Why do some surgeons prefer not to place an arm lift scar along the tricep/bicep line?

Question

Does the scar heal better in the middle of the arm or back of the arm?

J. Timothy Katzen, MD, FACS · Answer

Hello,
Thank you for your question about the different incision placements for arm lifts (brachioplasty) and the reasoning behind these surgical choices.
The placement of the incision during an arm lift can vary, with some surgeons opting for the back of the arm and others choosing the inside of the arm. Each approach has its advantages and considerations.
When the incision is placed on the back of the arm, one of the main reasons for this choice is the relative ease of the procedure. This approach is technically simpler and allows for the avoidance of nerves and lymph nodes, potentially reducing complications. However, a significant downside is the visibility of the scar. With your arms down at your sides, the normal resting position, the scar on the back of the arm can be quite noticeable. While many general surgeons might opt for this approach, most plastic surgeons tend to avoid it due to the visibility of the scar.
On the other hand, placing the incision on the inside of the arm is often considered superior by many plastic surgeons, despite being technically more challenging. This approach does involve navigating around nerves and lymph nodes, which can increase the risk of complications slightly. However, the major benefit is the concealment of the scar. The incision is typically made in the bicipital groove, between the biceps and triceps muscles, making the scar less visible when your arms are at your sides. While the scar may become more apparent with the arms raised, this is a less common position in daily activities.
In conclusion, the decision on incision placement depends on balancing factors such as ease of surgery, risk of complications, and scar visibility. Most plastic surgeons prefer the inside of the arm for the incision due to the less visible scarring, despite the increased technical difficulty and slight increase in complication risk.
I hope this explanation clarifies the reasoning behind the different incision placements for arm lifts. Wishing you the best in your journey.
Good luck.

Fernando Ovalle Jr., MD · Answer

Hello and thank you for your question! In short, the scar placement is traditionally taught that it is best placed at or below the groove of the biceps muscle. This keeps the scar hidden is most everyday situations as usually patients carry on about their everyday activities and converse in a position with their elbows relatively close to their sides. Only in lifting the arms up and out would one see the scars on the upper inner arms. Placing the scars more posteriorly, or on the back side of the arms, can be done and some surgeons may routinely do this. This minimizes the view of the scar if patients raise the arms up while facing someone; however the downside is with the arms down and elbows at their side (as mentioned above), the scar may be more visible from behind. In the end, both are safe and possible and it comes down to surgeon-patient conversation!

Chet Mays, MD · Answer

Thank you for the inquiry!  A Scar along the middle of the arm will constantly graze the lateral side of the body and irritate the incision / scar.  An in-person consultation with a Board Certified Plastic Surgeon to discuss you goals will help get you to your goals. After a thorough examination, you will be provided with information to help you reach your perfect you!

Andrei Rios, MD · Answer

The placement of the scars is decided because of many reasons: anatomic, skin quality, best healing intended (less friction for example), but also to hide them better for cosmetic reasons, among many others. In an arm lift my personal preference is to go in the middle of the arm, between the biceps/triceps because when you have the arm in a normal position against your body (resting on the side of your chest), the incision/scar will be hidden. If you place the scar in the back of the arm, along the triceps midline, when you take photos with the arms up, you can't see the scar, but when you're in a resting position, the scar is very noticeable from the back and anybody who's standing behind you will be able to see it.

Kristopher Hamwi, MD · Answer

The position of the incision is chosen to make the resulting scar as inconspicuous as possible. The 2 most common locations are down the back of the arm or on the inside of the arm. Surgeons and patients choose the location they think will be hidden the best. 
1. Back of the arm When an incision is down the back of the arm the scar tends to be more visible from the back when your arm is resting at your side. These scars tend to be less noticeable when your arm is out to the side, as if you are waving. In this position the patient rarely sees the scar but someone standing behind you would notice it.
2. Inside the arm When an incision is on the inside of the arm the resulting scar tends to be less visible when your arm is resting at your side and more visible when you are waving. 
There is also the possibility of placing an incision somewhere between the two locations described. This is still considered to be on the inside of the arm and has some of the benefits and down sides to each of the places described above
In the end there is no "best" location. I prefer inactions on the inside of the arms but it is really a matter of the preference for the patient. When you have a consult with your plastic surgeon

Azita Madjidi, MD, MS, FACS · Answer

It all depends on the comfort level of the surgeon. The arm does not like to be cut, period. I personally do not like to put a scar where it is visible. I put it in a way that it's not visible when the arm is down, neither from the front or the back. It's just a preference and patient's care about having a visible or not a scar.

Miguel Mota, MD · Answer

Interesting question. The traditional arm lift scar should always be bellow the bicep line. This guaranties that the scar faces internally towards the torso or rib cage, ensuring it be hidden when the arm is at rest.

Best of luck,
Dr. Miguel Mota

Best of luck,
Dr. Miguel Mota

Zoran Potparic, MD · Answer

In most patients arm lift scar is placed inside the arm in the groove just behind biceps muscle. In some cases scar can be placed on the posterior aspect of the arm, over triceps muscle. Hope this helps.

Harry T. Haramis, MD, FACS · Answer

Position of the scar is personal and should be discussed with your plastic surgeon.

Arm lift scar in the biceps groove is most common and seen when arm is away from body. Scars can widen over time.

An alternative is to place along back of arm- like a short seam, so scar may be visible from behind.

Scar healing depends upon the patient.

Connie Hiers, MD, FACS · Answer

We try to place the scar where it is not visible from the frontal view with your arms down by your sides, and minimally visible from the back with the same pose.

Why do some surgeons prefer not to place an arm lift scar along the tricep/bicep line?

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