These are both the same incisions, just worded differently. You should have your surgeon drain with a red sharpie where the incision would be. You can also visit my website at feplasticsurgery.com where you can see photos and the incisions.
There is a trade off on this procedure so be prepared for the incisions and scars.
Posterior versus Medial Based Scars
The first point to realize with a brachioplasty that the scar is the biggest issue with the overall outcome. You have to trade the excess skin and fat of the upper arm for a much better and tighter shape to the upper arm, but at the expense of scar.
So there have been many different approaches to addressing the scar in brachioplasty. These range from the traditional inner medial incision to a posterior based incision to short scar types.
The traditional inner medial incision is well hidden when the arms are down at your side, but quite noticeable when your arms are up.
The posterior incision is located at the bottom part of the upper arm when your arms are raised at 90 degrees to your body. This scar is not seen from the front when your arm is by your side. It is also not seen when your arm is raised up. The only time this is seen is from behind when your arm is by your side.
I draw a red line with a marker on my patients arms in both locations so they can decide for themselves which scar they would rather have.
As for the short scar brachioplasty, this tries to hide the scar horizontally in the armpit. It can be useful in people with arm laxity in the upper 1/3 of the upper arm, but it doesn't reduce the circumferential excess that is frequently seen in people needing brachioplasty.
The scars from brachioplasty can be bad, or they may not be. In any event, I place my scars on the inner side of the upper armat the level of the brachialis muscls which tends to hide the scar.
My goal is to have the scar hidden when you have your arms to your sidse. With luck, when the scars are healed, they will be slight, and better than the hanging flesh.
Hope this helps.
Posterior–medial incision placement in brachioplasty
In performing a brachioplasty an incision is made on the inside of the arm extending from the elbow into the armpit. Sometimes it is necessary to extend the incision further into the armpit and sometimes past it. Utilizing this incision excess skin is removed and the wound is closed. It is very important to position the scar properly so that it is concealed as much as possible. A well-placed incision should result in a scar that is only visible when the arms are raised. This operation is normally performed as an outpatient. It is very important for the surgeon to discuss the resultant scar thoroughly with the patient preoperatively. Very commonly this scar takes a longer time to undergo the full healing and maturation process. Maturation refers to the process whereby the scar becomes less apparent. Brachioplasty scars commonly take up to 2 years to fully mature.
Postero-medial Incision Placement in Brachioplasty
There are multiple locations to place an incision for an arm lift or brachioplasty. Typically, the incision can be placed anywhere from the inner arm to the posterior arm around the triceps. For the best hidden scar, this scar should be placed in the line drawn between the biceps and triceps extending from the armpit to the elbow Some surgeons make an incision over the back of the arm extending from the armpit to the elbow. However, the resulting scar is on the posterior triceps. The difficulty with this incision and resultant scar is at the scars are highly visible when your arms are down by your side and when you're walking away from someone. However the most important thing to do before undergoing a brachioplasty is to go to a board-certified plastic surgeon with a significant amount of experience in arm lifts. Arm lift scars can be difficult to revise. Accurate incision placement during the first surgery is critical to maximize the concealment of the final scar. Again, I would suggest making the incision between the biceps and triceps. Good luck with your surgery. Sincerely, Dr. Katzen.
Options in Brachioplasty incisions--Medially or posteriorly?
For the last 8 years I have used the posterior incision for brachioplasty. Why? For years I utilized the medial scar because our Plastic Surgery publications and presentations at national meetings suggested that any deviation was akin to malpractice. Unfortunately those same proponents final results( and my own) were so meager I avoided brachioplasty. Often at national presentations the only difference between pre and post operative brachioplasty patient's photos was the scar. I was amazed when more fresh concepts developed to help our massive weight loss patients and the posterior incision has ,in my opinion, revolutionized brachioplasty. Before I got moderate results with nasty scars. Now I can expect good results with obvious but less obnoxious scars.
There are basically two common incisions used for brachioplasty surgery. This can leave the final scar along the medial or inner aspect of the arm of on the posterior arm.
Scar Location is your most important decision when considering an armlift
Every significant armlift involves a longitudinal excision of upper arm skin and fat. No matter where this cutout is oriented, a good circumferential reduction of the floppy upper arm will result. Since it involves a scar, the question is where you prefer it to be located. Most armlift scars are not great as defined but what most patients expect. That is a function of placing the scar perpendicular to the relaxed skin tensions lines of the arm which is circumferential not longitudinal. Having placed armlift scars in every conceivable location, I have found that the best healing and scar results occur in those that are placed closer to the back or posterior aspect of the arm. The postero-medial location is somewhere between the inside and back of the arm and is my preferred scar location currently as it is the least visible (to the patient) and is done using a favorable arm position during surgery.
Brachioplasty scar - which is best?
The traditional scar placed on the inside of the arm will almost universally hypertrophy or stretch out.
The posterior scar is a curvy scar that is visible when your arms are down at your side.
I was fortunate enough to have a patient willing to have each technique done and her overwhelming choice was the posterior scar.
Scars will mature with time and become less noticeable. The posterior approach is much simpler to revise if needed and the scar has potential to be better than the medial arm scar.
Its a choice you will be presented with and only you can decide on what scar you can live with.
I think the most important part of arm lift scar management is dealing with the scar redness and thickening that often develops in these patients. The scar should be positioned beneath the biceps muscle in the groove along the inside of the arm. More posterior placement risks migration of the scar onto the back of the arm, where it is always visible.