I developed PAH after a non-invasive procedure. Do I need an Arm Lift or Is there a less invasive option? (Photos)

Question

Hi doctors – I’m a mom in my mid-30s seeking advice on upper arm contouring. I developed PAH (paradoxical adipose hyperplasia) after a non-invasive procedure, which left me with a persistent bulge and sagging in my upper arms that hasn’t responded to weight loss or exercise. I have two small children, including a 1.5-year-old, so extended downtime (more than 2 weeks) is really challenging right now. That said, I’m feeling impatient and eager to address the issue. Would liposuction with skin tightening (like Renuvion or BodyTite) be enough to achieve good results, or do I need a full or extended brachioplasty? Is there a mini arm lift option that could work for my situation? I’m also planning a mommy makeover, and most surgeons have recommended splitting the procedures—understandably—but that’s tough to manage with little ones at home. Any guidance would be appreciated, especially around: -Whether I can avoid a full arm lift -If combining procedures safely is an option -Realistic downtime expectations for different approaches Thank you so much in advance! Height: 5'1 Weight: 124

J. Timothy Katzen, MD, FACS · Answer

Hello Exuberant872628, thank you for your question regarding what to do with your arms after you developed PAH after a non-invasive procedure, and whether you need an arm lift or if there is any less invasive option.  Thank you for your history and your pictures.  PAH is paradoxical adipose hyperplasia.  This is a rare but known possible complication of CoolSculpting procedures.  
In analyzing your pictures, you have excess skin and fat from the axilla or armpit to the elbow.  You have cutis pleonasmus (excess skin) and dermatocholosis (loose skin) without stretch marks (striae).  That means you have a Type 4 arm.  The best treatment would be an extended brachioplasty (arm reduction with arm lift) combined with arm liposuction.  That would mean you would have arm liposuction and an incision from the axilla to the elbow.  The incision is placed between the biceps and the triceps.  This would give your best results.  Because of your children, most plastic surgeons would suggest doing the brachioplasty in isolation without any other procedures.  Renuvion and Body Tite will not significantly improve your arms.  Renuvion and Body Tite may tighten your arm skin slightly, but they will not remove arm fat.  Additionally, if there is scar tissue left from the PAH, Renuvion and Body Tite will struggle to dissolve the scar.  A mini arm lift is not indicated and would not improve your arms.  A mini arm lift is reserved for Type 2 arm patients to have excess arm skin and fat in the proximal third of their upper arm, near the armpit.  Plan on a two-week recovery for the extended brachioplasty.  Good luck.  I hope I answered your questions regarding what to do with your arms after developing PAH following a non-invasive procedure, and whether you need an arm lift or if there is a less invasive option.  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 150 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, MD, MBA. (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.)

Camille Cash, MD · Answer

An in person evaluation is best, but based on the photos it appears the skin laxity is too severe to achieve great results from the more minimal approaches.  A standard arm lift would be able to address the excess fat, remove redundant skin, and recontour the arms.  You could consider the other options if you are accepting that you wouldn't likely get optimal results.

Gary M. Horndeski, MD · Answer

Most of your excess skin seems to be in the middle and distal third.  It may be possible to use a shorter incision but I do not think a transverse axillary lift would be adequate.  When I do axillary lifts I combine it with liposuction at the same time.  If you are willing to accept a less than perfect result then you can consider liposuction and then a transverse axillary lift.

Best Wishes,

Gary Horndeski, M.D.

I developed PAH after a non-invasive procedure. Do I need an Arm Lift or Is there a less invasive option? (Photos)

Answers (3)

Recommended reading

Everything you need to know about Arm Lift

Our mission is to create a world where every investment in modern beauty is Worth It.

I developed PAH after a non-invasive procedure. Do I need an Arm Lift or Is there a less invasive option? (Photos)

Answers (3)

Browse related questions

Recommended reading

Everything you need to know about Arm Lift

Our mission is to create a world where every investment in modern beauty is Worth It.