What's really the best fix for batwing arms without surgery?

This is a difficult question to answer without pictures or physical examination.if you have only a mild amount of arm fat excess, arm liposuction may work. There is no medically proven laser that has been shown to significantly reduce on fat.Due to your age and history, I believe even with arm liposuction, you would be left with excess arm skin.  The only way to remove excess arm skin is with a surgical incision. Sorry. 

It's not unusual for women to develop redundant saggy upper arm tissue with normal aging. When this situation arises, women frequently seek treatment of this condition. A variety of treatment options are available, but with the exception of brachioplasty, most of these procedures have limited value.Your history suggests that you have a relatively severe deformity, but without pictures or a physical examination, it's hard to make a specific treatment recommendation. With this said, it's safe to say that the vast majority of patients with bat wings will require brachioplasty surgery.This procedure utilizes an incision that extends from the armpit to the elbow. In some cases, it may utilize a transverse incision in the axilla, as well. It removes excess skin in multiple dimensions and dramatically improves arm contour. It's associated with excellent clinical results and high levels of patient satisfaction.This procedure involves trade-offs between excess upper arm skin and additional scarring. For this reason, it's appropriate to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Liposuction can be helpful only if you have minimal skin laxity.  This can only be determined by an in person examination.

In patients who have mild excess skin on the underarm, a laser assisted arm lift can tighten the skin without big incisions or surgical drains.SmartLipo uses a laser to heat the underside of the skin which helps form new collagen for skin tightening over time. Excess fat is also removed at the time of surgery. This decreases the effects of gravity on the hanging skin to further tighten the arm's appearance.Laser-assisted liposuction is the most aggressive form of non-surgical skin tightening clinically available. The other treatments (massage, radiofrequency) are not aggressive enough to generate an appreciable difference in my opinion. Find a board certified plastic surgeon who is experienced in laser assisted liposuction.

If your skin is not too bad, there may be subtle improvement with various radiofrequency devices to carefully heat and tighten the skin. Liposuction alone will not help loose skin but can be used selectively to sculpt and reduce if localized fat is more of a problem and not so much skin. If however, skin is very loose, then the most effective treatment is surgery with removal of excess skin/fat and tightening with incisions. Sometimes a short  incision in the armpit only is sufficient but a longer incision down the arm may be needed. Have a consultation with a plastic surgeon to discuss your options.