Hi Hascgauajanmama, Thank you for your question regarding "mini arm lift WITH or WITHOUT lipo".  Thank you for your history and your pictures.  First, we should analyze your pictures to determine the best arm procedure.  You have mild lipodystrophy (excess fat) from the axillae (armpit) to the elbow.  You have mild cutis pleonasmus (excess skin) and dermatocholosis (loose skin) from the axillae (armpit) to the halfway down your arm.  Since you have arm fat and loose skin, you need more than just arm lipo.  You need an arm lift.  A "mini" arm lift could be the removal of a crescent area of excess arm skin, or a “mini" arm lift could be a limited incision from the armpit down the inner arm.  You will obtain the best results with a limited incision down the inner arm.  If you choose the crescent arm lift, you will not see much improvement in your arms.  If you undergo the "mini" arm lift with the limited incision down the inner arm, most plastic surgeons would highly suggest you have arm liposuction with the "mini" arm lift.  Arm liposuction should be performed first. During the same surgery, if lipo results in loose arm skin, it can be pulled tightly and surgically removed.    I hope that I have answered your questions regarding the arm reduction and whether you need a mini arm lift WITH or WITHOUT lipo.  If you have any more questions regarding the arm lift, arm reduction, brachioplasty, or arm crease fat grafting, contact 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.  Make sure they have performed at least 100 arm lift procedures.  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, 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.)