Should I try 4D PAL liposuction first for arm lipedema, or proceed directly with an arm lift? (Photos)

Question

I would like my arms to appear slimmer, without excess fat or loose skin. I have been told this may be lipedema, and one surgeon recommended starting with 4D PAL liposuction to assess how well the skin retracts, and then deciding in about a year whether an arm lift is necessary. Another surgeon advised that an arm lift would be unavoidable and should be done from the outset.

J. Timothy Katzen, MD, FACS · Answer

Hi Peruish, 
Thank you for your question about whether you should first consider 4D PAL liposuction for arm lipedema or proceed directly with an arm lift.  Thank you for your history and your pictures.  First, we should analyze your pictures to determine the best arm procedure.  You have moderate lipodystrophy (excess fat) from the axillae (armpit) to the elbow.  You have moderate cutis pleonasmus (excess skin) and dermatocholosis (loose skin) from the axillae (armpit) to the elbow.  Since you have excess skin and fat on your upper arms, the best procedure would be an arm lift, arm reduction, or brachioplasty.  The best type of brachioplasty for your arms would be a longitudinal brachioplasty with an incision from the axillae to the elbow, combined with liposuction to be performed at the same time.  You could have the 4D PAL liposuction performed first.  Since you have moderate cutis pleonasmus (excess skin) and dermatocholosis (loose skin) from the axillae (armpits) to the elbow, your arm skin will not recoil that much with liposuction, even if you use VASER or radio-frequency.  Therefore, you will need an arm lift after 4D PAL arm liposuction.  Therefore, the arm lift is unavoidable.  However, your BEST arm lift results would be achieved with primary arm liposuction, followed by a secondary arm lift (brachioplasty) 4 to 6 months later.  However, you must be committed to that second surgery, namely the arm lift.  During the healing phase after your 4D PAL arm liposuction, you should expect loose, hanging arm skin.  Additionally, you must be prepared for the arms to appear worse after arm liposuction, only to look their best after the arm lift.  If you can perform only one surgery, perform brachioplasty.  If you can do two surgeries and want the best results, do the 4D PAL liposuction and then the arm lift.  However, don’t do the 4D PAL arm liposuction thinking you will not “need” an arm reduction.  I hope I have answered your questions regarding arm reduction, specifically whether you should first consider 4D PAL liposuction for arm lipedema or proceed directly with an arm lift.  If you have any further questions regarding arm lift, arm reduction, brachioplasty, arm scar revision, or arm crease fat grafting, consult an experienced plastic surgeon.  To get an accurate assessment of what exactly you need, schedule a free virtual consultation.  Most plastic surgeons offer free virtual consultations.  Since an arm lift can be a challenging surgery, please seek an experienced, board-certified plastic surgeon with significant experience performing these types of lifts.  Do your research.  Ensure they have performed at least 150 arm-lift procedures.  Ensure they have the before-and-after pictures to substantiate it.  Carefully examine their before-and-after images and review their RealSelf reviews.   Sincerely, Dr. Katzen, MD, MBA, FACS, FICS ( Plastic Surgeon, President of  the American Society of Bariatric Plastic 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 and RealSelf Hall of Fame.)

Gary M. Horndeski, MD · Answer

I recommend brachioplasty to excise the excess skin.  At the same time, liposuction is done to remove excess fat.

Best Wishes,

Gary Horndeski, M.D.

Should I try 4D PAL liposuction first for arm lipedema, or proceed directly with an arm lift? (Photos)

Answers (2)

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