, MD · Answer

Experiencing chronic pain and pressure seven months after an arm lift (brachioplasty) is not typical and may warrant a follow-up with your surgeon. While some residual tightness or mild discomfort can persist as the tissues heal and adapt, ongoing pain or pressure could indicate an underlying issue. Here are a few possibilities to consider:
Potential Causes
1.	Scar Tissue (Fibrosis): Excessive scar tissue formation can cause tightness or discomfort. This is common in areas where the skin has been excised and sutured.
2.	Nerve Sensitivity or Damage: During arm lift surgery, nerves can be stretched, irritated, or occasionally damaged, leading to pain or tingling sensations. Neuropathic pain might persist if the nerves haven't fully healed.
3.	Lymphedema: If lymphatic vessels were disrupted during surgery, fluid buildup might cause pressure and swelling.
4.	Infection or Inflammation: Although rare this far post-op, a low-grade infection or localized inflammation could cause persistent symptoms.
5.	Seroma or Hematoma: Fluid or blood accumulation under the skin might cause pressure or discomfort.
6.	Muscle or Tissue Strain: Overuse of the arms during the healing process could strain the muscles and surrounding tissues, delaying recovery.
What to Do
1.	Consult Your Surgeon: Schedule a follow-up appointment with your plastic surgeon to rule out complications. They may recommend imaging studies like an ultrasound or MRI to identify issues.
2.	Pain Management: Over-the-counter pain relievers or prescribed medications may help in the short term, but chronic pain should not be self-treated indefinitely.
3.	Physical Therapy: A physical therapist experienced in post-surgical recovery can provide exercises to improve mobility and reduce tightness.
4.	Massage Therapy: Lymphatic drainage or scar massage therapy can reduce scar tissue and improve lymphatic flow, alleviating tightness and discomfort.
5.	Neuropathy Treatments: If nerve damage is suspected, treatments like nerve-blocking medications, topical creams, or injections may be helpful.
If you experience significant swelling, redness, fever, or increasing pain, contact your surgeon immediately, as these could be signs of infection or other serious complications.

Chronic pain and pressure 7 months after arm lift

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