1 year post op - Asymmetry and still noticeable "Bat Wings" following double brachioplasty

Question

I had bilateral arm lift 1 yr ago. Both slimmer with right noticeably larger and saggier. Smaller bat wings. Opinions vary from "live with it" to redo it entirely but include lipo. Is there a lesser surgery or will I remain unsatisfied? I find myself once again hiding my arm which defeats the purpose of the first surgery. Would any nonsurgical options be of value or just dumping money? Cryo, lipo, Bodytite, shapewear ,injections? Routinely exercise and eat well per recommendations,

Jeffrey M. Darrow, MD · Answer

Your best result would come from redoing your arm lift, with liposuction of the inner and posterior portions of your upper arm to shrink the volume of your arm so that when your skin is sutured again, it is being wrapped around a smaller volume.  It is not possible to reduce the size of the arm by wrapping the skin tighter. It simply results in a worse scar.  A pattern for your new arm lift incision should be able to remove your present incision line and leave you with a fresh new one in approximately the same position.  I do not believe that any of the non-invasive options that you mentioned would deliver the results that you were looking for.  Discuss this at length with your plastic surgeon.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and for sharing your concerns about your arm lift results. Asymmetry and residual sagging after a brachioplasty can indeed be frustrating, especially if the outcome has not met your expectations. Based on your description, I’d like to explore potential contributing factors and recommend solutions.

Do you have a history of significant weight loss? Weight loss often results in skin laxity that can be challenging to fully address with a single surgery. Alternatively, conditions such as Ehlers-Danlos Syndrome, a connective tissue disorder, can also contribute to persistent skin laxity even after surgery. If either of these applies to you, it might explain the remaining "bat wings" and asymmetry.

For optimal results, I would recommend revisiting brachioplasty combined with liposuction. This approach would allow your surgeon to remove any residual fat contributing to the asymmetry while refining and tightening the skin further. Redoing the procedure would provide a more tailored contour and address your specific concerns about your right arm.

Non-surgical options such as Cryolipolysis (CoolSculpting), BodyTite, or injections are unlikely to provide a significant improvement in cases of moderate to severe skin laxity or asymmetry. These treatments work best for minor adjustments and typically do not produce results comparable to surgery. If your goal is to achieve symmetry and eliminate the remaining sagging skin, surgical intervention is the most effective solution.

It’s essential to consult a board-certified plastic surgeon experienced in revision brachioplasty. They can assess your unique anatomy and prior surgical results to craft a plan tailored to your needs. With a carefully executed revision, you can achieve arms you’ll feel confident showing off.

Sincerely,
Dr. Katzen

Kristopher Hamwi, MD · Answer

If you are looking to shrink your arms and put them in better proportion with your forearms you would want to consider liposuction as an option. Doing this would "deflate the skin" and likely make it loose again so it would need to be combined with a revision of the brachioplasty.

Oliver Chang, MD · Answer

Based off your photos (without examining you) it seems that there is still some skin laxity - without knowing the technique or what was done at the procedure (there could have been a reason for not as being aggressive) versus post 1 year - if you have lost more weight then the brachioplasty would have become loose again. 
A lot of toning - weight lifting, pilates reformer, get a trainer that can help with toning the muscle which maybe helps with further tightening of the skin. High protein diet to help build more lean muscle. And if all that doesn't get you to where you want after a good try of 6-12 months - maybe a re-lift is needed (another brachioplasty to tighten the skin again).

John Reilly, MD, FACS · Answer

Hello, I am sorry you're dissatisfied with your previous surgery. Of note, I would consider scar therapies as you appear to have hypertrophied (thick) scars. Some patients may see a benefit with 6 weeks of silicone tape and others with cortisone injections. If you do have an additional procedure I would be mindful of starting scar therapies a few weeks after surgery in hopes of preventing thick scarring again.

You appear to have a small amount of excess fat and excess skin. Two options as I see it. One option is liposuction alone where you decrease the volume on the bottom part of the arm that is currently hanging and you may get some skin contraction and possibly avoid a much larger procedure. Most plastic surgeons are able to perform this type of liposuction in the office. If you want a more reliable results then you need repeat surgery to treat the skin excess. I almost always perform liposuction at the same time as the brachioplasty to maximize results. This includes liposuction on the outside part of the arm to make it appear more toned and athletic. Good luck!

Mustafa Aydinol, MD · Answer

At one year post-op, persistent asymmetry and residual “bat wings” after brachioplasty can be challenging to correct with non-surgical treatments. While options like cryolipolysis (CoolSculpting), BodyTite, liposuction, or injectables can help tighten and contour the arms, their results are often unpredictable, typically requiring multiple sessions. This can ultimately become as expensive, if not more so, than a revision surgery.
Liposuction alone can improve contour but won’t significantly address skin laxity, which seems to be part of the issue. BodyTite may provide some skin tightening through radiofrequency, but the degree of improvement varies, and results might not meet your expectations for noticeable asymmetry.
In cases like yours, a surgical revision – potentially combining liposuction with a more aggressive skin excision – tends to provide the most consistent and definitive result. Since you’re already unhappy with the current outcome, redoing the procedure may be a more straightforward and cost-effective solution than investing in non-surgical treatments with uncertain results.
I recommend consulting with a board-certified plastic surgeon who can assess the extent of the asymmetry and provide a tailored revision plan.

Justin Yovino, MD, FACS · Answer

Your best and most satisfying option would be to undergo another round of skin excision. Essentially this is another brachioplasty. If there is excess fat present around the arm, then liposuction would further reduce the size. The good news is that in our office this can all be performed under local anesthesia if you are wanting to avoid general anesthesia. Your current scar would be removed and replace with a new scar in roughly the same location. Although we offer non-invasive approaches such as Morpheus8, I don't think this would provide enough change for you to be satisfied.

Chet Mays, MD · Answer

Thank you for your inquiry!  Have you lost weight since the surgery.  Losing weight can cause increased skin laxity.  There are some options to help with this.  We would love to meet with you to discuss your concerns.  Schedule an appointment with a Board-Certified Plastic Surgeon to help you meet your goals.

Gary M. Horndeski, MD · Answer

You will need the brachioplasty repeated. At the time of brachioplasty, I routinely liposuct to create a non-vascular track for excision. Both are done simultaneously, the operation takes 1-2 hours to perform under general anesthesia and costs $7,000. Other non-invasive techniques would not be effective.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Tek Przylecki, MD, FACS · Answer

Hello,Thank you for your question. You have asymmetry after bilateral arm lift. I do not think non-surgical treatments will provide the result and correction you desire and to get this correction you will need additional surgery. I, and many plastic surgeons, combine skin excision with liposuction to achieve the best cosmetic result. I recommend you seek consultation with a board certified plastic surgeon. Wishing you the best on your journey!

1 year post op - Asymmetry and still noticeable "Bat Wings" following double brachioplasty

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